Mucomyst iv

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One of our interventionists ordered mucomyst 1200mg iv if available on a patient post heart cath with elevated BUN and creatinine. The pharmacy did not sent iv, only the usual po dose, which was the physician's second choice. I've heard the docs talking about using mucomyst iv, but I can't find any printed info on this. Is anyone else using mucomyst iv for renal function? Any links to literature?

Thanks in advance.

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Nope, never heard of it. I've always given it po. Feel sorry for the pts who have to chug it down. It smells like rotten eggs...and I'm sure it tastes even worse. I couldn't imagine giving that stuff IV, I bet it would burn like K does.

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Specializes in CCU/CVU/ICU.
One of our interventionists ordered mucomyst 1200mg iv if available on a patient post heart cath with elevated BUN and creatinine. The pharmacy did not sent iv, only the usual po dose, which was the physician's second choice. I've heard the docs talking about using mucomyst iv, but I can't find any printed info on this. Is anyone else using mucomyst iv for renal function? Any links to literature?

Thanks in advance.

When i've given it IV it's always been given in drug over-dose patients (tylenol)... (somehow protectes liver in a similar fashion).

I've not given it IV for renal-protection post-cath. Only orally. Perhaps iv for renal protection is the next up-and-coming??

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Specializes in CCU/CVU/ICU.
... Feel sorry for the pts who have to chug it down...It smells like rotten eggs... I, I bet it would burn like K does.

We usually dilute it with juice or ginger-ale. Thats funny if you gave it in a shot-glass LOL! Stuff smells...It's one of those drugs that nurses warn one-another about.. "i'm opening and pouring mucomyst!...it's not me!..."

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Always have given it p.o., pre and post cardiac caths and when contrast is used, for renal compromise.

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Specializes in Critical Care, Cardiothoracics, VADs.

i agree, it is generally given orally to minimize contrast-related renal toxicity due to it's antioxidant properties which prevent oxidative renal tissue damage.

a couple of studies:

1. [color=#336699]tepel m., van der giet m., schwarzfeld c., laufer u., liermann d., zidek w. prevention of radiographic-contrast-agent–induced reductions in renal function by acetylcysteine. n engl j med 2000; 343:180-184, jul 20, 2000.

2. marenzi g., assanelli e., marana i., lauri g., campodonico j., grazi m., de metrio m., galli s., fabbiocchi f., montorsi p., veglia f., bartorelli a. l. n-acetylcysteine and contrast-induced nephropathy in primary angioplasty. n engl j med 2006; 354:2773-2782, jun 29, 2006.

3. pannu, n., wiebe, n., tonelli, m., for the alberta kidney disease network, (2006). prophylaxis strategies for contrast-induced nephropathy. jama 295: 2765-2779

this is just a sample - there were literally dozens of articles about this on a quick medline search.

tepel in nejm 2000, and briguori et al. in 2002 in the american college of cardiology journal.

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Augigi,

I found those same articles when I searched, too. I wasn't able to find anything about giving it IV, though, except for acetminophen overdose. I work tomorrow, so I'll ask our interventionists and post again with their answer!

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We usually dilute it with juice or ginger-ale. Thats funny if you gave it in a shot-glass LOL! Stuff smells...It's one of those drugs that nurses warn one-another about.. "i'm opening and pouring mucomyst!...it's not me!..."

Yep, you smell that stuff all over the unit. I always tell my patients straight up, it stinks, it's nasty, but you gotta drink it. We usually dilute it too, but some pts prefer to drink a little swig of it to get it over with quick instead of a whole mixed 8 ounce glass, but either way I would have to hold my nose and chug it to get that gross stuff down.

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Specializes in Critical Care, Cardiothoracics, VADs.

Just trying to help :). Try this one:

J. Webb, G. Pate, K. Humphries, C. Buller, S. Shalansky, A. Al Shamari, A. Sutander, T. Williams, R. Fox, A. Levin. A randomized controlled trial of intravenous N-acetylcysteine for the prevention of contrast-induced nephropathy after cardiac catheterization. American Heart Journal, Volume 148, Issue 3, Pages 422-429

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http://www.medscape.com/medline/abstract/16807414?queryText=intravenous%20n%20acetylcysteine

Just found this one while searching again.

I'll post later, after talking to the docs.

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Specializes in Critical Care/ICU.

Yes, I've given it IV, but not routinely. Premed the patient with benedryl and tylenol.

We use inhaled mucomyst for lung transplants more frequently than for any other reason.

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Ok Finally had a chance to talk to two of our interventionist. Of course I got two slightly different stories! Here's the scoop: 600-1200 mg iv as the patient is being prepped for intervention, then 600 mg po bid for 48 hours post intervention. However, our pharmacy will not stock the iv route as they claim it is "too expensive". Another nurse questioned, "too expensive for whom?" Evidently this is being used in Europe, and perhaps the iv route is manufactured in Europe so it is cost effective there. Our docs are still pursuing this and I anticipate seeing it ordered routinely later this year.

Thanks to all who replied!

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