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Acetylcysteine

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John G. Webb – One of the best experts on this subject based on the ideXlab platform.

  • n Acetylcysteine for prevention of radiographic contrast material induced nephropathy is the intravenous route best
    Pharmacotherapy, 2005
    Co-Authors: Stephen Shalansky, Gordon E. Pate, Adeera Levin, Karin H. Humphries, John G. Webb
    Abstract:

    Use of oral N-Acetylcysteine for preventing radiographic contrast material-induced nephropathy (RCIN) has become widespread, despite conflicting results from clinical trials and meta-analyses. The variability in study results may reflect differences in baseline risks in study patients, hydration regimens, choice of contrast agent, definition of RCIN, and the oral dosage formulation of N-Acetylcysteine used. Injectable N-Acetylcysteine recently has become available in the United States. Although oral N-Acetylcysteine regimens are typically administered during a 48-hour period, more rapid intravenous administration could offer an important advantage for urgent procedures such as coronary angiography. However, the three published studies in which intravenous N-Acetylcysteine protocols were used have produced divergent results, likely because of substantially different dosage regimens. With few intravenous studies available, clinicians may look to more broadly studied oral regimens to estimate equivalent intravenous dosages. In the oral studies, however, a wide range of formulations were used, and the bioavailability of each product was uncertain. In addition, the intravenous route circumvents first-pass metabolism, resulting in less glutathione production, perhaps compromising the antioxidant effects of N-Acetylcysteine administration. Overall, little evidence exists that any studied N-Acetylcysteine protocol improves clinical outcomes in terms of reducing length of hospital stay, need for dialysis, or mortality. Furthermore, N-Acetylcysteine may directly affect serum creatinine level, which all clinical trials to date have used as a primary outcome measure. If oral or intravenous N-Acetylcysteine is used with the intention of preventing RCIN, more established preventive measures should not be overlooked, including adequate hydration with isotonic saline, avoidance of potentially nephrotoxic drugs, and use of iso-osmolar radiographic contrast media.

  • N-Acetylcysteine for Prevention of Radiographic Contrast Material–Induced Nephropathy: Is the Intravenous Route Best?
    Pharmacotherapy, 2005
    Co-Authors: Stephen Shalansky, Gordon E. Pate, Adeera Levin, Karin H. Humphries, John G. Webb
    Abstract:

    Use of oral N-Acetylcysteine for preventing radiographic contrast material-induced nephropathy (RCIN) has become widespread, despite conflicting results from clinical trials and meta-analyses. The variability in study results may reflect differences in baseline risks in study patients, hydration regimens, choice of contrast agent, definition of RCIN, and the oral dosage formulation of N-Acetylcysteine used. Injectable N-Acetylcysteine recently has become available in the United States. Although oral N-Acetylcysteine regimens are typically administered during a 48-hour period, more rapid intravenous administration could offer an important advantage for urgent procedures such as coronary angiography. However, the three published studies in which intravenous N-Acetylcysteine protocols were used have produced divergent results, likely because of substantially different dosage regimens. With few intravenous studies available, clinicians may look to more broadly studied oral regimens to estimate equivalent intravenous dosages. In the oral studies, however, a wide range of formulations were used, and the bioavailability of each product was uncertain. In addition, the intravenous route circumvents first-pass metabolism, resulting in less glutathione production, perhaps compromising the antioxidant effects of N-Acetylcysteine administration. Overall, little evidence exists that any studied N-Acetylcysteine protocol improves clinical outcomes in terms of reducing length of hospital stay, need for dialysis, or mortality. Furthermore, N-Acetylcysteine may directly affect serum creatinine level, which all clinical trials to date have used as a primary outcome measure. If oral or intravenous N-Acetylcysteine is used with the intention of preventing RCIN, more established preventive measures should not be overlooked, including adequate hydration with isotonic saline, avoidance of potentially nephrotoxic drugs, and use of iso-osmolar radiographic contrast media.

Stefano Sdringola – One of the best experts on this subject based on the ideXlab platform.

  • oral Acetylcysteine does not protect renal function from moderate to high doses of intravenous radiographic contrast
    Catheterization and Cardiovascular Interventions, 2003
    Co-Authors: Fernando Boccalandro, Stefano Sdringola, Muhammad Amhad, Richard W Smalling
    Abstract:

