Is there a better way to administer IV N-acetylcysteine?

3 out of 5 stars Fewer adverse effects with a modified two-bag acetylcysteine protocol in paracetamol overdose. McNulty R et al. Clin Toxicol 2017 Dec 8 [Epub ahead of print] Abstract Current recommendations for dosing intravenous N-acetylcysteine (Acetadote) for treating acute acetaminophen (paracetamol) poisoning involves a somewhat complex three-bag protocol, using 3 direct concentrations of the antidote given over a 21-hour period. Unfortunately, this protocol results in a high incidence of (usually mild) adverse events, including cutaneous effects, nausea and vomiting, and anaphylactoid reactions. Severe reactions such as hypotension and bronchospasm occur but are unusual. In addition, the three-bag protocol has been shown to result in medication errors in up to one-third of patients. As the Missouri Poison Center points out in an excellent post: The FDA-approved 21-hour, three-bag protocol for Acetadote administration is effective; however, there is substantial risk for dosing and administration errors because the regimen involves preparing three bags of differing concentrations derived from weight-based doses and dilutions, each with a different length of infusion. Mistakes may occur due to inaccurate dose calculation and IV admixture preparation, incorrect rate of administration, interruptions in therapy associated with changing bags or adverse effects (i.e., anaphylactoid reactions and dose-related vomiting), and unnecessary administration. In February 2015, The We...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical Acetadote acetaminophen antidote N-acetylcysteine paracetamol three-bag protocol toxicity two-bag protocol Source Type: news