When should N-acetylcysteine (NAC) be administered for treatment of acetaminophen toxicity?

Updated: Jun 13, 2019
  • Author: Gagan K Sood, MD; Chief Editor: BS Anand, MD  more...
  • Print
Answer

The protective effect of NAC is greatest when administered within 8 hours of ingestion; however, when indicated, administer NAC regardless of the time since the overdose. Therapy with NAC has been shown to decrease mortality in late-presenting patients with fulminant hepatic failure (in the absence of acetaminophen in the serum).

If patients present within 4 hours of overdosing on acetaminophen, administer activated charcoal just prior to starting NAC. [1, 2]

Never administer aminoglycosides or nonsteroidal anti-inflammatory drugs (NSAIDs) to patients with acetaminophen hepatotoxicity, because the potential for nephrotoxicity is greatly exaggerated in this setting.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!