Intravenous N-acetylcystine: the treatment of choice for paracetamol poisoning.
Open accessAbstract
One hundred cases of severe paracetamol poisoning were treated with intravenous N-acetylcysteine (acetyl-cysteine). There was virtually complete protection against liver damage in 40 patients treated within eight hours after ingestion (mean maximum serum alanine transaminase activity 27 IU/1). Only one out of 62 patients treated within 10 hours developed severe liver damage compared with 33 out of 57 patients (58%) studied retrospectively who received supportive treatment alone. Early treatment and acetylcysteine also prevented renal impairment and death. The critical ingestion-treatment interval for complete protection against severe liver damage was eight hours. Efficacy diminished progressively thereafter, and treatment after 15 hours was completely ineffective. Intravenous acetylcysteine was more effective than cysteamine and methionine and noticeably free of adverse effects. It is the treatment of choice for paracetamol poisoning.
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NAC efficacy decreases stepwise with further delays, and there is no benefit if NAC is started more than 15 h after overdose.
“Efficacy then decreases in a stepwise fashion with further delays, and there is no benefit if NAC administration is started more than 15 h after the overdose (167).”
From Paracetamol: New Vistas of an Old Drug (2006) · cites this paper as [167]
Before the availability of NAC treatment, morbidity and mortality following paracetamol overdose was considerable; many developed acute liver injury and 3-5% died.
“Before the availability of NAC treatment, morbidity and mortality following paracetamol overdose was considerable; many developed acute liver injury and 3-5% died [99,100].”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [99]
Acetylcysteine is an effective antidote: without it it is estimated that 3-5% of overdoses would be lethal.
“Acetylcysteine is an effective antidote: without it it is estimated that 3-5% of overdoses would be lethal [99,100].”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [99]
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- Authors
- Prescott, L. F., Illingworth, R. N., Critchley, J. A., Stewart, M. J., Adam, R. D., & Proudfoot, A. T.
- Affiliations
- Leeds General Infirmary (GB)
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1979-11-03
- Volume
- 2
- Issue
- 6198
- Pages
- 1097-1100
- ISSN
- 0007-1447 (ISSN-L)
- 1468-5833
- OpenAlex
- W4233165942
- Cited by
- 667
- References
- 2
- Citations by year
- 2026: 13 · 2025: 18 · 2024: 17 · 2023: 18 · 2022: 22 · 2021: 18 · 2020: 19 · 2019: 11 · 2018: 18 · 2017: 18 · 2016: 20 · 2015: 16 · 2014: 14 · 2013: 17 · 2012: 16
- FWCI
- 13.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (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
- acetaminophen toxicity, N-acetylcysteine, intravenous administration, time to treatment, liver injury, alanine aminotransferase, renal dysfunction, cysteamine, methionine, antidote efficacy
- MeSH terms
- Acetaminophen, Acetylcysteine, Adolescent, Adult, Aged, Cysteamine, Female, Humans, Infusions, Parenteral, Kidney Diseases, Liver Diseases, Male, Methionine, Middle Aged, Risk, Time Factors, Chemical and Drug Induced Liver Injury
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