Drug Topics - August 25, 2008 - (Page 3) 3 Of Interest to Pharmacists Kevin Weissman, PharmD, Eric Im, PharmD candidate Are N-acetylcysteine (NAC) capsules available? A patient who is soon to undergo coronary angiography walks into a local community pharmacy and hands the pharmacist a prescription written for N-acetylcysteine (NAC) capsules to be taken at a dose of 600 mg q12h the day before the procedure and 600 mg q12h following the procedure. With no capsule or tablet form of NAC in his or her possession, the pharmacist quickly peruses the wholesaler database and again comes up empty-handed. Fairly confident that NAC does not exist in those forms, the pharmacist decides to contact the doctor who wrote the prescription. The doctor insists that the unpalatable NAC be provided in capsule form and not in the faux-injectable vials, which are hard to open and not user-friendly. It’s a dilemma for the pharmacist. What should he do? When it comes to dealing with different dosage forms of NAC, many community pharmacists are inexperienced. Until recently the only indications for N-acetylcysteine have been acetaminophen overdose and mucolysis. Acetaminophen overdose is always treated in the inpatient setting and does not involve dispensing N-acetylcysteine directly to the patient for home use. Mucolytic treatment is commonly given by nebulizer, making the solution form the obvious choice. However, a recent indication that is becoming increasingly popular (especially in community pharmacies) has been nephropathy prophylaxis, which requires that oral doses be given 24 hours before a procedure and lasts for 24 hours after the procedure. The use of N-acetylcysteine for this indication by a growing number of prescribers has exposed a misconception common among healthcare providers about the availability of NAC capsules. Are these NAC capsules commercially available? A prescription database for NAC will show that it is available only as a 10 percent (100 mg/ml) and 20 percent (200 mg/ml) solution that can be given by nebulizer, nasogastric tube, intratracheally, or orally. There is no mention of a capsule form. Yet Many community pharmacists are inexperienced when dealing with different dosage forms of NAC. sitting right out in the open (over the counter) of your local pharmacy or health food store are NAC capsules in various dosages, ranging from 500 mg to 1,000 mg. To add to the confusion, look farther down the aisle and you’ll see a powder containing 500-gram NAC. So the answer is, yes, NAC capsules do exist. Problem solved, right? Not so fast. It sounds like a quick and easy alternative. Just point the patient toward the over-the-counter NAC, and the pharmacist can avoid all the effort that must go into filling the prescription. There would be no need to calculate the dose from either a 10 percent (100 mg/ml) or 20 percent (200 mg/ml) solution, and no need to counsel the patient on how to open the N-acetylcysteine vial, how much to draw into the oral syringe, and of course how to make the final softdrink dilution. These steps are not only time-consuming, they are laborious and confusing and can lead to a variety of errors. Another benefit to using the capsules, from the patient's perspective, would be the opportunity to avoid time spent waiting for the prescription to be filled. All this is tempting, but here is something to know before you head down that road. The Food and Drug Administration (FDA) categorizes NAC capsules as a food/herbal/dietary supplement (alternative medicine) — not as a drug. Substantial confusion usually arises when a prescription drug product is also available as an herbal product without a prescription. Knowledge of NAC’s dual categorization is lacking in the healthcare community, leading prescribers to write numerous prescriptions for capsules under the assumption that this product is an FDA-approved drug. If prescribers were educated about the differences between NAC capsules and the prescription solution, they might be more hesitant to recommend that a patient take herbal capsules for renal prophylaxis. This might in turn decrease the likelihood of a severe adverse outcome. While the debate goes on about the safety and efficacy of herbal medicine versus conventional
Table of Contents Feed for the Digital Edition of Drug Topics - August 25, 2008 Drug Topics - August 25, 2008 Are N-acetylcysteine (NAC) Capsules Available? Largest Generics Firm Teva Gets Even Larger Latest News Roundup Drug Topics - August 25, 2008 Drug Topics - August 25, 2008 - Drug Topics - August 25, 2008 (Page 1) Drug Topics - August 25, 2008 - Drug Topics - August 25, 2008 (Page 2) Drug Topics - August 25, 2008 - Are N-acetylcysteine (NAC) Capsules Available? (Page 3) Drug Topics - August 25, 2008 - Are N-acetylcysteine (NAC) Capsules Available? (Page 4) Drug Topics - August 25, 2008 - Largest Generics Firm Teva Gets Even Larger (Page 5) Drug Topics - August 25, 2008 - Latest News Roundup (Page 6)
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.