Annals of Emergency Medicine
Volume 45, Issue 4 , Pages 409-413 , April 2005

Oral or Intravenous N-Acetylcysteine for Acetaminophen Poisoning?

  • Laurie Prescott, MD, FRCP

      Affiliations

    • Corresponding Author InformationAddress for correspondence: Laurie Prescott, MD, FRCP, 24 Colinton Road, Edinburgh EH10 5EQ, United Kingdom

References 

  1. Prescott LF. Paracetamol overdosage: pharmacological considerations and clinical management. Drugs. 1983;25:290–314
  2. Prescott LF, Wright N, Roscoe P, et al. Plasma-paracetamol half-life and hepatic necrosis in patients with paracetamol overdosage. Lancet. 1971;i:519–522
  3. Prescott LF, Park J, Ballantyne A, et al. Treatment of paracetamol (acetaminophen) poisoning with N-acetylcysteine. Lancet. 1977;ii:432–434
  4. Prescott LF, Illingworth RN, Critchley JA, et al. Intravenous N-acetylcysteine: the treatment of choice for paracetamol poisoning. Br Med J. 1979;2:1097–1100
  5. Rumack BH, Peterson RG. Acetaminophen overdose: incidence, diagnosis and management in 416 patients. Pediatrics. 1978;62(Suppl):898–903
  6. Rumack BH, Peterson RG, Koch GC, et al. Acetaminophen overdose. 662 cases with evaluation of oral acetylcysteine treatment. Arch Intern Med. 1981;141:380–385
  7. Smilkstein MJ, Knapp GL, Kulig KW, et al. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose: analysis of the national multicenter study (1976-1985). N Engl J Med. 1988;319:1557–1562
  8. Jones AL. Mechanism of action and value of N-acetylcysteine in the treatment of early and late acetaminophen poisoning: a critical review. J Toxicol Clin Toxicol. 1998;36:277–285
  9. James LP, Mayeux PR, Hinson JA. Acetaminophen-induced hepatotoxicity. Drug Metab Dispos. 2003;31:1499–1506
  10. Smilkstein MJ, Bronstein AC, Linden C, et al. Acetaminophen overdose: a 48-hour intravenous N-acetylcysteine treatment protocol. Ann Emerg Med. 1991;20:1058–1063
  11. Perry HE, Shannon MW. Efficacy of oral versus intravenous N-acetylcysteine in acetaminophen overdose: results of an open-label, clinical trial. J Pediatr. 1998;132:149–152
  12. Donovan JW, Mancuso E, Burkhart KK. Intravenous N-acetylcysteine for acetaminophen overdose: an abbreviated protocol. [abstract] J Toxicol Clin Toxicol. 1999;37:642
  13. Woo OF, Mueller PD, Olson KR, et al. Shorter duration of oral N-acetylcysteine therapy for acute acetaminophen overdose. Ann Emerg Med. 2000;35:363–368
  14. Buckley NA, Whyte IM, O'Connell DL, et al. Oral or intravenous N-acetylcysteine: which is the treatment of choice for acetaminophen (paracetamol) poisoning. J Toxicol Clin Toxicol. 1999;37:759–767
  15. Rumack BH. Acetaminophen overdose. Am J Med. 1983;75(Suppl 5A):104–112
  16. Yip L, Dart RC, Hurlbut KM. Intravenous administration of oral N-acetylcysteine. Crit Care Med. 1998;26:40–43
  17. Wu M-L, Tsai W-J, Deng J-F, et al. Hemodialysis as adjunctive therapy for severe acetaminophen poisoning: a case report. Chin Med J (Taipei). 1999;62:907–913
  18. Tenenbein PK, Sitar DS, Tenenbein M. Interaction between N-acetylcysteine and activated charcoal: implications for the treatment of acetaminophen poisoning. Pharmacotherapy. 2001;21:1331–1336
  19. Wright RO, Anderson AC, Lesko SL, et al. Effect of metoclopramide dose on preventing emesis after oral administration of N-acetylcysteine for acetaminophen overdose. J Toxicol Clin Toxicol. 1999;37:35–42
