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N-Acetyl Cysteine

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Are there any interactions with medications?



Nitroglycerin
Interaction Rating: Major Do not take this combination.

Nitroglycerin can dilate blood vessels and increase blood flow. Taking N-acetyl cysteine seems to increase the effects of nitroglycerin. This could cause increased chance of side effects including headache, dizziness, and lightheadedness.



Activated charcoal
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Activated charcoal is sometimes used to prevent poisoning in people who take too much acetaminophen and other medications. Activated charcoal can bind up these medications in the stomach and prevent them from being absorbed by the body. Taking N-acetyl cysteine at the same time as activated charcoal might decrease how well it works for preventing poisoning.



Chloroquine (Aralen)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Chloroquine (Aralen) is a drug used to treat malaria. It kills malaria by causing a chemical called heme to build up inside of cells. N-acetyl cysteine might prevent the build-up of heme inside of cells. This might reduce the effects of chloroquine.



Medications for high blood pressure (ACE inhibitors)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

N-acetyl cysteine might decrease blood pressure. Taking N-acetyl cysteine along with medications for high blood pressure might cause your blood pressure to go too low.

Some medications for high blood pressure include captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), ramipril (Altace), and others.



Medications for high blood pressure (Antihypertensive drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

N-acetyl cysteine might decrease blood pressure. Taking N-acetyl cysteine along with medications for high blood pressure might cause your blood pressure to go too low.

Some medications for high blood pressure include captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), Amlodipine (Norvasc), hydrochlorothiazide (HydroDiuril), furosemide (Lasix), and many others.



Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

N-acetyl cysteine might slow blood clotting. Taking N-acetyl cysteine along with medications that also slow clotting might increase the chances of bruising and bleeding.

Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.

Dosing considerations for N-acetyl Cysteine.

The following doses have been studied in scientific research:

ADULTS

BY MOUTH:
  • For acetaminophen (Tylenol) overdose: 140 mg/kg of N-acetyl cysteine at first, followed by 70 mg/kg every 4 hours for 3 days or until acetaminophen is no longer detected in the blood.
  • For chest pain that is not relieved by rest (unstable angina): 600 mg of N-acetyl cysteine three times daily with a nitroglycerin patch.
  • For preventing sudden worsening of chronic bronchitis: Doses of 200 mg twice daily, 200 mg three times daily, 300 mg slow-release twice daily, and 600 mg controlled-release twice daily have been used for up to 6 months. Doses up to 1.5 grams per day for up to 4 months have also been used.
  • For treating chronic obstructive pulmonary disease (COPD): 400-1200 mg of N-acetyl cysteine daily in divided doses, in addition to standard care, has been used for up to 6 months.
  • For preventing kidney damage due to X-ray dye: 400 to 600 mg of N-acetyl cysteine twice daily on the day before and on the day of iopromide administration, with IV saline (0.45%) 1 mL/kg body weight per hour for 12 hours before and 12 hours after iopromide administration. Also, a starting dose of 1200 mg of N-acetyl cysteine, followed by 1200 mg twice daily thereafter for 48 hours after dye has also been used.
  • For treating a lung condition called fibrosing alveolitis that makes breathing difficult: 600 mg of N-acetyl cysteine three times daily for 12 weeks.
  • For preventing damage to the bladder due to treatment with a cancer drug called ifosfamide: 1-3 grams of N-acetyl cysteine every 6 hours beginning one hour before ifosfamide treatment and continuing for up to 5 days after treatment.
  • For reducing levels of homocysteine in the blood: 600-1200 mg of N-acetyl cysteine daily.
  • For epilepsy: 4-6 grams daily.
  • For reducing flu symptoms: 600 mg twice daily for up to 30 months.
  • For reducing the risk of heart attacks and strokes in patients with end-stage kidney disease: 600 mg twice daily.
  • For high cholesterol: 1.2 grams daily for 6 weeks or 2 grams daily for 4 weeks followed by 4 grams daily for another 4 weeks.
BY INHALATION:
  • For collapse of part or all of a lung (atelectasis): 3-5 mL of 20% solution or 6-10 mL of 10% solution administered using a nebulizer 3-4 times per day. The solution may also be administered through a tracheostomy at a dose of 1-2 mL of 10% or 20% solution every 1-4 hours. The solution may also be administered through a tracheal catheter at a dose of 1-2 mL of 20% solution or 2-4 mL of 10% solution every 1-4 hours.
  • For diagnostic lung tests: 1-2 mL of 20% solution of 2-4% of 10% solution administered via intratracheal instillation 2-3 times prior to the diagnostic test.
  • For treating chronic obstructive pulmonary disease (COPD): 20% solution administered via a nebulizer for at least 4 days.
  • For care of people with a tube in their windpipe (people who have undergone a tracheostomy): 1-2 mL of 10-20% solution administered via intratracheal instillation.
BY INTRAVENOUS (IV) INJECTION:
  • For acetaminophen (Tylenol) overdose: Healthcare providers give N-acetyl cysteine intravenously (by IV) for acetaminophen poisoning. Dosing is usually 150 mg/kg initially followed by 50 mg/kg over 4 hours, followed by 100 mg/kg over 16 hours or until acetaminophen levels are no longer detected.
  • For chest pain that is not relieved by rest (unstable angina): 5 grams every 6 hours along with IV nitroglycerine 5 mcg/min for 24 hours.
  • For preventing kidney damage due to X-ray dye: 900 mg before and after dye. Also, 1200 mg by IV before giving an oral dose of N-acetyl cysteine 1200 mg twice daily has also been used.
  • For heart attack: 100 mg/kg six times daily with the drug streptokinase. Also, 20 mg/min for 23 hours with streptokinase and nitroglycerin has also been used. In addition, 15 grams along with streptokinase over 24 hours has been used.
CHILDREN

BY MOUTH:
  • For acetaminophen (Tylenol) overdose: 140 mg/kg initially followed by 70 mg/kg every 4 hours for 72 hours or until acetaminophen is no longer detected in the body.
  • For autism: 900 mg daily for 4 weeks followed by 900 mg twice daily for 4 weeks followed by 900 mg three times daily for 4 weeks. Taking 1200 mg daily with the drug risperidone for 8 weeks has also been used.
BY INHALATION:
  • For collapse of part or all of a lung (atelectasis): 3-5 mL of 20% solution or 6-10 mL of 10% solution administered using a nebulizer three to four times per day. The solution may also be administered through a tracheostomy at a dose of 1-2 mL of 10% or 20% solution every 1-4 hours. The solution may also be administered through a tracheal catheter at a dose of 1-2 mL of 20% solution or 2-4 mL of 10% solution every 1-4 hours.
  • For diagnostic lung tests: 1-2 mL of 20% solution or 2-4 mL of 10% solution administered via intratracheal instillation 2-3 times prior to the diagnostic test.
  • For care of people with a tube in their windpipe (people who have undergone a tracheostomy): 1-2 mL of 10% or 20% solution administered via intratracheal instillation.

Therapeutic Research Faculty copyright

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