| Name | Acetylcysteine (N-acetylcysteine, NAC)—a mucolytic and antioxidant available in oral, IV, and nebulized formulations. |
| Uses | Elective use in wellness/medspa settings as antioxidant support, detoxification aid (e.g., liver support), and respiratory health (mucolytic). Not intended for acute acetaminophen overdose or hospitalized care in this setting. |
| Route Of Administration | Oral capsules, oral effervescent tablets, IV infusion (under medical supervision), or nebulized inhalation. |
| Frequency Of Use | Oral: once daily or every other day. IV: no more than once weekly. Nebulized: as needed up to 3x/week. |
| Concentration(s) | Oral: 600 mg or 1200 mg per capsule/tablet. IV: 200 mg/mL. Nebulized: 10% or 20% solutions. |
| Maximum Dosage (Day, Wk) | Oral max: 1800 mg/day. IV max: 6000 mg/week in wellness setting. Nebulized max: 3 mL per session, 3x/week. |
| Contraindications | Absolute: Active GI ulcer, sulfite allergy (IV form), severe asthma (for inhaled use), acute respiratory distress. Relative: active infections, pregnancy, lactation. |
| Possible Side Effects | Oral: nausea, diarrhea, flatulence. IV: flushing, hypotension, rash. Inhaled: throat irritation, cough, bronchospasm. Rare: anaphylactoid reactions (IV). |
| Compatibility With Other Treatments/Drugs | Compatible with most oral supplements and medications. IV: monitor with other parenteral therapies. Avoid with activated charcoal if given orally. |
| Allergies | Sulfite allergy (IV), NAC sensitivity, or preservatives in compounding base. Use caution with asthma for inhaled forms. |
| Administration Time | Oral: take with food or after meals. IV: infuse over 30–60 minutes. Nebulized: 15–20 minutes via mask or nebulizer. |
| Dosing/Settings | Oral: 600–1200 mg/day. IV: typical 1200–1500 mg diluted in 100–250 mL NS over 30–60 minutes. Nebulized: 3 mL of 10–20% solution per session. |
| Test Spot Requirement | Not required. For inhaled forms, perform test dose in sensitive patients or history of asthma. Observe 15–30 minutes post-administration. |
| Pre-Treatment Guidelines | Avoid alcohol, NSAIDs, and high-dose acetaminophen. Hydrate prior to infusion. For respiratory use, rinse mouth after nebulized delivery. |
| Provider Clearance Guidelines | Must be over age 18, no contraindications on GFE. Obtain verbal or written consent. Consider deferral in uncontrolled asthma or sulfite sensitivity. |
| Pre-Treatment Screening Workflow | 1. Confirm age, symptoms (e.g., detox, lung support), no history of GI ulcers or sulfite allergy. 2. Labs optional: LFTs, CBC, CMP. 3. Review prior supplement use. |
| What To Do If Adverse Reaction Occurs | 1) Stop treatment immediately. 2) IV: manage anaphylactoid response with antihistamines, fluids, and epinephrine if indicated. 3) Inhaled: administer albuterol if bronchospasm. 4) Report and document. |
| Clinic Implementation Guidelines | Front desk: confirm consent and indication. Supplies: NAC capsules/tablets, IV supplies (if applicable), nebulizer unit, crash cart for IV. Provider: review GFE, confirm route and dose. |
| Photographic Documentation Protocol | Not required unless used for aesthetic benefit (e.g., IV skin protocol). If so, optional pre/post photos with consent. |
| Post-Treatment Care | Hydrate, avoid alcohol and high-toxicity medications. For IV: monitor for flushing. For nebulized: rinse mouth post-use. Follow up in 1 week for repeat. |
| Additional Documentation Requirements | Consent form for NAC use, treatment log, EMR entry with route/dose/response. Document any adverse events, patient education given. |