Indications for ACETADOTE:
To minimize hepatic injury after acetaminophen overdose.
Adults and Children:
Administer within 8 hours for maximal protection against hepatic injury. Estimate time of acetaminophen ingestion. If <24 hours since overdose, obtain serum acetaminophen level 4 hours post-ingestion or as soon as possible thereafter and plot level on nomogram, draw second level 4–6 hours after first; if either falls above toxicity line, initiate therapy. If >8 hours post-ingestion, start treatment immediately. If time of ingestion unknown: consider empiric initiation of treatment. 300mg/kg given as 3 separate doses and administered over a total of 21 hours. See full labeling for preparation based on patient weight. >100kg: loading dose: 15,000mg over 1 hour; first maintenance dose: 5,000mg over 4 hours; second maintenance dose: 10,000mg over 16 hours.
Asthma. History of bronchospasm. Monitor for severe hypersensitivity reactions; may treat with antihistamines and epinephrine; interrupt or discontinue treatment if persistent. Avoid fluid overload esp. in patients <40kg or those requiring fluid restriction; reduce volume of diluent as needed (see full labeling). Monitor liver enzymes, INR, creatinine, BUN, blood glucose, electrolytes. Hepatic or renal impairment: see full labeling. Pregnancy. Nursing mothers (pump and discard milk for 30hrs after therapy).
Hypersensitivity reactions (eg, rash, urticaria/facial flushing, pruritus, edema, hypotension, cough, wheezing, SOB, bronchospasm), GI upset, tachycardia.
Generic Drug Availability:
Single-use vial (30mL)—4