A review of alternative intravenous acetylcysteine regimens for acetaminophen overdose

ABSTRACT

Introduction

Acetylcysteine is the standard treatment for preventing hepatotoxicity caused by acetaminophen overdose. Several novel approaches to the management of acetaminophen overdose have been suggested to improve patient safety by reducing adverse drug reactions and dosing errors. This article reviews these alternative treatment regimens and intends to offer a detailed assessment of the available options to assist providers in managing cases of acetaminophen overdose.

Areas covered

This review article covers observational and experimental studies that assessed the efficacy and safety of alternative intravenous acetylcysteine regimens for acetaminophen overdose. A literature search was conducted using PubMed, ProQuest, and Scopus to identify the studies, which included results through April 2021. The assessment of alternative regimens consists of a discussion on the limitations and benefits, barriers to implementation, and important considerations for each regimen.

Expert opinion

Several alternative regimens have been studied and implemented in various institutions. Many of these dosing regimens have supporting safety data but most lack robust data. A reduction in infusion-related side effects is an important outcome, but established efficacy, local poison center familiarity with the regimen, institutional resources, and patient-specific factors should be equally considered when deciding on implementing and using an alternative dosing strategy.

KEYWORDS:

• Acetaminophen overdose
• acetylcysteine regimen
• toxicology
• hepatotoxicity
• drug safety

Article highlights

• Detailed history of the acetylcysteine dosing regimens for use in acetaminophen overdose and a brief discussion over some of the standard treatment principles

• A review of the literature evaluating alternative acetylcysteine regimens, including their strengths and limitations and a comprehensive summary table

• Rationale for potential implementation of alternative intravenous acetylcysteine regimens and important considerations

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer of this article discloses being an author of the SNAP Trial and the Pettie et al. paper.

Additional information

Funding

This manuscript was not funded.