The Pharmacokinetic Profile and Bioavailability of Enteral N-Acetylcysteine in Intensive Care Unit.

Kersti Teder,Andres Meos,Hiie Soeorg,Liivi Maddison,Juri Karjagin

doi:10.3390/medicina57111218

Kersti Teder, Andres Meos + Show 3 more

Open Access

https://doi.org/10.3390/medicina57111218

Copy DOI

Abstract

Background and Objectives: N-acetylcysteine (NAC) is a mucolytic agent used to prevent ventilator-associated pneumonia in intensive care units. This study aimed to evaluate the oral bioavailability of NAC in critically ill patients with pneumonia, isolated acute brain injury and abdominal sepsis. Materials and Methods: This quantitative and descriptive study compared NAC’s pharmacokinetics after intravenous and enteral administration. 600 mg of NAC was administered in both ways, and the blood levels for NAC were measured. Results: 18 patients with pneumonia, 19 patients with brain injury and 17 patients with abdominal sepsis were included in the population pharmacokinetic modelling. A three-compartmental model without lag-time provided the best fit to the data. Oral bioavailability was estimated as 11.6% (95% confidence interval 6.3–16.9%), similar to bioavailability in healthy volunteers and patients with chronic pulmonary diseases. Conclusions: The bioavailability of enteral NAC of ICU patients with different diseases is similar to the published data on healthy volunteers.

Highlights

N-acetylcysteine (NAC), a precursor of cysteine and glutathione, is a beneficial mucolytic agent [1,2]
This study aimed to evaluate the oral bioavailability of NAC in critically ill patients with pneumonia, isolated acute brain injury and abdominal sepsis
The patients with established pneumonia or with isolated acute brain injury of traumatic and nontraumatic origin or with abdominal sepsis and NAC indicated for mucolytic effect for preventing ventilator-associated pneumonia (VAP) or treating pneumonia were included in the study

Summary

Introduction

N-acetylcysteine (NAC), a precursor of cysteine and glutathione, is a beneficial mucolytic agent [1,2]. The mucolytic effect of intravenous (IV) NAC has been proven to have a more rapid onset of action, but there is no significant difference in long term effects [3]. This might suggest that in acute situations, such as preventing VAP or treating patients with established pneumonia, NAC’s administration should be IV. This study aimed to evaluate the oral bioavailability of NAC in critically ill patients with pneumonia, isolated acute brain injury and abdominal sepsis. Conclusions: The bioavailability of enteral NAC of ICU patients with different diseases is similar to the published data on healthy volunteers

Objectives

Methods

Results

Discussion

Conclusion