How are N -acetylcysteine (NAC) and oral activated charcoal used together to treat acetaminophen toxicity/poisoning?

Updated: Jan 17, 2020
  • Author: Susan E Farrell, MD; Chief Editor: Michael A Miller, MD  more...
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In cases of acetaminophen overdose, early administration of NAC takes priority over GI decontamination with oral AC. Although AC does bind to NAC, AC adsorbs APAP more avidly. Therefore, any decrease in the bioavailability of oral NAC that may result from the administration of AC is clinically inconsequential. Importantly, AC administration may prevent significant APAP absorption from the GI tract and obviate the need for NAC if AC is administered within 60 minutes of an acute ingestion. [45]

Oral NAC administration may be staggered with AC administration in the rare cases where the patient needs multiple doses of AC for the treatment of a co-ingestant. [46] Treatment with intravenous NAC is preferable in this situation.

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