[Evaluation of the efficacy of N-acetylcysteine administered alone or in combination with activated charcoal in the treatment of acetaminophen overdoses].
OBJECTIVE
To evaluate the efficacy of N-acetylcysteine (N-AC) alone or combined with multiple-dose activated charcoal (AC) in the treatment of acetaminophen (ACT) overdose.


METHODS
Prospective observational case series of 14 consecutive pediatric patients. Group A (n = 7) were treated only with N-AC and group B (n = 7) with N-AC combined with AC. Plasma ACT concentrations were measured at 0.0, 24 and 48 h. As a measure of ACT disappearance, half-life of elimination (t1/2 beta) and exogenous body clearance (ClB) were calculated.


RESULTS
Group A, Initial and final mean ACT plasmatic levels were 27 micrograms/mL and 4 micrograms/mL; t1/2 beta of 17 h and ClB 0.640 mL.kg.min. Group B, 27 micrograms/mL and 0.66 microgram/mL; t1/2 beta of 10 h and ClB 1.092 mL.kg.min. For both t1/2 beta and ClB differences, p < 0.05 (SS).


CONCLUSIONS
N-AC significantly decreased the plasma ACT levels in both treatments; however, there were several advantages with the combined therapy: AC enhanced the efficacy of N-AC according with the higher eliminatión of the overdosed drug (97.6% vs. 85.2%), the t1/2 beta decreased 42%, and the ClB increased 70% in relation to the group A. Data of this study suggested that N-AC plus AC is more effective than N-AC alone in enhancing ACT elimination in overdosed patients and that it provided additional hepatoprotective benefit.
Montoya-Cabrera
M A
MA
Departamento de Farmacología Clínica, Instituto Nacional de Perinatología (SSA), México D.F.
Escalante-Galindo
P
P
Nava-Juárez
A
A
Terroba-Larios
V M
VM
Terán-Hernández
J A
JA
D000082:Acetaminophen / Q000506:poisoning*; D000111:Acetylcysteine / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D000931:Antidotes / Q000627:therapeutic use*; D002606:Charcoal / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D062787:Drug Overdose; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies
D018712:Analgesics, Non-Narcotic; D000931:Antidotes; D016166:Free Radical Scavengers; D002606:Charcoal; D000082:Acetaminophen; D000111:Acetylcysteine
Evaluación de la eficacia de la N-acetilcisteina administrada sola o combinada con carbón activado en el tratamiento de la sobredosis por acetaminofén.