{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T04:55:42Z","timestamp":1770785742532,"version":"3.50.0"},"reference-count":22,"publisher":"The Pediatric Pharmacy Association","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6]]},"abstract":"\n OBJECTIVE<\/jats:title>\n This study evaluated the chemical compatibility of N-acetylcysteine (NAC) and ondansetron to simplify the treatment of acute nausea and vomiting during intravenous (IV) NAC administration. NAC is commonly used to treat acetaminophen overdose, but its 21-hour IV infusion is often interrupted for ondansetron administration, which can pose risks.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n \n High-performance liquid chromatography with ultraviolet detection was used to quantify NAC. To simulate IV administration, a closed-circuit pump with multiple independent lines, was plumbed with Y-sites to circulate NAC at concentrations matching 30- and 100-kg loading doses and 4-mg ondansetron was pushed into the flow paths. Control lines without ondansetron were also maintained. Samples were collected at 10, 20, and 30 minutes postondansetron introduction. NAC concentrations in single-drug and combination lines were compared using an unpaired\n t<\/jats:italic>\n -test with Welch\u2019s correction (p = 0.05).\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n The mean concentrations for the 100-kg dose were 55.23 and 55.28 mg\/mL for control and with ondansetron, respectively. The 30-kg cohort included 36.38 mg\/mL for control and 36.49 mg\/mL with ondansetron. The results of the unpaired\n t<\/jats:italic>\n -test for either weight illustrated that no statistical significance was achieved. Furthermore, the\n t<\/jats:italic>\n -values of 0.2013 for 100 kg and 0.8556 for 30 kg support a less likely chance of significant difference.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n \n Based on this experiment, ondansetron can be introduced into an NAC infusion via IV push\n in vitro<\/jats:italic>\n without affecting the NAC concentration in the solution. The likelihood of IV compatibility for NAC and ondansetron could permit no infusion interruptions, reducing unnecessary risk of acetaminophen toxicity.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.5863\/jppt-24-00075","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T13:56:37Z","timestamp":1750946197000},"page":"362-366","source":"Crossref","is-referenced-by-count":0,"title":["Chemical Compatibility of N-Acetylcysteine After the Simultaneous Intravenous Administration of Ondansetron"],"prefix":"10.5863","volume":"30","author":[{"given":"Stacy","family":"Brown","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Sciences (SB, BK), Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Kennard","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Sciences (SB, BK), Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN"},{"name":"Allucent (BK), Cary, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jim","family":"Thigpen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice (JT), Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3883","reference":[{"key":"i2331-348X-30-3-362-b01","series-title":"StatPearls","article-title":"Acetaminophen toxicity","author":"Agrawal","year":"2024","unstructured":"Agrawal S, Khazaeni B. Acetaminophen toxicity. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2024."},{"issue":"5","key":"i2331-348X-30-3-362-b02","series-title":"Clin Toxicol (Phila)","first-page":"424","article-title":"A multicenter comparison of the safety of oral versus intravenous acetylcysteine for treatment of acetaminophen overdose","volume":"48","author":"Bebarta","year":"2010","unstructured":"Bebarta VS, Kao L, Froberg B, et al. A multicenter comparison of the safety of oral versus intravenous acetylcysteine for treatment of acetaminophen overdose. Clin Toxicol (Phila). 2010;48(5):424\u2013430."