Risk factors in the development of adverse reactions to N‐acetylcysteine in patients with paracetamol poisoning
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Aims To identify risk factors in the development of side‐effects to N‐acetylcysteine (NAC) in patients with paracetamol poisoning. Methods A retrospective study was carried out based upon the hospital charts of 529 consecutive patients admitted with paracetamol poisoning, all treated with NAC, at the Department of Hepatology, Copenhagen University Hospital (the tertiary care centre of liver disease in Denmark). Results Forty‐five patients (8.5%; 95% confidence intervals (CI) 6.4, 11%) developed side‐effects to NAC and 18 patients (3.4%; 95% CI 2.1, 5.4%) developed systemic side‐effects. Asthmatics were 2.9 times (95% CI 2.1, 4.7) more likely to develop side‐effects (Chi‐square: P = 0.004). Side‐effects were of similar severity in asthmatics and nonasthmatics. A history of medical allergy was not a risk factor. Serum paracetamol was lower in patients with side‐effects than in those without (Mann–Whitney: P = 0.00006). Conclusions Asthma must be considered a risk factor in the development of side‐effects to NAC. However, the side‐effects are easily managed and there is no reason to withhold NAC from any patient with paracetamol poisoning. Paracetamol itself seems to offer some protection against the development of side‐effects to NAC.
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Patients with lower paracetamol levels have a greater rate of experiencing adverse effects when treated with NAC.
“Further, various studies have shown that patients with lower paracetamol levels have a greater rate of experiencing adverse effects when treated with NAC [77,80].”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [80]
Denmark forgoes use of the Rumack-Matthew nomogram and treats all patients with a full course of NAC regardless of paracetamol concentrations.
“Denmark even forgoes the use of this nomogram and treats all patients with a full course of NAC regardless of paracetamol concentrations [80].”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [80]
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- Authors
- Schmidt, L. E., & Dalhoff, K.
- Affiliations
- Rigshospitalet (DK)
- Corresponding author
- Schmidt, L. E.
- ORCID
- Dalhoff, K
- Venue
- British Journal of Clinical Pharmacology
- Publisher
- Wiley
- Published
- 2001-01
- Volume
- 51
- Issue
- 1
- Pages
- 87-91
- ISSN
- 0306-5251 (ISSN-L)
- 1365-2125
- PMC
- PMC2014432
- OpenAlex
- W1597851562
- Cited by
- 127
- References
- 24
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 3 · 2022: 3 · 2021: 6 · 2020: 1 · 2019: 5 · 2018: 6 · 2017: 3 · 2016: 5 · 2015: 12 · 2014: 6 · 2013: 9 · 2012: 7
- FWCI
- 4.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Clinical Pharmacology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
- Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
- Health Sciences › Medicine › Surgery › Paraquat toxicity studies and treatments
- Keywords
- N-acetylcysteine, acetaminophen toxicity, adverse drug reactions, asthma, risk factors, systemic side effects, drug hypersensitivity, hepatoprotection
- MeSH terms
- Acetaminophen, Acetylcysteine, Adolescent, Adult, Aged, Aged, 80 and over, Child, Denmark, Female, Humans, Infusions, Intravenous, Male, Middle Aged, Poisoning, Prognosis, Risk Factors, Analgesics, Non-Narcotic, Drug Overdose
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