ACETYLCYSTEINE PARVOLEX

CLASSIFICATION- Detoxifying agent.

MODE OF ACTION

Restores glutathione stores in the liver facilitating conjugation of toxic metabolites of paracetamol, and therefore protecting the liver when paracetamol over dosage has occurred.. When used in conjunction with I.V G.T.N, a reduced incidence of AMI and less adjustments of I.V G.T.N rates.

INDICATIONS

� Used as an antidote in paracetamol poisoning, where blood levels are in the toxic range. � Short term treatment of patients with unstable angina on I.V G.T.N. � Nitrate intolerance in acute coronary syndromes � NB blood testing of serum paracetamol levels must not be done until 4 hours post ingestion.

PRECAUTIONS

� Some report of allergic reactions. � Give with caution with asthmatics or atropic individuals. � Monitor serum k in paracetamol overdose.

ADVERSE REACTIONS

� Rash, asthma, anaphylaxis have been reported � hypokalemia can occur in paracetamol overdose.

NURSING CONDIDERATIONS

� Parvolex may increase the haemodynamic effects of nitroglycerine and thus induce hypotension. Large doses of sublingual G.T.N. should be avoided. � Patients with Panadol overdose do not require cardiac monitoring during administration of Parvolex and it may be given on the general ward.

PRESENTATION

200 mg/ml 10 ml (2 grams per 10 ml ampoule)

DOSAGE AND ADMINISTRATION

according to patients body weight initial dose second dose third dose total ml 150 mg/kg 50 mg/kg 100 mg/kg in 200 ml in 500 ml in 1000 ml then then 5 % D5W over 5 % D5W over 5 % D5W over 15 min 4 hours 16 hours mls of acetylcysteine mls of acetylcysteine 50 37.5 12.5 25 75 60 45.0 15.0 30 90 70 52.5 17.5 35 105 80 60.0 20.0 40 120 90 67.5 22.5 45 135

* NITRATE INTOLERANCE GIVE 100 MG/KG IN 1 LITRE 5 % DEXTROSE OVER 16 HOURS

Dosage and administration as per MMC drug protocol booklet 10 grams of Parvolex in 250 ml 5 % Dextrose infused over 24 hours.