    The use of radiographic contrast during cardiac catheterization can cause acute renal failure with an increase in morbidity and mortality. Prophylactic Acetylcysteine plus intravenous hydration have been shown to prevent contrast-induced nephropathy (CIN) in patients with chronic renal failure undergoing computed tomography scan, who receive low doses of intravenous contrast. Whether the use of prophylactic Acetylcysteine can decrease the incidence of CIN when larger doses of contrast are used remains to be determined. We sought to evaluate whether the prophylactic administration of Acetylcysteine plus intravenous hydration is superior to intravenous hydration alone in prevention of CIN in patients with chronic renal failure undergoing cardiac catheterization and receiving moderate to high doses of intravenous contrast (> 1 cc/kg). Seventy-three consecutive patients with renal insufficiency who received intravenous hydration and 600 mg of Acetylcysteine twice a day 24 hr before and the day of the cardiac catheterization were compared with 106 consecutive patients who received hydration alone. Baseline and 48-hr serum creatinine concentrations were compared between the two groups before and after cardiac catheterization. Multivariate and univariate analysis were performed to assess the effects of Acetylcysteine and other clinical variables in the change of serum creatinine after the procedure. Both groups had comparable clinical characteristics and received similar volumes of intravenous hydration. The volume of contrast used was similar for the two groups (2.2 +/- 1.7 vs. 2.3 +/- 1.5 cc/kg; P = 0.67). A mean change in serum creatinine of 0.17 +/- 0.54 mg/dl for the Acetylcysteine group vs. 0.19 +/- 0.40 mg/dl for the control group (P = 0.77) was observed at 48 hr. The incidence CIN was 13% in the Acetylcysteine vs. 12% in the control group (P = 0.84). Acetylcysteine, whether analyzed with multivariate or univariate analysis, failed to demonstrate a significant effect in the change of serum creatinine after cardiac catheterization. In patients with chronic renal insufficiency, Acetylcysteine in a dose of 600 mg twice a day before and after cardiac catheterization, along with intravenous fluids, is as effective as fluids alone in the prevention of CIN when moderate to high doses of contrast are used.

Stephen Shalansky – One of the best experts on this subject based on the ideXlab platform.

  • n Acetylcysteine for prevention of radiographic contrast material induced nephropathy is the intravenous route best
    Pharmacotherapy, 2005
    Co-Authors: Stephen Shalansky, Gordon E. Pate, Adeera Levin, Karin H. Humphries, John G. Webb
    Abstract:

    Use of oral N-Acetylcysteine for preventing radiographic contrast material-induced nephropathy (RCIN) has become widespread, despite conflicting results from clinical trials and meta-analyses. The variability in study results may reflect differences in baseline risks in study patients, hydration regimens, choice of contrast agent, definition of RCIN, and the oral dosage formulation of N-Acetylcysteine used. Injectable N-Acetylcysteine recently has become available in the United States. Although oral N-Acetylcysteine regimens are typically administered during a 48-hour period, more rapid intravenous administration could offer an important advantage for urgent procedures such as coronary angiography. However, the three published studies in which intravenous N-Acetylcysteine protocols were used have produced divergent results, likely because of substantially different dosage regimens. With few intravenous studies available, clinicians may look to more broadly studied oral regimens to estimate equivalent intravenous dosages. In the oral studies, however, a wide range of formulations were used, and the bioavailability of each product was uncertain. In addition, the intravenous route circumvents first-pass metabolism, resulting in less glutathione production, perhaps compromising the antioxidant effects of N-Acetylcysteine administration. Overall, little evidence exists that any studied N-Acetylcysteine protocol improves clinical outcomes in terms of reducing length of hospital stay, need for dialysis, or mortality. Furthermore, N-Acetylcysteine may directly affect serum creatinine level, which all clinical trials to date have used as a primary outcome measure. If oral or intravenous N-Acetylcysteine is used with the intention of preventing RCIN, more established preventive measures should not be overlooked, including adequate hydration with isotonic saline, avoidance of potentially nephrotoxic drugs, and use of iso-osmolar radiographic contrast media.

  • N-Acetylcysteine for Prevention of Radiographic Contrast Material–Induced Nephropathy: Is the Intravenous Route Best?
    Pharmacotherapy, 2005
    Co-Authors: Stephen Shalansky, Gordon E. Pate, Adeera Levin, Karin H. Humphries, John G. Webb
    Abstract:

    Use of oral N-Acetylcysteine for preventing radiographic contrast material-induced nephropathy (RCIN) has become widespread, despite conflicting results from clinical trials and meta-analyses. The variability in study results may reflect differences in baseline risks in study patients, hydration regimens, choice of contrast agent, definition of RCIN, and the oral dosage formulation of N-Acetylcysteine used. Injectable N-Acetylcysteine recently has become available in the United States. Although oral N-Acetylcysteine regimens are typically administered during a 48-hour period, more rapid intravenous administration could offer an important advantage for urgent procedures such as coronary angiography. However, the three published studies in which intravenous N-Acetylcysteine protocols were used have produced divergent results, likely because of substantially different dosage regimens. With few intravenous studies available, clinicians may look to more broadly studied oral regimens to estimate equivalent intravenous dosages. In the oral studies, however, a wide range of formulations were used, and the bioavailability of each product was uncertain. In addition, the intravenous route circumvents first-pass metabolism, resulting in less glutathione production, perhaps compromising the antioxidant effects of N-Acetylcysteine administration. Overall, little evidence exists that any studied N-Acetylcysteine protocol improves clinical outcomes in terms of reducing length of hospital stay, need for dialysis, or mortality. Furthermore, N-Acetylcysteine may directly affect serum creatinine level, which all clinical trials to date have used as a primary outcome measure. If oral or intravenous N-Acetylcysteine is used with the intention of preventing RCIN, more established preventive measures should not be overlooked, including adequate hydration with isotonic saline, avoidance of potentially nephrotoxic drugs, and use of iso-osmolar radiographic contrast media.