ArticleEClinicalMedicine
Safety and Efficacy of the SNAP 12-hour Acetylcysteine Regimen for the Treatment of Paracetamol Overdose.
Article in EClinicalMedicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.
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Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it, 87 citations in OpenAlex.
- Is Two Better Than Three? A Systematic Review of Two-bag Intravenous N-acetylcysteine Regimens for Acetaminophen Poisoning.The western journal of emergency medicine · 2023Pooled it
- A metabolomic analysis of thiol response for standard and modified N-acetyl cysteine treatment regimens in patients with acetaminophen overdose.Clinical and translational science · 2021Trial
- Trial
- In vitro Study of the Effects of Acetylcysteine on the International Normalized Ratio Over Time.Therapeutic drug monitoring · 2026Article
- Paracetamol Half-Life Declines over Time After an Acute Overdose.Therapeutic drug monitoring · 2026Observational
- Binankadsurin A fromNutrients · 2026Article
- Scottish and Newcastle Antiemetic Protocol (SNAP) 12-hour acetylcysteine regimen for paracetamol overdose reduces anaphylactoid reactions without compromising hepatic protection in all age groups: a secondary analysis.Emergency medicine journal : EMJ · 2025Article
- Quality improvement project to enhance adherence to RCEM standards for patients with paracetamol overdose.BMJ open quality · 2025Article
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- Liver quad culture chip as a model for radiation injury research.Scientific reports · 2025Article
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- Paeoniflorin Attenuates APAP-Induced Liver Injury via Intervening the Crosstalk Between Hepatocyte Pyroptosis and NETs.International journal of molecular sciences · 2025Article
- Article
- Clinically relevant therapeutic approaches against acetaminophen hepatotoxicity and acute liver failure.Biochemical pharmacology · 2024Review
- Investigating a Novel Two-Bag N-Acetylcysteine Regimen for Acetaminophen Toxicity.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2024Article
- Intravenous Acetylcysteine: What Should Replace the Prescott "Three-Bag" Protocol?Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2024Article
- Article
- The role of N-acetylcysteine in osteogenic microenvironment for bone tissue engineering.Frontiers in cell and developmental biology · 2024Review
- A comparative study on the hepatoprotective effect of selenium-nanoparticles and dates flesh extract on carbon tetrachloride induced liver damage in albino rats.Anatomy & cell biology · 2023Article
- MRI Detection of HepaticBiomedicines · 2022Article
Corrections and comments
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Authors and funding
14 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundAcetylcysteine (NAC) is effective at preventing liver injury after paracetamol overdose. The Scottish and Newcastle Anti-emetic Pre-treatment for Paracetamol Poisoning (SNAP) Study demonstrated that a 12 h NAC regimen was associated with fewer adverse drug reactions compared with the standard 21 h regimen. Here, we describe the clinical effectiveness of the SNAP NAC regimen.
methodsThe SNAP regimen, consisting of intravenous NAC 100 mg/kg over 2 h then 200 mg/kg over 10 h, was introduced to treat all paracetamol overdose patients at the Royal Infirmary of Edinburgh, the Royal Victoria Infirmary, Newcastle and St Thomas' Hospital, London. Patient data were prospectively and systematically collected before and after the change in treatment (total patients N = 3340, 21 h N = 1488, SNAP N = 1852). Health record linkage was used to determine patient outcome after hospital discharge.
findingsThere was no difference in liver injury or liver synthetic dysfunction between regimens. Hepatotoxicity (peak ALT > 1000 U/L) occurred in 64 (4.3%) and 67 (3.6%) patients, respectively, in the 21 h and SNAP groups (absolute difference - 0.7%, 95% CI - 2.1 to 0.6). Multivariable logistic regression did not identify treatment regimen as an outcome-associated factor. No patients were readmitted to hospital with, or died from, liver failure within 30 days of discharge. Anti-histamine treatment (for NAC anaphylactoid drug reactions) was prescribed for 163 (11.0%) patients with the 21 h regimen and 37 (2.0%) patients with the SNAP regimen (absolute difference 9.0% (95% CI 7.3 to 10.7)).
interpretationIn clinical use the SNAP regimen has similar efficacy as standard therapy for preventing liver injury and produces fewer adverse reactions.
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