Acetilcisteína
Acetylcysteine
N-acetyl-L-cysteine
También conocido como: Mucomyst · Acetadote · NAC · ACC · Ilube · Parvolex · Fluimucil · N-acetylcysteine · N-acetyl-L-cysteine · 5052 acetylcysteinum · NSC-111180
Revisado por el equipo veterinario de VetSheetActualizado 5 abr 2026Referencia veterinaria basada en la evidencia
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Dosis por especie
🌎 NA — North America🌍 EU — Europe
Perros
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Acetaminophen toxicity | 140 mg/kg PO loading dose, followed by 70 mg/kg PO q6h | PO | q6h | For 7 treatments (up to 12-17 doses for massive ingestions) | 🌎 NA |
| Acetaminophen toxicity | 150 mg/kg PO or IV initially, then 50 mg/kg q4h | PO/IV | q4h | For 17 additional doses | 🌎 NA |
| Acetaminophen toxicity | 140 mg/kg PO loading dose, then 70 mg/kg PO every 6 hours | PO | q6h | For 7 treatments | 🌎 NA |
| Phenol toxicity | 140 mg/kg PO or IV initially, then 50 mg/kg q4h | PO/IV | q4h | For 3 days | 🌎 NA |
| Hepatotoxicity secondary to xylitol poisoning | 140-280 mg/kg loading dose IV or PO; followed by 70 mg/kg four times daily | IV/PO | q6h | — | 🌎 NA |
| Degenerative myelopathy (anecdotal) | 25 mg/kg PO q8h for 2 weeks, then q8h every other day | PO | q8h | Indefinitely (every other day after 2 weeks) | 🌎 NA |
| Mucolytic | nebulize 50 mg as a 2% (dilute with saline) solution over 30-60 min or instil directly into the trachea 1-2 ml of a 20% solution | Nebulization/Intratracheal | prn | As needed | 🌍 EU |
| Paracetamol poisoning | 140-280 mg/kg diluted to a 5% solution using 5% dextrose by slow i.v. infusion over 15-20 min, followed by further slow infusions of 70 mg/kg (similarly diluted) every 6 hours | IV | q6h | for at least 7 doses | 🌍 EU |
| KCS | 1 drop of the ophthalmic solution | topical | q6-8h | As directed | 🌍 EU |
- Acetaminophen toxicity: Dilute to 5% in dextrose or sterile water. May also be given slow IV over 15-20 minutes. Wait 2-3 hours after activated charcoal if giving PO.
- Phenol toxicity: May be partially effective to reduce hepatic and renal injury.
- Hepatotoxicity secondary to xylitol poisoning: Used as part of a comprehensive protocol including vitamin K, plasma, SAMe, vitamin E, and silymarin.
- Degenerative myelopathy (anecdotal): Dilute 20% solution to 5% with chicken broth. Used in conjunction with aminocaproic acid. Note: No treatment has been shown to be effective in published trials.
- Mucolytic: Dilute with saline for nebulization.
- Paracetamol poisoning: Administer after inducing emesis if appropriate (within 2 hours of ingestion). IV preferred for serious intoxications. Can be given PO but must be diluted to improve palatability.
- KCS: Rarely used now for this indication.
Gatos
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Acetaminophen toxicity | 140 mg/kg PO loading dose, followed by 70 mg/kg PO four times daily (q6h) | PO | q6h | For 7 treatments (up to 12-17 doses for massive ingestions) | 🌎 NA |
| Phenol toxicity | 140 mg/kg PO or IV initially, then 50 mg/kg q4h | PO/IV | q4h | For 3 days | 🌎 NA |
| Adjunctive treatment of hepatic lipidosis | 140 mg/kg IV over 20 minutes, then 70 mg/kg IV q12h | IV | q12h | — | 🌎 NA |
| Mucolytic | nebulize 50 mg as a 2% (dilute with saline) solution over 30-60 min or instil directly into the trachea 1-2 ml of a 20% solution | Nebulization/Intratracheal | prn | As needed | 🌍 EU |
| Paracetamol poisoning | 140-280 mg/kg diluted to a 5% solution using 5% dextrose by slow i.v. infusion over 15-20 min, followed by further slow infusions of 70 mg/kg (similarly diluted) every 6 hours | IV | q6h | for at least 7 doses | 🌍 EU |
| KCS | 1 drop of the ophthalmic solution | topical | q6-8h | As directed | 🌍 EU |
- Acetaminophen toxicity: Dilute to 5% in dextrose or sterile water. May also be given slow IV over 15-20 minutes. Wait 2-3 hours after activated charcoal if giving PO.
