Mucomyst iv

[msn2008]

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.

[cathlab1]

muomyst Iv , if I am not mistaken is for the tylenol overdose, it is dose as such. I am sure that this has become an "off label'' type use and it won't be long before it is on label.. I gave it in the ED for Tylenol ods and if not dosed correctly can be fatal.

[lglnurse]

I gave it in the ER recently, and I was so shocked, as I had only ever given it PO. The guy had OD'd on every Tylenol containing drug known to man, and it actually saved him - he was out of the unit in 3 days! I was happy because my patient didn't puke and I didn't have to smell rotten eggs!

[cardiacRN2006, ADN, RN]

On the cardiac hospital I used to work at we gave it IV all the time (pre-cath). It's off-label use is to protect the kidneys.

http://www.webmd.com/drugs/drug-89245-Acetylcysteine+IV.aspx?drugid=89245&drugname=Acetylcysteine+IV&pagenumber=4

http://www.acetadote.com/

http://www.radiology.uiowa.edu/healthcare/contrast_policy.pdf

In life-threatening situations where a contrast-enhanced CT is required

immediately (e.g., suspected pulmonary embolism, suspected aortic dissection,

suspected aortic rupture, immediate requirement for vascular intervention), and

where a 24-hour delay is unacceptable based on clinical grounds, one can

consider administration of IVacetylcysteine (Acetadote® 150 mg/kg over 30

minutes immediately prior contrast administration, following by 50 mg/kg over 4

hours after).

IV acetylcysteine (>$100/vial)

[msn2008, MSN, RN]

CaridacRN2006, Thanks! I haven't heard of others using it iv for renal protection pre or post PTCA, until you posted.

Thanks to all other posters, as well!

[cvryder]

I've worked cardiac for several years, ICU off and on, and have given mucomyst *only* po. Never heard of it being given IV. One hint, though...the best things I've found to mix it with are grape juice (the nurse who told me that called it a "rooster poop" LOL) and believe it or not, Dr. Pepper! I don't get nearly as many complaints from the patients when I do the grape juice mix. Back when I was a new nurse the only way to give it was by inhalation, and that was even for the acetaminophen IVs. We used to make the RTs shut the doors (ICU--glass doors). I guess if we have got to po, IV can't be far behind.

[cardiacRN2006, ADN, RN]

I've worked cardiac for several years, ICU off and on, and have given mucomyst *only* po. Never heard of it being given IV.

Well, it's been out on the market for years, and the company is based in Nashville!

http://www.acetadote.com/

We only gave one dose to the pt, two doses if we had time prior to the cath (non-emergent). But if you click on dosage info on this website, it has the calculations for a IVPB/gtt.

Just last week we had someone getting a gtt, but it was for tylenol, not for kidney protection.

[NurseguyFL]

I've never seen an order for Mucomyst IV. It is one really nasty smelling drug so I always give it it in a small cup with a little cold orange juice and encourage the patient to chug it in one gulp. Here we use it as a part of the post CABG protocol and also for renal patients with elevated creatinine.

[talaxandra]

This thread is so interesting! We've used Parvolex (trade name for acetylcysteine) infusions for paracetamol (aka acetaminophen) overdoses for at least ten years. I've only seen it used for renal protection against contrast in the last three or four years. When used for this purpose we give the IV form (ie ampoules) orally. I've never heard of cost being a factor, but will check out next week what the unit price is.

[Loribabble]

We give it PO all the time for our pts who need it pre-angio... but our pharmacy carries it in the pill form... NO SMELL!!!!

We had one pt refuse the liquid stating that he had the 'pills' in the past - asked pharmacy about it and sure enough... it exists! They were a bit reluctant to admit it due to the cost... but they started providing it that way to our floor... I haven't given the nasty stuff in over a year...

[slinkeecat]

I have given it in a nebulized form to break up funky mucus in a repiratory compromised pt and I have given it orally.... It is stinky!!!

[hrtprncss]

po here, x 18 doses usually, then patient can be transferred to the floor. Some attendings prefer to keep their patients in the ICU until the 18 doses is finished, with tylenol overdose, but some physicians transfer the patients after 36 hours or 9 doses depending on the labs.

[Bethy-lynn]

Only ever given it PO, however, had a new nurse that was told to give Mucamyst post cath iv, and not knowing that our pharmacy only carries po, called and asked if mucomyst is ever given IV, NOT could he give OUR mucomyst iv...YES, HE GAVE THE PO MUCOMYST IV!!! ( no , its not sterile). just a heads up to be very aware of.