Do we need to change the dosing regimen for IV N-acetylcysteine

1.5 out of 5 stars Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomized controlled trial. Bateman DM et al. Lancet 2013 Nov 28 [Epub ahead of print] Abstract The authors argue that since there is a high incidence of adverse events — nausea and vomiting, anaphylactoid reactions —  associated with the standard protocol for administering intravenous N-acetylcysteine (IV-NAC), a different dosing regimen might be safer and just as effective. In this somewhat complicated trial from Great Britain, subjects were randomized to 4 groups: Standard (in the U.K.) IV-NAC (150 mg/kg over 15 min, then 50 mg/kg over 4 h, then 100 mg/kg over 16 hours) plus pretreatment with ondansetron 4 mg Standard IV-NAC plus placebo Modified (shorter) IV-NAC protocol (100 mg/kg over 2 h, then 200 mg/kg over 10 h) plus pretreatment with ondansetron 4 mg Modified IV-NAC protocol plus placebo There were 217 study subjects. The authors report that there were severe anaphylactoid reactions reported in 5/108 (4.6%) patients assigned to the shorter modified protocol vs. 31/109 (19,3%) patients getting standard IV-NAC. Vomiting and need for rescue antiemetic therapy in the first 2 hours of treatment occurred in 39/108 (36%) patients receiving the short regimen vs. 71/109 (65%) of patients receiving the standard protocol. The study did not have enough power to demonstrate that the shorter modified protocol was non-inferior to the standard protoco...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical acetaminophen adverse events N-acetylcysteine NAC rumack-matthew nomogram Source Type: news