Paracetamol overdose

Acute paracetamol overdose exceeding therapeutic doses with risk of fulminant liver failure. N-acetylcysteine antidote is effective when given within 8–10 hours of ingestion, dosed per the Rumack-Matthew nomogram.

ICD-10 T39.11 drug

Also known as: Acetaminophen overdose

Drugs used for this condition

AAcetylcysteineFirst line · Mucolytic; paracetamol overdose antidote; glutathione precursorFirst-line antidote for paracetamol overdose. AEMPS and FDA approve oral and intravenous routes; maximum benefit when started within 8 hours of ingestion. IV Prescott protocol: 150 mg/kg over 1 hour, then 50 mg/kg over 4 hours, then 100 mg/kg over 16 hours. Efficacy declines after 10 hours but Cochrane 2018 shows benefit even with late initiation. The only NAC indication with tier A.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit