아세틸시스테인

Acetylcysteine

N-acetyl-L-cysteine

해독제 / 점액용해제POIVInhalation (Nebulization)IntratrachealTopical ophthalmicEnemaIntra-guttural pouch instillation개고양이말

다른 이름: Mucomyst · Acetadote · NAC · ACC · Ilube · Parvolex · Fluimucil · N-acetylcysteine · N-acetyl-L-cysteine · 5052 acetylcysteinum · NSC-111180

VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료

140 mg/kg PO loading dose, followed by 70 mg/kg PO q6hPO· q6h· For 7 treatments (up to 12-17 doses for massive ingestions)

체중— 🐕

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

동물 종별 용량

🌎 NA — North America🌍 EU — Europe

개

적응증	용량	경로	빈도	기간	지역
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.

고양이

적응증	용량	경로	빈도	기간	지역
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.

말

적응증	용량	경로	빈도	기간	지역
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.

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개요

아세틸시스테인(흔히 NAC로 불림)은 수의학에서 매우 다용도로 사용되는 치료제입니다. 특히 개와 고양이에서 아세트아미노펜(타이레놀) 중독의 생명을 구하는 해독제로 가장 잘 알려져 있으며, 심각한 간 괴사와 메트헤모글로빈혈증을 예방합니다.

해독 특성 외에도 아세틸시스테인은 강력한 점액용해제입니다. 호흡기로 투여될 때 끈적하고 점성이 높은 점액을 효과적으로 분해하여 호흡기 분비물의 배출을 돕습니다.

임상 적용:

독성학: 아세트아미노펜, 자일리톨, 페놀 중독의 일차 치료제.
호흡기계: 만성 상부 호흡기 질환이나 점액 부담이 큰 상태를 치료하기 위해 네뷸라이저 또는 기관 내 주입으로 사용.
안과: 콜라게나아제를 억제하여 '각막 융해(melting)' 궤양의 진행을 막기 위해 국소적으로 적용.
말 의학: 기낭 내 연골양 물질을 용해하기 위해 국소적으로 사용되며, 신생 망아지의 난치성 태변 매복에 관장제로 사용.
내과: 고양이 지방간증의 보조 치료 및 반려견의 퇴행성 골수병증에 대한 경험적 치료제로 사용.

작용 기전

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.

안전성·주의사항

금기사항

Hypersensitivity to the drug (specifically for pulmonary indications)

부작용

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)

주의

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.

약물 상호작용

Activated CharcoalModerate

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.

모니터링

Hepatic enzymes (especially in dogs)
Acetaminophen levels (if available)
Hemogram, specifically monitoring methemoglobin values (especially critical in cats)
Serum electrolytes
Hydration status

약동학

흡수

Well absorbed from the gastrointestinal tract when administered orally.

분포

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.

대사

Absorbed drug is rapidly deacetylated into the amino acid cysteine in the liver, which is then further metabolized.

과다투여

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.

제품

제형

Injection: 20% (200 mg/mL)
Oral/Inhalation Solution: 10% and 20%
Oral capsules: 600 mg (OTC nutritional supplement)

인용의약품

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)

규제 현황

European Union✓ 승인됨처방전의약품EMA

Human authorized products used under the cascade.

United Kingdom✓ 승인됨처방전의약품VMD

Human authorized products used under the cascade.

규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

보관·안정성

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.

보호자 정보

응급 상황 전용: 아세틸시스테인은 일반적으로 생명을 위협하는 중독(예: 타이레놀/아세트아미노펜 섭취)을 치료하기 위해 수의사의 감독 하에 응급 상황에서 가장 흔히 사용됩니다.

맛과 냄새: 경구용 액체 제제는 썩은 달걀(유황)과 같은 매우 강하고 불쾌한 냄새가 나며 맛이 매우 나쁩니다. 반려동물이 복용을 거부할 가능성이 높습니다. 병원에서는 전체 용량을 확실히 투여하기 위해 급여 튜브를 통해 투여하거나 강한 향료와 섞어 투여하는 경우가 많습니다.
부작용: 가장 흔한 부작용은 메스꺼움이나 구토입니다. 반려동물이 경구 투여 직후 구토를 한다면 용량을 다시 투여해야 할 수 있으므로 즉시 수의사에게 연락하십시오.
모니터링: 간이 회복되고 독소가 체내에서 제거되고 있는지 확인하기 위해 잦은 혈액 검사를 포함한 반려동물에 대한 면밀한 모니터링이 필요합니다.

VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.