Impact of reducing the threshold for acetylcysteine treatment in acute paracetamol poisoning: The recent United Kingdom experience

Clinical Toxicology

Volumn 52, Issue 8, 2014, Pages 868-872

  Bateman, D N ^a,e   Dear, J W ^a,e   Carroll, R ^b   Pettie, J ^a   Yamamoto, T ^c   Elamin, M E M O ^d   Peart, L ^d   Dow, M ^a   Coyle, J ^a   Gray, A ^a   Dargan, P I ^c,f   Wood, D M ^c,f   Eddleston, M ^a,e   Thomas, S H L ^d,g  

^a ROYAL INFIRMARY OF EDINBURGH   (United Kingdom)

^b UNIVERSITY OF BRISTOL   (United Kingdom)

^c GUY'S AND ST THOMAS' NHS FOUNDATION TRUST   (United Kingdom)

^d NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST   (United Kingdom)

^e UNIVERSITY OF EDINBURGH   (United Kingdom)

^f KING'S COLLEGE LONDON   (United Kingdom)

^g NEWCASTLE UNIVERSITY   (United Kingdom)

Author keywords

Acetylcysteine; Antidote; Paracetamol; Poisoning; Regulation

Indexed keywords

ACETYLCYSTEINE; ANTIDOTE; PARACETAMOL;

ACUTE PARACETAMOL POISONING; ARTICLE; COHORT ANALYSIS; CONTROLLED STUDY; DRUG BLOOD LEVEL; DRUG COST; DRUG INTOXICATION; HOSPITAL ADMISSION; HUMAN; MAJOR CLINICAL STUDY; MEDICAL ETHICS; NOMOGRAM; UNITED KINGDOM; DRUG EFFECT; DRUG OVERDOSE; HOSPITALIZATION; INTOXICATION; LIVER; PATHOLOGY; PRACTICE GUIDELINE; REGULATORY MECHANISM; RETROSPECTIVE STUDY; RISK FACTOR; TOXIC HEPATITIS;

ACETYLCYSTEINE; ANTIDOTE; PARACETAMOL; POISONING; REGULATION;

ACETAMINOPHEN; ACETYLCYSTEINE; ANTIDOTES; DRUG OVERDOSE; DRUG-INDUCED LIVER INJURY; GREAT BRITAIN; HOSPITALIZATION; HUMANS; LIVER; NOMOGRAMS; PRACTICE GUIDELINES AS TOPIC; RETROSPECTIVE STUDIES; RISK FACTORS;

EID: 84907060711     PISSN: 15563650     EISSN: 15569519     Source Type: Journal    
DOI: 10.3109/15563650.2014.954125     Document Type: Article

References (14)

1. Rumack BH, Matthew H. Actaminophen poiosning and toxicity. Paediatrics 1975; 55:871-876.
2. Prescott LF, Illingworth RN, Critchley JA, Stewart MJ, Adam RD, Proudfoot AT. Treatment of paracetamol (acetaminophen) poisoning with N-acetylcysteine. Lancet 1977; 2:432-434.
3. Routledge PA, Vale JA, Bateman DN, Johnston GD, Jones A, Judd A, et al. Paracetamol (acetaminophen) poisoning. No need to change current guidelines to accident departments. BMJ 1998; 317:1609-1610.
4. Daly FF, Fountain JS, Murray L, Graudins A, Buckley NA; Panel of Australian and New Zealand clinical toxicologists. Guidelines for the management of paracetamol poisoning in Australia and New Zealand-explanation and elaboration. A consensus statement from clinical tox-icologists consulting to the Australasian poisons information centres. MJA 2008; 188:296-301.
5. MHRA. Benefit risk profile of acetylcysteine in the management of paracetamol overdose. 2012. http://www.mhra.gov.uk/home/groups/pl-p/documents/drugsafetymessage/con184709.pdf. Accessed 13th May 2013.
6. Bateman DN, Carroll R, Pettie J, Yamamoto T, Elamin ME, Peart L, et al. Effect of the UK's revised paracetamol poisoning management guidelines on admissions, adverse reactions, and costs of treatment. B J Clin Pharm 2014. doi:10.1111/bcp.12362.
7. McQuade DJ, Dargan PI, Keep J, Wood DM. Paracetamol toxicity: what would be the implications of a change in UK treatment guidelines? Eur J Clin Pharmacol 2012; 68:1541-1547.
8. Schmidt L. Identification of patients at risk of anaphylactoid reactions to N-acetylcysteine in the treatment of paracetamol overdos. Clin Toxicol 2013; 51:467-472.
9. Waring WS, Stephen AF, Robinson OD, Dow MA, Pettie JM. Lower incidence of anaphylactoid reactions to N-acetylcysteine in patients with higher acetaminophen concentrations after overdose. Clin Toxicol 2008; 46:496-500.
10. BNF. British National Formulary, 64th edn London: BMJ Group and RPS publishing; 2012.
11. Gosselin S, Hoffman RS, Juurlink DN, Whyte IM, Yarema M, Caro J. Treating acetaminophen overdose: thresholds, costs and uncertainties. Clin Toxicol 2013; 51:130-133.
12. Koppen A, van Reil A, de Vreis I, Meulenbelt J. Recommendations for the paracetamol treatment nomogram and side effects of N-acetylcysteine. Neth J Med 2014; 72:251-257.
13. Thompson G, Fatima SB, Shah N, Kitching G, Waring WS. Impact of amending the acetylcysteine marketing authorisation on treatment of paracetamol overdose. ISRN Toxicol 2013; 2013:494357.
14. Wong A, Graudins A, Kerr F, Greene SL. Paracetamol toxicity: what would be the implications of a change in Australian treatment guidelines?. Emerg Med Australas 2014; 26:183-187.