- Phenol toxicity: May be partially effective to reduce hepatic and renal injury.
- Adjunctive treatment of hepatic lipidosis: Dilute 10% NAC with saline 1:4 and administer IV using a 0.25 micron filter.
- Mucolytic: Dilute with saline for nebulization.
- Paracetamol poisoning: IV administration is strongly preferred in cats as bioavailability is reduced with oral administration.
- KCS: Rarely used now for this indication.
Caballos
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| To help break up chondroids in the guttural pouch | Instill 20% solution | Local instillation | — | — | 🌎 NA |
| Meconium impaction in neonatal foals | 8 grams in 20 g sodium bicarbonate in 200 mL water (pH of 7.6), give as enema as needed to effect | Enema | PRN | — | 🌎 NA |
| Meconium impaction in neonatal foals | Infuse slowly 100-200 mL of 4% acetylcysteine solution and retain for 30-45 minutes | Retention enema | Once | Retain 30-45 minutes | 🌎 NA |
- Meconium impaction in neonatal foals: Use a 30 French Foley catheter with a 30 cc bulb. Monitor for possible bladder distention.
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Resumen
La acetilcisteína (a menudo denominada NAC) es un agente terapéutico altamente versátil en medicina veterinaria. Se utiliza principalmente como un antídoto vital para la toxicidad por acetaminofén (paracetamol), particularmente en gatos y perros, donde previene la necrosis hepática grave y la metahemoglobinemia.
Más allá de sus propiedades antídotas, la acetilcisteína es un potente agente mucolítico. Cuando se administra en el tracto respiratorio, descompone eficazmente el moco espeso y viscoso, ayudando a la eliminación de las secreciones respiratorias.
Aplicaciones clínicas:
- Toxicología: Tratamiento primario para toxicidades por acetaminofén, xilitol y fenol.
- Respiratorio: Utilizado mediante nebulización o instilación intratraqueal para tratar enfermedades respiratorias superiores crónicas o afecciones con una carga excesiva de moco.
- Oftalmología: Aplicado tópicamente para detener la progresión de úlceras corneales "en fusión" al inhibir las colagenasas.
- Medicina equina: Utilizado localmente para disolver condroides en la bolsa gutural y administrado como enema para impactaciones de meconio refractarias en potros neonatos.
- Medicina interna: Utilizado como coadyuvante para la lipidosis hepática felina y anecdóticamente para la mielopatía degenerativa canina.
Mecanismo de acción
Antidote Mechanism (Hepatoprotection): Acetaminophen is metabolized in the liver to a highly reactive and toxic intermediate called NAPQI (N-acetyl-p-benzoquinone imine). Normally, NAPQI is safely conjugated by endogenous glutathione. In an overdose, glutathione is rapidly depleted, allowing NAPQI to cause severe oxidative stress and hepatocellular necrosis. Acetylcysteine acts as a glutathione precursor and provides an alternate sulfhydryl substrate to conjugate directly with NAPQI, thereby neutralizing the toxin and restoring cellular antioxidant defenses.
Mucolytic Mechanism: The free sulfhydryl group (-SH) on the acetylcysteine molecule directly interacts with mucoproteins in respiratory secretions. It cleaves the disulfide bonds linking these proteins, which drastically reduces the viscosity of both purulent and non-purulent mucus. This effect is optimal in an alkaline environment (pH 7-9). It has no effect on living tissue or fibrin.
