Concord Repatriation General Hospital

Intensive Care Unit Drug Guidelines

N-ACETYLCYSTEINE (NAC)
(FOR RENAL PROTECTION)

 The action of N-Acetylcysteine is not well understood, however it is thought to

primarily scavenge oxygen free radicals and minimise renal medullary
vasoconstriction caused by administering intravenous contrast via its vasodilatory
effects, thus decreasing damage to renal tissues
 Radio-contrast induced nephropathy is a common cause of hospital acquired acute
ACTIONS
kidney injury AKI

 Contrast agents cause vasoconstriction induced renal ischaemia and have direct
cytotoxic effects on glomerular cells.
MIMS, Mircomedex, and The Australian Injectable Drugs Handbook., Australian Medicines handbook

 As prophylaxis in patients who are at risk of developing contrast induced –AKI (CI-
AKI); ie patients with acute or chronic renal dysfunction , diabetes, hypertension,
CCF, increase age, volume depletion, haemodynamic instability, and those on
nephrotoxic agents
INDICATIONS
 Kidney Disease Improving Global Outcomes guidelines recommend using NAC with
Isotonic crystalloid in patients at increased risk of CI-AKI
IMPORTANT: This is a guideline ONLY, for more detailed information please refer to:

The use of N-Acetylcysteine is at the discretion of the treating Intensivist.

Not recommended for Intramuscular injection

N-Acetylcysteine can be given orally or as an intravenous (IV) infusion.

DOSAGE &
ADMINISTRATION The recommendation for N-Acetylcysteine is 600 mg orally or IV every 12 hours, started
24 hours in advance of contrast administration, and continued for 24 to 48 hours post
contrast administration.

ENTERAL & ORAL ADMINISTRATION

Check compatibility
before administering
 Dose : 600mg of Acetylcysteine 800mg/4mL Nebulising Solution
with other
medications
 The dose should be prepared immediately before use

 600mg N-Acetylcysteine is prepared by drawing up 3ml of neat

Acetylcysteine 800mg/4mL Nebulising Solution (200mg/ml)

 If nasogastric insitu: 600mg dose is diluted into 100ml sterile water for injection
and administered

 If Nasogastric tube not present & oral administration appropriate: 600mg is

diluted into 100mLorange juice & consumed (orange juice is used to make it
palatable)

CRGH ICU Drug Guideline: This guideline is written for use in the ICU only | N-ACETYLCYSTEINE 1
Renal protection
 Concord Repatriation General Hospital
Intensive Care Unit Drug Guidelines
Depending on the fluid status of the patient and presence of co-morbidities, consider
Intravenous fluid hydration with IL Normal Saline 0.9% over 12 hours pre and post
procedure requiring contrast.

INTRAVENOUSADMINISTRATION (IV)

 Dose 600mg

 N-Acetylcysteine can be given by IV infusion Using Acetylcysteine [DBL]

2g/10mL if use of the oral route is contraindicated

 600mg/3mL N-Acetylcysteine is diluted in 50-100ml 5% Dextrose and is given as

an intravenous infusion over 30 minutes

 Do not administer undiluted N-Acetyl-Cysteine

 Administer as an infusion via volumetric pump only; DO NOT administer as a

bolus

In urgent cases N-Acetylcysteine can be given IV or orally immediately before the

procedure. Thereafter, 2 doses may be given 12 hours apart. The IV hydration
regimen should be administered as previously discussed
 ECG, blood pressure and saturations
MONITORING  Biochemistry and Full blood count
 Site of Intravenous cannula

ADVERSE REACTIONS  Allergic type reactions (anaphylaxis and anaphylactoid reactions) including rash,
bronchospasm and angioedema
 Hypotension and shock
 Hypokalemia, thrombocytopenia and platelet dysfunction.
 Nausea, vomiting

CONTRAINDICATIONS Previous allergic reactions

PRECAUTIONS Administer with caution in asthmatic patient with a history of bronchospasm
PREGNANCY CATEGORY B2
INCOMPATIBILITY Cefepime, Ceftazidime
COMPATABILITY Glucose 5%, Saline 0.9%
TRADE NAMES For oral administration: Omegapharm 800mg/4mL Nebulising Solution,
For IV administration: Acetylcysteine [DBL] 2g/10mL concentrated vial
REFERENCES: MIMS, Micromedex, The Australian Injectable Drugs Handbook, Australian Medicines
Handbook; KDIGO: Kidney Disease Improving Global Outcomes: Clinical Practice
Guideline for AKI, 2012; BMJ Best practice (International Guidelines) via CIAP; Uptodate
REVISED BY: Arlene Adriano CNS
Katina Skylas ICU CNC June 2015
Rosalba Cross July 2015
Najat Nizam-Nahhas Pharmacist
ENDORSED BY: Nursing Policy & Practice Committee December 2015
CRGH Drug Committee February 21016
REVISION DUE: February 2020

CRGH ICU Drug Guideline: This guideline is written for use in the ICU only | N-ACETYLCYSTEINE 2
Renal protection