Oral or intravenous N-acetylcysteine: which is the treatment of choice for acetaminophen (paracetamol) poisoning?

@article{Buckley1999OralOI,
  title={Oral or intravenous N-acetylcysteine: which is the treatment of choice for acetaminophen (paracetamol) poisoning?},
  author={N. Buckley and I. Whyte and D. O’Connell and A. Dawson},
  journal={Journal of toxicology. Clinical toxicology},
  year={1999},
  volume={37 6},
  pages={
          759-67
        }
}
BACKGROUND The optimal route and duration of administration for N-acetyl-cysteine in the management of acetaminophen (paracetamol) poisoning are controversial. It has been stated on the basis of a selected post-hoc analysis that oral N-acetylcysteine is superior to intravenous N-acetylcysteine in presentations later than 15 hours. AIM OF STUDY To investigate the efficacy of intravenous or oral N-acetylcysteine. PATIENTS AND METHODS We analyzed a series of acetaminophen poisonings treated… Expand
Is the oral acetylcysteine protocol the best treatment for late-presenting acetaminophen poisoning?
  • G. Bond
  • Medicine
  • Annals of emergency medicine
  • 2009
In this issue of Annals, Yarema et al present a comparison of an experience with an intravenous N-acetylcysteine protocol for acetaminophen poisoning and an oral protocol. Their model suggests thatExpand
Is the oral acetylcysteine protocol the best treatment for late-presenting acetaminophen poisoning?
  • G. Bond
  • Medicine
  • Annals of emergency medicine
  • 2009
In this issue of Annals, Yarema et al present a comparison of an experience with an intravenous N-acetylcysteine protocol for acetaminophen poisoning and an oral protocol. Their model suggests thatExpand
Should N-Acetylcysteine be Administered Orally or Intravenously for the Treatment of Paracetamol Overdose?
Introduction Paracetamol is the most commonly used drug in deliberate poisoning. N-acetylcysteine is the standard antidote for significant acute paracetamol overdose, but the route of administrationExpand
A prospective evaluation of shortened course oral N-acetylcysteine for the treatment of acute acetaminophen poisoning.
STUDY OBJECTIVE Treatment with a shortened duration of oral N-acetylcysteine (20 to 48 hours) after acute acetaminophen poisoning is effective in the prevention of subsequent hepatic failure andExpand
Comparison of oral and i.v. acetylcysteine in the treatment of acetaminophen poisoning.
  • M. Kanter
  • Medicine
  • American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
  • 2006
PURPOSE The efficacy, safety, and cost issues that should be considered when deciding on the appropriate route of acetylcysteine for the treatment of patients with acetaminophen poisoning areExpand
Cost minimization analysis comparing enteral N-acetylcysteine to intravenous acetylcysteine in the management of acute acetaminophen toxicity
Context. Acetaminophen poisoning is one of the most common exposures and causes of poisoning-related fatalities as reported to U.S. poison information centers. Acetylcysteine is indicated for theExpand
A retrospective evaluation of shortened-duration oral N-acetylcysteine for the treatment of acetaminophen poisoning
IntroductionThe use of less than the traditional 72-hour course of oral N-acetylcysteine has been an alternative treatment option following potentially toxic acute and chronic acetaminophenExpand
Oral or intravenous N-acetylcysteine for acetaminophen poisoning?
Acetaminophen (paracetamol, N-acetyl-p-aminophenol) is an effective, mild analgesic, antipyretic agent and is probably the most widely used of all drugs in the world. It does not share the formidableExpand
Oral and Intravenous Acetylcysteine for Treatment of Acetaminophen Toxicity: A Systematic Review and Meta-analysis
Introduction: There are few reports summarizing the effectiveness of oral and intravenous (IV) acetylcysteine. We determined the proportion of acetaminophen poisoned patients who developExpand
Intravenous acetylcysteine versus oral and intravenous acetylcysteine: Does a combination therapy decrease side effects of acetylcysteine?
Objective: Acetylcysteine (NAC) is the antidote for acetaminophen toxicity given by two routes (intravenous or orally). Both routes have adverse side effects. We applied a new protocol using theExpand
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References

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Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985)
TLDR
It is concluded that N-acetylcysteine treatment should be started within eight hours of an acetaminophen overdose, but that treatment is still indicated at least as late as 24 hours after ingestion, and it may be superior when treatment is delayed. Expand
Adverse Reactions to intravenous N-Acetylcysteine in Chinese Patients with Paracetamol (Acetaminophen) Poisoning
TLDR
In the dose that is recommended for the treatment of acute paracetamol poisoning, intravenous NAC is generally safe in Chinese but mild side effects are common and the initial loading dose is given over 60 rather than 15 min. Expand
Adverse reactions to N‐acetylcysteine during treatment for paracetamol poisoning
TLDR
N-acetylcysteine is an effective antidote and its toxicity is acceptable if patients are selected carefully for treatment on the basis of the time that has elapsed since the poisoning, and the blood concentrations of paracetamol. Expand
A prospective evaluation of the effect of activated charcoal before oral N-acetylcysteine in acetaminophen overdose.
TLDR
Administration of AC before the administration of oral N- acetylcysteine in acetaminophen overdose does not reduce the efficacy of N-acetylcy Steine therapy and may provide some additional hepatoprotective benefit. Expand
Acetaminophen overdose: a 48-hour intravenous N-acetylcysteine treatment protocol.
TLDR
This 48-hour IV N-acetylcysteine treatment protocol is safe and effective antidotal therapy for acetaminophen overdose and is equal to 72-hour oral and 20-hour intravenous treatment protocols when started early and superior to the 20- hour IV regimen when treatment is delayed. Expand
Efficacy of oral versus intravenous N-acetylcysteine in acetaminophen overdose: results of an open-label, clinical trial.
TLDR
It is indicated that 52 hours of intravenous NAC is as effective as 72 hours of oral NAC in treating acetaminophen poisoning. Expand
THE USE OF ACTIVATED CHARCOAL IN A SIMULATED POISONING WITH ACETAMINOPHEN: A NEW LOADING DOSE FOR N‐ACETYLCYSTEINE?
TLDR
The results suggest that activated charcoal can be used safely for victims of acetaminophen overdose and suggest that bioavailability can be ensured by increasing the N-acetylcysteine loading dose from 140 mg/kg to 235mg/kg. Expand
Intravenous N-acetylcysteine: still the treatment of choice for paracetamol poisoning.
TLDR
Intravenous acetylcysteine was more effective than cysteamine and methionine and noticeably free of adverse effects and is the treatment of choice for paracetamol poisoning. Expand
The effect of activated charcoal on N-acetylcysteine absorption in normal subjects.
TLDR
Although it may be preferable to avoid completely the use of activated charcoal when using NAC to treat overdoses of acetaminophen, it is recommended that if these agents are used together, doses of NAC be increased by 40% to compensate for the decreased oral absorption of Nac. Expand
TREATMENT OF PARACETAMOL (ACETAMINOPHEN) POISONING WITH N-ACETYLCYSTEINE
TLDR
Fifteen patients with paracetamol (acetaminophen) poisoning were treated with intravenous N-acetylcystein (300 mg/kg given over 20 h), which was very well tolerated and has the advantage of being available as a pharmaceutical preparation in a 20% sterile solution. Expand
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