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...
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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.

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