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

• In the WHO list of Essential Medicines 2023

Antidote

Acute paracetamol toxicity in the following situations:

• Patients with acute ingestion and paracetamol concentrations in the possible/probable toxic range of the Rumack-Mathew nomogram. Paracetamol concentrations may not be routinely available in MSF contexts and thus empiric treatment may be indicated.
• Indications for empiric treatment:
• history (or collateral history) consistent with supratherapeutic ingestion of paracetamol, and
• clinical features of stage 1, 2, or 3 paracetamol toxicity
• evidence of hepatic damage (elevated ALT, +/- elevated AST)
• +/- elevated creatinine
• Patients presenting late after paracetamol ingestion with evidence of hepatic injury (elevated ALT/AST), hepatic failure (coagulopathy and encephalopathy), or repeated supratherapeutic ingestion.

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

Intravenous N-acetylcysteine, given within 24 hrs of ingestion of a potentially hepatotoxic overdose of paracetamol, is indicated to prevent or reduce the severity of liver damage.

Dosage:

Loading infusion over 4 hrs then maintenance infusion over 20 hrs (for a minimum of 24 hrs of IV N-acetycysteine).

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 hrs
• Dose 3: 100 mg/kg in 1000 ml of 5% dextrose over 16 hrs

Children:

• 200-240 mg/kg over the first 4 hrs
• 100-120 mg/kg over the next 20 hrs

The duration of treatment will depend on the patient's clinical progress and serial laboratory tests. Reassessment at least after 24 hrs, then at least every 12 hrs.

Only to be used if laboratory monitoring of plasma paracetamol levels is available.