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Acetaminophen (Tylenol) Poisoning
Published in Charles Theisler, Adjuvant Medical Care, 2023
N-acetylcysteine, a derivative of the amino acid L-cysteine, taken within eight hours of a Tylenol overdose mitigates liver toxicity4 and is effective in reducing the death rate and preventing the permanent harm caused by acetaminophen poisoning. For this use, N-acetylcysteine given by mouth (140 mg/kg, followed by 70 mg/kg every four hours for three days)5 is as effective as when given intravenously.1 N-acetylcysteine remains the preferred antidote for acetaminophen overdose in the U.S., Canada, Scotland, and most of England.6,7 Taking both Tylenol and NAC together can provide a convenient and effective way of preventing toxicity associated with large doses of acetaminophen.8 As a caution, taking N-acetylcysteine at the same time as activated charcoal may decrease the effectiveness of NAC to prevent poisoning.
Acetylcysteine
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Acetylcysteine is a synthetic N-acetyl derivative of the endogenous amino acid L-cysteine, a precursor of the antioxidant enzyme glutathione. Acetylcysteine is used mainly as a mucolytic drug to reduce the viscosity of mucous secretions, in the management of paracetamol (acetaminophen) overdose, and as a protective agent for renal function in contrast medium-induced nephropathy. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. Acetylcysteine is essentially a prodrug that is converted to cysteine in the intestine and absorbed there into the blood stream. In combination with hypromellose eye drops, is commonly used to alleviate the chronic soreness associated with dry eyes (1, 2).
Drugs Affecting the Respiratory System
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: Although there is limited data from the human pregnancy experience regarding the use of acetylcysteine as a mucolytic, but the possible maternal benefit extremely outweighs the unknown or known embryo/fetal risk.
Performance of the paracetamol-aminotransferase multiplication product in risk stratification after paracetamol (acetaminophen) poisoning: a systematic review and meta-analysis
Published in Clinical Toxicology, 2023
Chun En Yau, Haoyang Chen, Bryant Po-Yuen Lim, Mingwei Ng, R. Ponampalam, Daniel Yan Zheng Lim, Yip Han Chin, Andrew Fu Wah Ho
Paracetamol (acetaminophen) overdose is the most common treatable cause of acute liver failure in the United States and the United Kingdom [1]. Paracetamol was estimated to cause up to 48% of acute liver failure in patients [2]. Studies have also shown an increase in incidence of paracetamol overdose cases in the past few years [3–6]. Although an effective antidote acetylcysteine exists [7], acetylcysteine is associated with high incidence of adverse drug reactions (ADR), with studies reporting ADR between 9% and 77% of patients [8]. Symptoms reported include anaphylactoid reactions, headache, dizziness and convulsion [8]. Failure to initiate acetylcysteine promptly could conversely lead to paracetamol-induced liver failure necessitating liver transplant. Acetylcysteine is also very effective when treatment starts earlier. Patients who receive treatment within the first 8 h after an overdose have an extremely low risk of developing hepatotoxicity [9,10], further highlighting the necessity of early identification of overdose. While there has been recent literature [11,12] highlighting treatment regimens that lower the risk of acetylcysteine-associated ADR, objective risk stratification tools are still required to prevent unnecessary acetylcysteine initiation, while minimising the risk of paracetamol-associated hepatotoxicity.
A review of alternative intravenous acetylcysteine regimens for acetaminophen overdose
Published in Expert Review of Clinical Pharmacology, 2021
Kevin Burnham, Tianrui Yang, Haleigh Smith, Steven Knight
No formal society or government-endorsed guidelines for the treatment of acetaminophen overdose have been published in the U.S. However, Australian and New Zealand guidelines have recently been updated to include recommendations for a modified acetylcysteine regimen and a more intense regimen for those with massive ingestions [14]. This guideline recommends using a two-bag NAC regimen as first-line management in most cases. In the United Kingdom (U.K.), TOXBASE and guidelines produced by large institutions recognize a shortened 12 h two-bag regimen [15]. Despite the lack of formal guidance in the U.S., there are treatment principles that are generally accepted internationally [16,17]. Of these principles, initiating treatment as early as possible and utilizing the Rumack–Matthew nomogram for risk assessment could be considered two of the utmost essential treatment principles.
Development of renal function during staged balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2019
Steffen D. Kriechbaum, Christoph B. Wiedenroth, Maura L. Hesse, Ruth Ajnwojner, Till Keller, Jan Sebastian Wolter, Moritz Haas, Fritz C. Roller, Andreas Breithecker, Andreas J. Rieth, Stefan Guth, Andreas Rolf, Christian W. Hamm, Eckhard Mayer, Christoph Liebetrau
Strategies to prevent contrast-induced acute renal failure were subject to intensive investigations during the last decades. However, no definite recommendation exists, particularly for the special field of BPA therapy. The renal protection strategy in the current study is based on the pathophysiological hypothesis that an elevated intravascular volume, promoted diuresis and balanced serum electrolytes might reduce the nephrotoxic effects of contrast agent. Periprocedural, intravenous hydration proofed to be effective for the prevention of contrast-induced renal failure in several studies [19,22]. Although, the evidence for the benefit of additional administration of loop diuretics is weaker, the standardized combination of matched hydration and loop diuretics was associated with a lower incidence of acute renal failure in several studies [19,22]. The use of antioxidants, mainly acetylcysteine, is discussed controversially, since the initially published benefit regarding the prevention of contrast-induced renal failure could not be confirmed in large randomized trials [19,23]. Given the limited negative side effects and the inhomogeneous recommendations in the literature, the use of acetylcysteine is maintained at our center.