Acetylcysteine
- Drugs List
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Eye drops, solution containing acetylcysteine 5% w/v
Drugs List
Dosage
Wash hands prior to use.
Avoid contact of the container with the eye or other surfaces as contamination leading to ophthalmic infection may occur.
To reduce systemic absorption compress the lacrimal sac during administration and for one minute afterwards.
Leave an interval of at least 5 minutes before instilling another ophthalmic medication.
Soft contact lenses should be removed before instillation of eye drops containing benzalkonium chloride and may be re-inserted after 15 minutes.
Discard 4 weeks after first opening.
Adults
Instil one or two drop(s) into the affected eye(s) three or four times a day.
Elderly
Instil one or two drop(s) into the affected eye(s) three or four times a day.
Children
Instil one or two drop(s) into the affected eye(s) three or four times a day.
Administration
For ocular administration.
Contraindications
None known.
Precautions and Warnings
Application may cause transient blurring of vision; patients should avoid driving or operating machinery until vision is clear.
Discontinue use if discomfort, increased reddening or irritation occurs and persists.
Pregnancy (see notes under Pregnancy).
Breastfeeding (see notes under Lactation).
Contains benzalkonium chloride. Soft contact lenses should be removed before instillation of the eye drops and may be reinserted after 15 minutes.
Pregnancy and Lactation
Pregnancy
Acetylcysteine eye drops are probably compatible for use during pregnancy.
Acetylcysteine is not teratogenic or embryotoxic in animal studies. It has a low molecular weight and crosses the human placenta. Although data is limited in human pregnancy, it does not appear to represent a risk to the foetus even when intravenous doses are used for paracetamol overdose. Schaefer concludes that eye drops can be used for the appropriate indications (Schaefer 2007).
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password at ( https://www.toxbase.org/ ) or if this is unavailable at the backup site ( https://www.TOXBASEbackup.org/ ).
Lactation
Acetylcysteine eye drops are probably compatible with breastfeeding.
Although excretion into breast milk would be expected because of its low molecular weight, systemic absorption is likely to be negligible. Schaefer concludes that eye drops are usually compatible with breastfeeding (Schaefer 2007). Intravenous acetylcysteine has been administered to preterm neonates, for therapeutic indications at doses far above those that would be obtained from milk, without causing toxicity.
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Counselling
Advise patient to wash their hands prior to use.
Advise patient to avoid contact of the container with the eye or other surfaces as contamination leading to ophthalmic infection may occur.
Advise patients to leave an interval of at least 5 minutes before instilling another ophthalmic medication.
Advise patient to compress the lacrimal sac during administration and for one minute afterwards, to reduce systemic absorption.
Advise patients that instillation of eye drops may cause transient blurring of vision and to avoid driving or operating machinery until vision is clear.
Advise patient to remove soft contact lenses before instillation of the eye drops and re-insert them after 15 minutes.
Advise patient to discard eye drops 4 weeks after first opening.
Side Effects
Blurred vision (transient)
Ocular itching
Ocular irritation
Reddening of eyes
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111)
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( https://www.toxbase.org/ ) or if this is unavailable at the backup site ( https://www.TOXBASEbackup.org/ ).
Shelf Life and Storage
Do not store above 25 degrees C.
Keep in the outer carton and protect from light.
Further Information
Last Full Review Date: April 2012
Reference Sources
British National Formulary, 63rd Edition (2012) Pharmaceutical Press, London.
BNF for Children (2011-2012) Pharmaceutical Press, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Patient Information Leaflet: Ilube Eye Drops, Moorfields Pharmaceuticals. September 2010.
Summary of Product Characteristics: Ilube Eye Drops, Moorfields Pharmaceuticals. Revised July 2011.
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.