Indications for CETYLEV:
To minimize hepatic injury after acetaminophen overdose in patients with acute ingestion or from repeated supratherapeutic ingestion (RSI).
Adults and Children:
Acute ingestion: assess history and timing of acetaminophen ingestion and obtain serum acetaminophen level at least 4hrs post-ingestion. If time of ingestion is unknown: give loading dose immediately and obtain acetaminophen level to determine need for continued treatment. If serum acetaminophen level unobtainable within 8hr interval or if toxicity evident: give loading dose immediately then continue for a total of 17 doses. If >8hrs post-ingestion and time of ingestion is known, give loading dose immediately and obtain acetaminophen level to determine need for continued treatment. If <8hrs post-ingestion and time of ingestion and the acetaminophen level are known, plot level on Rumack-Matthew nomogram to determine whether or not to initiate treatment (see full labeling). Loading dose: 140mg/kg. Maintenance dose: 70mg/kg every 4hrs for a total of 17 doses. May be administered by nasoduodenal tube or can consider IV form if unable to retain Cetylev. For weight-based dosage and others: see full labeling. RSI: obtain acetaminophen level and other lab tests for guidance; or, contact regional poison center.
Discontinue if hypersensitivity reactions occur unless necessary and reactions can be controlled. Risk of upper GI hemorrhage risk in those with esophageal varices or peptic ulcers. Monitor AST, ALT, bilirubin, INR, creatinine, BUN, blood glucose, electrolytes. CHF, hypertension, renal impairment: consider total sodium intake. Pregnancy. Nursing mothers.
Nausea, vomiting, other GI symptoms, rash with/without fever; upper GI hemorrhage.
Generic Drug Availability:
Tabs—2x10 (blister packs)