Friday, June 30, 2006

Friday June 30, 2006
Double the dose of mucomyst ?

A noteworthy study came out yesterday in The New England Journal of Medicine1 regarding protective effect of N-Acetylcysteine in Contrast-Induced Nephropathy in primary angioplasty. When the cumulative dose of N-Acetylcysteine was doubled from 3000 mg (a 600mg IV bolus before angioplasty followed by 600 mg orally twice daily for the 48 hours after angioplasty) to 6000 mg (a 1200 mg IV bolus followed by 1200 mg orally twice daily for the 48 hours after intervention), it showed

  • significant decrease in increase of serum creatinine concentration (15 percent vs 8 percent)
  • overall decrease in in-hospital mortality in patients with contrast induced nephropathy (4 percent vs 3 percent).
  • When the combined end point of death, acute renal failure requiring temporary renal replacement therapy, or the need for ventilator during the acute phase of myocardial infarction was considered, the rate was 7% in the standard dose group, and 5% in the high dose group.

In study there were 3 groups - placebo, standard dose and double dose.

It appears that, the benefit of high-dose N-acetylcysteine is greater in patients receiving a larger or more than regular volume of contrast.

Conclusion: N-acetylcysteine reduced the severity of contrast medium induced nephropathy in patients with acute myocardial infarction treated with primary angioplasty. The effect appears to be dose dependent and is accompanied by a significantly improved in-hospital outcome.

Related previous pearls:
Contrast induced Nephropathy and
Preventing contrast-Induced Nephropathy

Reference: Click to get article/abstract
N-Acetylcysteine and Contrast-Induced Nephropathy in Primary Angioplasty - Volume 354:2773-2782, Number 26, June 29 2006
Contrast Nephropathy Prevention With N-Acetylcysteine in Acute Myocardial Infarction -