N-ACETYLCYSTEINE, 200mg/ml, 10ml, amp.

• In the WHO list of Essential Medicines 2025

Antidote

Acute paracetamol toxicity in the following situations:

• Patients with acute ingestion whose paracetamol blood levels within the possible or probable toxic range on the Rumack-Mathew nomogram.
• In contexts where paracetamol concentrations are not routinely available (e.g., MSF contexts), empiric treatment may be indicated if:
• the patient history (or collateral history) suggests supratherapeutic paracetamol ingestion, and
• clinical features consistent with stage 1, 2, or 3 paracetamol toxicity are present, and
• evidence of hepatic damage (elevated ALT, +/- elevated AST), and
• +/- elevated creatinine
• Patients presenting late after ingestion of paracetamol with any of the following:+
• evidence of hepatic injury (elevated ALT/AST),
• hepatic failure, indicated by coagulopathy and encephalopathy, or
• repeated supratherapeutic ingestion of paracetamol

Must be given as slow IV infusion using an infusion or syringe pump.

Intravenous N-acetylcysteine should be given within 24 hours of ingestion of a potentially hepatotoxic dose of paracetamol to prevent liver injury or reduce its severity.

Dosage:

Loading infusion over 4 hours followed by a maintenance infusion over 20 hours (for a minimum of 24 hours of IV N-acetylcysteine).

Adults:

• Loading dose: 150 mg/kg in 200 ml of 5% dextrose over 1 h
• Dose 2: 50 mg/kg in 500 ml of 5% dextrose over 4 hours
• Dose 3: 100 mg/kg in 1000 ml of 5% dextrose over 16 hours

Children:

• First phase: 200-240 mg/kg during the first 4 hours
• Second phase: 100-120 mg/kg over the following 20 hours

The duration of treatment will depend on the patient's clinical condition and serial laboratory results. Reassess at least at 24 hours, and then at least every 12 hours thereafter.

Only to be used when laboratory monitoring of plasma paracetamol concentrations is available.