Interaction between N-acetylcysteine and activated charcoal: implications for the treatment of acetaminophen poisoning.
OBJECTIVE
To determine if the presence of N-acetylcysteine reduces the ability of activated charcoal to adsorb acetaminophen both in the absence and presence of a coingestant.


METHODS
In vitro laboratory study.


METHODS
University hospital research laboratory.


RESULTS
The adsorption of acetaminophen and salicylic acid by activated charcoal in the presence and absence of N-acetylcysteine was measured in vitro. Acetaminophen and salicylic acid analyses were conducted with high-performance liquid chromatography. Adsorption data were compared using the appropriate parametric statistical test. The addition of N-acetylcysteine significantly decreased the binding of acetaminophen by activated charcoal (p<0.005). When salicylic acid was added to simulate a coingestant, N-acetylcysteine significantly decreased salicylate adsorption by charcoal (p<0.001).


CONCLUSIONS
The presence of N-acetylcysteine reduces the ability of activated charcoal to adsorb acetaminophen and coingestants. In vivo data will be required to determine the clinical relevance of these interactions.
Tenenbein
P K
PK
Department of Anesthesiology, University of Manitoba, Winnipeg, Canada.
Sitar
D S
DS
Tenenbein
M
M
D000082:Acetaminophen / Q000493:pharmacokinetics* / Q000506:poisoning*; D000111:Acetylcysteine / Q000493:pharmacokinetics* / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000493:pharmacokinetics* / Q000506:poisoning*; D001665:Binding Sites; D002606:Charcoal / Q000493:pharmacokinetics* / Q000627:therapeutic use; D004347:Drug Interactions; D016166:Free Radical Scavengers / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans
D018712:Analgesics, Non-Narcotic; D016166:Free Radical Scavengers; D002606:Charcoal; D000082:Acetaminophen; D000111:Acetylcysteine