Clinical

Short-course N-acetylcysteine effective for acetaminophen overdose

Last Updated: 2007-10-05 11:38:40 -0400 (Reuters Health)

NEW YORK (Reuters Health) - A shortened course of as few as six oral doses of N-acetylcysteine appears to be an effective treatment for certain patients with acute acetaminophen poisoning, researchers report in the September issue of the Annals of Emergency Medicine.

Although the standard longer N-acetylcysteine regimen is effective, "identifying those acetaminophen-poisoned individuals considered at no further risk of developing hepatotoxicity, for whom N-acetylcysteine may be discontinued before completion of a full 72 hours of treatment, would be of potential benefit to patients and health care providers."

To examine the outcome of a shortened treatment course, lead investigator Dr. David P. Betten of Sparrow Hospital in Lansing, Michigan, and his associates conducted a prospective observational study using information from a poison control database. Over a 12-month period they identified 205 patients with acetaminophen poisoning who received oral treatment with N-acetylcysteine for 48 hours or less. This consisted of a minimum of six oral doses given over 20 hours.

Treatment discontinuation was recommended by the poison center when serum acetaminophen was undetectable and liver test results were normal.

One hundred ninety-five patients were available for followup after discharge. These patients completed a questionnaire and 187 (95.9%) reported no symptoms consistent with hepatic failure.

Although eight patients reported abdominal pain or vomiting, none received further N-acetylcysteine treatment or additional hospitalization.

Certain patients may require longer treatment, the researchers conclude, but "a shortened duration of oral N-acetylcysteine administration to selected patients may offer benefits by reducing medication costs and shortening the length of hospital stay."

The author of accompanying editorial, Dr. Richard C. Dart of the Rocky Mountain Poison Center, Denver, Colorado, told Reuters Health that "individual physicians can use this information to carefully reduce the length of treatment."

"Most importantly," he added, "a prospective trial is needed confirm these observations and allow widespread application throughout the United States."

Ann Emerg Med 2007;50:272-282.