Cetylev is the new effervescent oral medication recently approved by the FDA for the treatment of acute liver toxicity, following over dosage of the popular drug Acetaminophen (better known as Tylenol).

The drug contained in Cetylev; acetylcysteine, is not new by any means. In fact, it was approved since the 1960’s for use, albeit as injectable intravenous solution. It is also available as an inhalable solution which has to be prepared by the pharmacist prior to use.

The Future- Convenience

In cases of acute poisoning or over dosage of Acetaminophen, the first line or therapy could be at home, as is likely to become the case thanks to the convenience of Cetylev effervescent tablets. The principle behind effervescence is simple; the tablets need to be dissolved in a quantity of water, which liberates the drug into free form, which is flavoured in a lemon-mint vehicle.

The tablets are available in 500mg and 2.5g (2500mg) sizes, and must be dosed according to weight. An initial loading dose of 140mg/kg of bodyweight is advised, followed by 70mg/kg every subsequent 4 hours for a total of 17 oral doses.

At this time, however, the medication will only be available for in-hospital management of over dosage.

Pharmacodynamics (Drug Chemistry)

Following oral ingestion of Cetylev, the drug elicits maximal effect in two hours, with a half-life of 18 hours. Cetylev is extensively metabolized by the liver, where it forms cysteine and sulfide metabolites. Following its metabolism, it is excreted in urine.

In patients suffering from renal impairment, dialysis may be needed to promote clearance from blood.

Possible Adverse Effects

Vomiting frequently occurs in cases of Acetaminophen over dosage, which may be worsened by Cetylev. Gastric bleeding may also follow in predisposed individuals (history of gastric ulcers, gastric valve disorders), so the need for risk-benefit analysis is important.

Allergic Reactions have also been reported in patients receiving oral Acetylcysteine medications, in which event the use should be discontinued unless deemed absolutely necessary.



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