N-Acetylcysteine

N-acetylcysteine (NAC) is the mainstay of therapy for acetaminophen toxicity. NAC has FDA approval for treating potentially hepatotoxic doses of acetaminophen (APAP) and is almost 100% effective if given within 8 hours post-ingestion. NAC is also approved for use in conditions with abnormal viscid or inspissated mucous secretions, such as pneumonia, bronchitis, tracheobronchitis, cystic fibrosis, tracheostomy patients, postoperative pulmonary complications, posttraumatic chest conditions and before diagnostic bronchoscopy to help with mucous plugging. Off-label indications include acute hepatic failure, prevention of contrast-induced nephropathy, and topical treatment of keratoconjunctivitis sicca. This activity discusses the indications, mechanism of action, methods of administration, significant adverse effects, contraindications, monitoring, and toxicity of NAC so clinicians can direct patient therapy to optimal outcomes when NAC is indicated.