Evidence map›Paper›PMID 26387650›Full record

ReviewBritish journal of clinical pharmacology2016

Evidence for the changing regimens of acetylcysteine.

Angela L Chiew, Geoffrey K Isbister, Stephen B Duffull, Nicholas A Buckley

Open access · bronzeAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in British journal of clinical pharmacology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
26citing papers in PubMed, 3 pooled it
9.6field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

26 citing papers in PubMed, 3 syntheses or guidelines pooled it, 66 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Interventions for paracetamol (acetaminophen) overdose.The Cochrane database of systematic reviews · 2018
    Pooled it
  4. Trial
  5. Article
  6. Article
  7. Article
  8. Review
  9. Article
  10. A stitch in time saves nine: timely use of N-acetyl cysteine (NAC) for chemotherapy-induced veno-occlusive disease (VOD)-is it a cost-effective alternative?Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2022
    Article
  11. Review
  12. Evaluation of Dosing Strategies of N-acetylcysteine for Acetaminophen Toxicity in Patients Greater than 100 Kilograms: Should the Dosage Cap Be Used?Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2021
    Article
  13. Article
  14. Anaphylactoid Reactions to Intravenous N-Acetylcysteine during Treatment for Acetaminophen Poisoning.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2018
    Article
  15. Review
  16. Article
  17. Article
  18. Should we treat very large paracetamol overdose differently?British journal of clinical pharmacology · 2017
    Article
  19. Observational
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 3 institutions in 2 countries.

Angela L ChiewClinical and Experimental Toxicology Unit, Department of Emergency Medicine, Prince of Wales Hospital, Randwick, NSW, Australia.
Geoffrey K IsbisterSchool of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
Stephen B DuffullSchool of Pharmacy, University of Otago, Dunedin, New Zealand.
Nicholas A BuckleyDepartment of Pharmacology, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia.
University of Sydney · AUUniversity of Newcastle Australia · AUUniversity of Otago · NZ

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Paracetamol overdose prior to the introduction of acetylcysteine was associated with significant morbidity. Acetylcysteine is now the mainstay of treatment for paracetamol poisoning and has effectively reduced rates of hepatotoxicity and death. The current three-bag intravenous regimen with an initial high loading dose was empirically derived four decades ago and has not changed since. This regimen is associated with a high rate of adverse effects due mainly to the high initial peak acetylcysteine concentration. Furthermore, there are concerns that the acetylcysteine concentration is not adequate for 'massive' overdoses and that the dose and duration may need to be altered. Various novel regimens have been proposed, looking to address these issues. Many of these modified regimens aim to decrease the rate of adverse reactions by slowing the loading dose and thereby decrease the peak concentration. We used a published population pharmacokinetic model of acetylcysteine to simulate these modified regimens. We determined mean peak and 20 h acetylcysteine concentrations and area under the under the plasma concentration-time curve to compare these regimens. Those regimens that resulted in a lower peak acetylcysteine concentration have been shown in studies to have a lower rate of adverse events. However, these studies were too small to show whether they are as effective as the traditional regimen. Further research is still needed to determine the optimum dose and duration of acetylcysteine that results in the fewest side-effects and treatment failures. Indeed, a more patient-tailored approach might be required, whereby the dose and duration are altered depending on the paracetamol dose ingested or paracetamol concentrations.

Indexed as

Drug Administration ScheduleAcetaminophenAcetylcysteineAntidotesDrug OverdoseHumansAcetaminophenAcetylcysteineAntidotesacetylcysteineantidoteoverdoseparacetamol

Identifiers

PMID26387650
PMCPMC4767192
OpenAlexW1922592834

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.