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New regimens for intravenous acetylcysteine, where are we now?

Lookup NU author(s): Professor Simon Thomas

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


Abstract

Acetylcysteine has been used as a treatment for paracetamol overdose as a 20.25- or 21-h infusion for nearly 40 years. These regimens give 50% of the dose in the first 15 min or 1 h, and are associated with high rates of adverse reactions. A randomised controlled trial has demonstrated that a shorter (12 h) and simpler (two infusions) acetylcysteine regimen using a slower initial infusion rate produces lower rates of adverse events than the original 20.25-h regimen. However, this study was not sufficiently large to show therapeutic equivalence as a hepatoprotective therapy in paracetamol overdose. Two further studies are now reported, which also suggest lower rates of adverse reactions with lower initial rates of acetylcysteine administration. These modified regimens can now be accepted as better tolerated, but it is unlikely that a randomised study of sufficient size to demonstrate non-inferiority of any novel regimen would ever be funded. Against this background we suggest what can be done to establish the efficacy of these less toxic and potentially shorter alternative acetylcysteine regimens and to establish them into routine clinical use.


Publication metadata

Author(s): Bateman DN, Dear JW, Thomas SHL

Publication type: Editorial

Publication status: Published

Journal: Clinical Toxicology

Year: 2016

Volume: 54

Issue: 2

Pages: 75-78

Print publication date: 01/01/2016

Online publication date: 14/12/2015

Acceptance date: 13/11/2015

ISSN (print): 1556-3650

ISSN (electronic): 1556-9519

Publisher: Taylor & Francis Inc

URL: http://dx.doi.org/10.3109/15563650.2015.1121545

DOI: 10.3109/15563650.2015.1121545


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