1 St John's University, College of Pharmacy
2 Long Island Regional Poison, Control Center and Department of Pharmacy, St John's University
3 Long Island Regional Poison Control Center, Department of Pediatrics, State University of New York at Stony Brook
To the Editor.
We received several calls from physicians planning to treat acetaminophen overdoses in adolescents with five doses of N-acetylcysteine (Mucomyst), orally. These physicians indicated that they obtained these guidelines from the Harriet Lane Handbook.1
The Harriet Lane Handbook1(p248) states the following "PO or NG: Mucomyst diluted 1:4 in a carbonated beverage as a loading dose of 140 mg/kg, then 70 mg/kg Q 4h for 5 doses (some recommend 18 doses)." The references cited in the handbook2,3 do not recommend five oral doses of N-acetylcysteine as stated and we could not find this recommendation in any other references.