Seguridad y advertencias
Contraindicaciones
- Hypersensitivity to the drug (specifically for pulmonary indications)
Efectos adversos
- Nausea and vomiting (especially with oral administration due to poor palatability)
- Urticaria (rare)
- Bronchospasm, chest tightness, and bronchial/tracheal irritation (when inhaled)
- Blood pressure changes and allergic reactions (reported with IV boluses in humans)
Precauciones
Use with caution in animals with pre-existing bronchospastic diseases (e.g., feline asthma) when administering via the pulmonary route, as it may trigger bronchospasm. Oral administration can be challenging due to the extremely foul taste and odor (sulfur/rotten eggs); administration via a gastric or duodenal tube is often necessary. If using the inhalation solution for intravenous administration, it is highly recommended to use a 0.2-micron in-line filter. Use caution in nursing dams as it is unknown if the drug enters milk.
Interacciones farmacológicas
May adsorb orally administered acetylcysteine, potentially reducing its systemic absorption and efficacy. A 2-3 hour wait between charcoal and oral acetylcysteine is recommended, or acetylcysteine should be given intravenously.
Monitorización
- Hepatic enzymes (especially in dogs)
- Acetaminophen levels (if available)
- Hemogram, specifically monitoring methemoglobin values (especially critical in cats)
- Serum electrolytes
- Hydration status
Farmacocinética
Absorción
Well absorbed from the gastrointestinal tract when administered orally.
Distribución
When administered via nebulization or intratracheally, most of the drug remains localized in the pulmonary tract to participate in sulfhydryl-disulfide reactions; the remainder is systemically absorbed.
Metabolismo
Absorbed drug is rapidly deacetylated into the amino acid cysteine in the liver, which is then further metabolized.
Sobredosis
Acetylcysteine is considered quite safe in overdose situations. The LD50 in dogs is reported to be 1 g/kg orally and 700 mg/kg intravenously. Massive overdoses may result in gastrointestinal distress (nausea, vomiting) or hypersensitivity reactions, but life-threatening toxicity from the drug itself is rare.
Productos disponibles
Formulaciones
- Injection: 20% (200 mg/mL)
- Oral/Inhalation Solution: 10% and 20%
- Oral capsules: 600 mg (OTC nutritional supplement)
Etiquetado para humanos
- Acetylcysteine injection: 20% (200 mg/mL) in 30 mL single-dose vials (Acetadote)
- Acetylcysteine Oral Solution: 10% & 20% (Mucomyst)
- Acetylcysteine Inhalation Solution: 10% & 20% (Mucomyst)
- N-Acetylcysteine (NAC) 600 mg capsules (OTC nutritional supplement)
Estado regulador
Human authorized products used under the cascade.
Human authorized products used under the cascade.
Sin datos reguladores para: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Almacenamiento y estabilidad
Unopened vials should be stored at room temperature (15-30°C). Once opened, vials must be refrigerated and used within 96 hours (products labeled specifically for IV use should be used within 24 hours). Acetylcysteine is incompatible with oxidizing agents and can liberate hydrogen sulfide when exposed to rubber, copper, or iron. It is incompatible in solution with amphotericin B, ampicillin, erythromycin, tetracyclines, hydrogen peroxide, and trypsin.
Información para el cliente
Uso de emergencia: La acetilcisteína se utiliza más comúnmente en entornos de emergencia bajo supervisión clínica para tratar intoxicaciones potencialmente mortales (como la ingestión de Tylenol/acetaminofén).
- Sabor y olor: La formulación líquida oral tiene un olor muy fuerte y desagradable que recuerda a huevos podridos (azufre) y un sabor muy amargo. Es probable que su mascota se resista a tomarla. En el hospital, a menudo se administra a través de una sonda de alimentación o se mezcla con saborizantes fuertes para asegurar que se reciba la dosis completa.
- Efectos secundarios: El efecto secundario más común es náuseas o vómitos. Si su mascota vomita poco después de recibir una dosis oral, comuníquese con su veterinario de inmediato, ya que es posible que sea necesario repetir la dosis.
- Monitoreo: Su mascota requerirá un monitoreo estrecho, incluyendo análisis de sangre frecuentes, para asegurar que el hígado se esté recuperando y que la toxina esté siendo eliminada del cuerpo.
La referencia de medicamentos de VetSheet está destinada a profesionales veterinarios autorizados como ayuda para la toma de decisiones clínicas, no como sustituto del criterio profesional ni del prospecto actual del fabricante.