NAC in COVID-19 Protocol

Concept: Administer NAC for symptomatic patients with respiratory sxs/findings (especially O2 requirement) to prevent progression to cytokine storm and development of ARDS

Goal is to enhance the body's immune response without letting it be overwhelmed by the same immune response.

NAC in COVID-19 Protocol

  • Pt's clinical picture should be at a phase where the body is already mounting an immune response; not given when asymptomatic (not given prophylactically).

  • Administer if any of the following are present:

    • SpO2 <=95%ra

    • Ambulatory desat <=90%

    • Tachypnea RR>=24

    • Fever >= 100.1 °F

    • Radiographic evidence of PNA

    • Pt has taken acetaminophen (TYLENOL™) in past 24 hrs or will be given acetaminophen


NAC DOSING

Outpatient dosing (discharge from ED or Respiratory Clinic):

  • Order 2400 mg PO ‘standard dose’ using NAC 600 mg capsules x 4

  • Discharge with Rx for 1200 mg PO BID x 2 weeks

From Respiratory Clinic: send patient home with pre-prepared NAC pack with #56 tablets

From ED: e-prescribe to Capsule Pharmacy (Boston). Capsule will contact the patient and deliver to them 7 days/week.


For patients with moderate symptoms requiring admission to the hospital (any level of care) and who are able to tolerate POs:

  • Order 150 mg/kg/day divided q4hrs = 25 mg/kg PO rounded up to nearest 600 mg q4hrs

  • Inpatient units to continue with

      • 25 mg/kg [rounded UP to nearest 600 mg] PO q4hrs until discharge

      • discharge on 1200 mg PO BID x 2 weeks

      • On hospital discharge please e-prescribe to Capsule Pharmacy (Boston). Capsule will contact the patient and deliver to them 7 days/week.