What are the recommended dosages of IV N -acetylcysteine (NAC) for the treatment of acetaminophen toxicity/poisoning?

Updated: Jan 17, 2020
  • Author: Susan E Farrell, MD; Chief Editor: Michael A Miller, MD  more...
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Answer

Pharmaceutical guidelines for IV NAC administration depend on the patient's body weight and/or on whether the ingestion is acute or chronic. Continuous IV infusion is recommended for acute ingestion, as follows:

  • Loading dose: 150 mg/kg IV; mix in 200 mL of 5% dextrose in water (D5W) and infuse over 1 h

  • Dose 2: 50 mg/kg IV in 500 mL D5W over 4 h

  • Dose 3: 100 mg/kg IV in 1000 mL D5W over 16 h

In patients who weigh more than 100 kg, limited data suggest a loading dose of 15,000 mg infused IV over 1 hours, then a first maintenance dose of 5,000 mg IV over 4 hours and a second maintenance dose of 10,000 mg over 16 hours.


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