  20. Tobias JD, Gregory DF, Deshpande JK. Ondansetron to prevent emesis following N-acetylcysteine for acetaminophen intoxication. Pediatr Emerg Care. 1992;8:345–346
  21. Lu HC, Shih RD, Marcus S, et al. Pseudomethemoglobinemia: a case report and review of sulfhemoglobinemia. Arch Pediatr Adolesc Med. 1998;152:803–805
  22. Appelboam AV, Dargan PI, Knighton J. Fatal anaphylactoid reaction to N-acetylcysteine: caution in patients with asthma. Emerg Med J. 2002;19:594–595
  23. Schmidt LE, Dalhoff K. Risk factors in the development of adverse reactions to N-acetylcysteine in patients with paracetamol poisoning. Br J Clin Pharmacol. 2001;51:87–91
  24. Ho SW-C, Beilin LJ. Asthma associated with N-acetylcysteine infusion and paracetamol poisoning; report of two cases. Br Med J. 1983;287:876–877
  25. Reynard K, Riley A, Walker BE. Respiratory arrest after N-acetylcysteine for paracetamol overdose. [letter] Lancet. 1992;340:675
  26. Mant TGK, Tempowski JH, Volans GN, et al. Adverse reactions to acetylcysteine and effects of overdose. Br Med J. 1984;289:217–219
  27. Bateman DN, Woodhouse KW, Rawlins MD. Adverse reactions to N-acetylcysteine. Hum Toxicol. 1984;3:393–398
  28. Schmidt LE, Dalhoff KP. Bivirkninger ved N-acetylcystein-behandling af paracetamolforgiftede patienter. Ugeskr Laeger. 1999;161:2669–2672
  29. Bailey B, McGuigan MA. Management of anaphylactoid reactions to intravenous N-acetylcysteine. Ann Emerg Med. 1998;31:710–715
  30. Chan TYK, Critchley JAJH. Adverse reactions to intravenous N-acetylcysteine in Chinese patients with paracetamol (acetaminophen) poisoning. Hum Exp Toxicol. 1994;13:542–544
  31. Dawson AH, Henry DA, McEwan J. Adverse reactions to N-acetylcysteine during treatment for paracetamol poisoning. Med J Aust. 1989;150:329–331
  32. Parker D, White JP, Paton D, et al. Safety of late acetylcysteine treatment in paracetamol poisoning. Hum Exp Toxicol. 1990;9:25–27
  33. Lifshitz M, Kommehl P, Reuveni H. The incidence and nature of adverse reactions during intravenous acetylcysteine therapy for acetaminophen overdose. J Pharm Technol. 2000;16:47–49
  34. Kao LW, Kirk MA, Furbee RB, et al. What is the rate of adverse events after oral N-acetylcysteine administered by the intravenous route to patients with suspected acetaminophen poisoning?. Ann Emerg Med. 2003;42:741–750
  35. Lynch RM, Robertson R. Anaphylactoid reactions to intravenous N-acetylcysteine: a prospective case controlled study. Accid Emerg Nurs. 2004;12:10–15
  36. Rosencrance JG, Scharman EJ. Anaphylactoid reaction to oral N-acetylcysteine: a case report. [abstract] Vet Hum Toxicol. 1993;35:337
  37. Mroz LS, Benitez JG, Krenzelok EP. Angioedema with oral N-acetylcysteine. Ann Emerg Med. 1997;30:240–241
  38. Prescott LF, Donovan JW, Jarvie DR, et al. The disposition and kinetics of intravenous N-acetylcysteine in patients with paracetamol overdosage. Eur J Clin Pharmacol. 1989;37:501–506
  39. Kerr F, Dawson A, Whyte I, et al. The Australasian Clinical Toxicology Investigators Collaboration randomized trial of different loading infusion rates of N-acetylcysteine. Ann Emerg Med. 2005;45:402–408

 Funding and support: The author reports this study did not receive any outside funding or support.Reprints not available from the author.

PII: S0196-0644(04)01493-3

doi: 10.1016/j.annemergmed.2004.09.028

Annals of Emergency Medicine
Volume 45, Issue 4 , Pages 409-413 , April 2005

Article Tools