CHAPTER 85 NAC IN ACETAMINOPHEN OVERDOSE

Efficacy of Oral N-acetylcysteine in the Treatment of Acetaminophen Overdose

Smilkstein MJ, Knapp GL, Kulig KW, Rumack BH. N Engl J Med. 1988;319(24):1557–1562

BACKGROUND

Acetaminophen toxicity is the most common drug toxicity leading to hepatic failure. In 1975, Rumack and Matthew published the first nomogram of plasma acetaminophen level as it pertained to hepatic toxicity at the same time that N-acetylcysteine (NAC) was developed as a possible antidote. A decade later, there was increasing interest in the true efficacy of NAC and appropriate timing of administration.

OBJECTIVES

To determine the efficacy of oral NAC in preventing acetaminophen-induced hepatotoxicity as it related to both the initial plasma acetaminophen concentration and the delay before treatment initiation.

METHODS

National, prospective, open, multicenter study between September 1976 and February 1985.

Patients

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