},{"issue":"4","key":"i2331-348X-30-3-362-b03","series-title":"J Med Toxicol","first-page":"152","article-title":"Antiemetic use in acetaminophen poisoning: how does the route of N-acetylcysteine administration affect utilization?","volume":"3","author":"Miller","year":"2007","unstructured":"Miller MA, Navarro M, Bird SB, Donovan JL. Antiemetic use in acetaminophen poisoning: how does the route of N-acetylcysteine administration affect utilization? J Med Toxicol. 2007;3(4):152\u2013156."},{"issue":"9918","key":"i2331-348X-30-3-362-b04","series-title":"Lancet","first-page":"697","article-title":"Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomised controlled trial","volume":"383","author":"Bateman","year":"2014","unstructured":"Bateman DN, Dear JW, Thanacoody HKR, et al. Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomised controlled trial. Lancet. 2014;383(9918):697\u2013704."},{"issue":"2","key":"i2331-348X-30-3-362-b05","series-title":"Clin Toxicol (Phila)","first-page":"81","article-title":"Adverse reactions associated with acetylcysteine","volume":"47","author":"Sandilands","year":"2009","unstructured":"Sandilands EA, Bateman DN. Adverse reactions associated with acetylcysteine. Clin Toxicol (Phila). 2009;47(2):81\u201388."},{"issue":"2","key":"i2331-348X-30-3-362-b06","series-title":"J Toxicol Clin Toxicol","first-page":"163","article-title":"The use of ondansetron in the treatment of nausea and vomiting associated with acetaminophen poisoning","volume":"34","author":"Clark","year":"1996","unstructured":"Clark RF, Chen R, Williams SR, et al. The use of ondansetron in the treatment of nausea and vomiting associated with acetaminophen poisoning. J Toxicol Clin Toxicol. 1996;34(2):163\u2013167."},{"issue":"6","key":"i2331-348X-30-3-362-b07","series-title":"Pediatric Emergency Care","first-page":"345","article-title":"Ondansetron to prevent emesis following N-acetylcysteine for acetaminophen intoxication","volume":"8","author":"Tobias","year":"1992","unstructured":"Tobias JD, Gregory DF, Deshpande JK. Ondansetron to prevent emesis following N-acetylcysteine for acetaminophen intoxication. Pediatric Emergency Care. 1992;8(6):345."},{"issue":"1","key":"i2331-348X-30-3-362-b08","series-title":"Toxicol Commun","first-page":"49","article-title":"Adverse reactions in patients treated with the one-bag method of N-acetylcysteine for acetaminophen ingestion","volume":"4","author":"Mullins","year":"2020","unstructured":"Mullins ME, Yu M, O\u2019Grady L, et al. Adverse reactions in patients treated with the one-bag method of N-acetylcysteine for acetaminophen ingestion. Toxicol Commun. 2020;4(1):49\u201354."},{"key":"i2331-348X-30-3-362-b09","series-title":"Cell Gene Ther Insights","first-page":"303","article-title":"A simple RP-HPLC method for the stability-indicating determination of N-acetyl-L-cysteine and N,N\u2019-diacetyl-L-cystine in cell culture media","volume":"6","author":"Gowda","year":"2020","unstructured":"Gowda P, Schaefer A, Schuck T. A simple RP-HPLC method for the stability-indicating determination of N-acetyl-L-cysteine and N,N\u2019-diacetyl-L-cystine in cell culture media. Cell Gene Ther Insights. 2020; 6:303\u2013323."},{"issue":"8","key":"i2331-348X-30-3-362-b10","series-title":"JAMA Netw Open","first-page":"e2327739","article-title":"Management of acetaminophen poisoning in the US and Canada: a consensus statement","volume":"6","author":"Dart","year":"2023","unstructured":"Dart RC, Mullins ME, Matoushek T, et al. Management of acetaminophen poisoning in the US and Canada: a consensus statement. JAMA Netw Open. 2023;6(8):e2327739."},{"key":"i2331-348X-30-3-362-b11","article-title":"Acetylcysteine dosage guide + max dose, adjustments","author":"Drugs","unstructured":"Drugs.com. Acetylcysteine dosage guide + max dose, adjustments. Accessed July 3, 2024. https:\/\/www.drugs.com\/dosage\/acetylcysteine.html"},{"key":"i2331-348X-30-3-362-b01","series-title":"StatPearls","article-title":"Acetaminophen toxicity","author":"Agrawal","year":"2024","unstructured":"Agrawal S, Khazaeni B. Acetaminophen toxicity. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2024."},{"issue":"5","key":"i2331-348X-30-3-362-b02","series-title":"Clin Toxicol (Phila)","first-page":"424","article-title":"A multicenter comparison of the safety of oral versus intravenous acetylcysteine for treatment of acetaminophen overdose","volume":"48","author":"Bebarta","year":"2010","unstructured":"Bebarta VS, Kao L, Froberg B, et al. A multicenter comparison of the safety of oral versus intravenous acetylcysteine for treatment of acetaminophen overdose. Clin Toxicol (Phila). 2010;48(5):424\u2013430."},{"issue":"4","key":"i2331-348X-30-3-362-b03","series-title":"J Med Toxicol","first-page":"152","article-title":"Antiemetic use in acetaminophen poisoning: how does the route of N-acetylcysteine administration affect utilization?","volume":"3","author":"Miller","year":"2007","unstructured":"Miller MA, Navarro M, Bird SB, Donovan JL. Antiemetic use in acetaminophen poisoning: how does the route of N-acetylcysteine administration affect utilization? J Med Toxicol. 2007;3(4):152\u2013156."},{"issue":"9918","key":"i2331-348X-30-3-362-b04","series-title":"Lancet","first-page":"697","article-title":"Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomised controlled trial","volume":"383","author":"Bateman","year":"2014","unstructured":"Bateman DN, Dear JW, Thanacoody HKR, et al. Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomised controlled trial. Lancet. 2014;383(9918):697\u2013704."},{"issue":"2","key":"i2331-348X-30-3-362-b05","series-title":"Clin Toxicol (Phila)","first-page":"81","article-title":"Adverse reactions associated with acetylcysteine","volume":"47","author":"Sandilands","year":"2009","unstructured":"Sandilands EA, Bateman DN. Adverse reactions associated with acetylcysteine. Clin Toxicol (Phila). 2009;47(2):81\u201388."},{"issue":"2","key":"i2331-348X-30-3-362-b06","series-title":"J Toxicol Clin Toxicol","first-page":"163","article-title":"The use of ondansetron in the treatment of nausea and vomiting associated with acetaminophen poisoning","volume":"34","author":"Clark","year":"1996","unstructured":"Clark RF, Chen R, Williams SR, et al. The use of ondansetron in the treatment of nausea and vomiting associated with acetaminophen poisoning. J Toxicol Clin Toxicol. 1996;34(2):163\u2013167."},{"issue":"6","key":"i2331-348X-30-3-362-b07","series-title":"Pediatric Emergency Care","first-page":"345","article-title":"Ondansetron to prevent emesis following N-acetylcysteine for acetaminophen intoxication","volume":"8","author":"Tobias","year":"1992","unstructured":"Tobias JD, Gregory DF, Deshpande JK. Ondansetron to prevent emesis following N-acetylcysteine for acetaminophen intoxication. Pediatric Emergency Care. 1992;8(6):345."},{"issue":"1","key":"i2331-348X-30-3-362-b08","series-title":"Toxicol Commun","first-page":"49","article-title":"Adverse reactions in patients treated with the one-bag method of N-acetylcysteine for acetaminophen ingestion","volume":"4","author":"Mullins","year":"2020","unstructured":"Mullins ME, Yu M, O\u2019Grady L, et al. Adverse reactions in patients treated with the one-bag method of N-acetylcysteine for acetaminophen ingestion. Toxicol Commun. 2020;4(1):49\u201354."},{"key":"i2331-348X-30-3-362-b09","series-title":"Cell Gene Ther Insights","first-page":"303","article-title":"A simple RP-HPLC method for the stability-indicating determination of N-acetyl-L-cysteine and N,N\u2019-diacetyl-L-cystine in cell culture media","volume":"6","author":"Gowda","year":"2020","unstructured":"Gowda P, Schaefer A, Schuck T. A simple RP-HPLC method for the stability-indicating determination of N-acetyl-L-cysteine and N,N\u2019-diacetyl-L-cystine in cell culture media. Cell Gene Ther Insights. 2020; 6:303\u2013323."},{"issue":"8","key":"i2331-348X-30-3-362-b10","series-title":"JAMA Netw Open","first-page":"e2327739","article-title":"Management of acetaminophen poisoning in the US and Canada: a consensus statement","volume":"6","author":"Dart","year":"2023","unstructured":"Dart RC, Mullins ME, Matoushek T, et al. Management of acetaminophen poisoning in the US and Canada: a consensus statement. 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