Acetylcysteine has long been recognized as an effective antidote, via oral or intravenous administration, minimizing the risk and severity of acute liver injury if administered sufficiently early after a paracetamol overdose.
Intravenous acetylcysteine is the antidote to treat paracetamol overdose and is virtually 100% effective in preventing liver damage when given within 8 hours of the overdose.
N-Acetylcysteine is the drug of choice for the treatment of an acetaminophen overdose. It is thought to provide cysteine for glutathione synthesis and possibly to form an adduct directly with the toxic metabolite of acetaminophen, N-acetyl-p-benzoquinoneimine.
The majority of patients survive acetaminophen toxicity with supportive care such as intravenous fluids and anti-nausea medication, activated charcoal, if used within one hour after ingestion, and antidotal therapy, including N-acetylcysteine (Acetadote®, Mucomyst®).
Untreated paracetamol poisoning may cause varying degrees of liver injury over the 2 to 4 days following ingestion, including fulminant hepatic failure. Rarely, massive overdose may initially present with coma and severe metabolic acidosis.
Paracetamol is a common painkiller that is normally safe. If you take more than the recommended amount (an overdose), it can harm the liver, and occasionally the kidneys. The medical team will assess you.
As for Paracetamol of 500mg per tablet, it is generally recommended to take no more than 8 tablets (500mg) within 24 hours, and 24 to 30 tablets taken at one time can lead to overdose or even death. Not sufficient time between doses or high amount of tablets taken at one time may lead to a fatal overdose.
But from what has been scientifically established so far, paracetamol is believed to metabolize by mean of obstructing the COX enzymes that are in the human brain as well as that of the spinal cord. This shouldn't take more than 5 hours.
If you take too much
Taking 1 or 2 extra tablets is unlikely to harm you. Do not take more than 8 tablets in 24 hours. Taking too much paracetamol can be dangerous and you may need treatment. Too much paracetamol can cause liver damage.
Oral N-Acetylcysteine
The FDA-approved dosage regimen for oral NAC starts with a loading dose of 140 mg/kg, followed by 17 doses, each at 70 mg/kg, given every 4 hours.
N-acetylcysteine is an effective antidote and should be administered to all patients judged to be at risk of developing hepatotoxicity after paracetamol overdose.
Specific signs of paracetamol poisoning include: yellowing of the skin and the whites of the eyes (jaundice) loss of co-ordination. low blood sugar (hypoglycaemia), which can cause symptoms including sweating, trembling and irritability.
HEPATOTOXICITY RISK FACTORS
While acute liver injury can occur when used at or below the recommended daily maximum dose (4000 mg)[4], paracetamol toxicity is often the result of ingestion of paracetamol over this maximum dose.
The dosing schedule for the 72-hour oral NAC protocol is as follows: 140 mg/kg loading dose orally. After 4 hours of the loading dose, 70 mg/kg should be given every 4 hours for an additional 17 doses, which is a total dose of 1330 mg/kg.
Paracetamol for adults Brand names: Disprol, Hedex, Medinol, Panadol.
Its effects usually last for about 4 to 6 hours.
Paracetamol works better as a painkiller if taken regularly every 4-6 hours rather than when taken occasionally or as required. The concentration of the drug slowly builds up in the blood stream and in the body tissues when taken regularly therefore giving more pain relief.
Reversing liver damage Liver Basics
For example, an overdose of acetaminophen (Tylenol) can destroy half of a person's liver cells in less than a week. Barring complications, the liver can repair itself completely and, within a month, the patient will show no signs of damage.
If levels exceed the above paracetamol can cause liver damage (hepatotoxicity) if you take larger doses than recommended. Adults must not take more than 4000 mg in a 24-hour period.
Paracetamol is the most common medicine taken in overdose. It can lead to liver failure in a number of days, despite using medication to protect the liver. Liver failure can be fatal.
Taking more than five medications is called polypharmacy. The risk of harmful effects, drug interactions and hospitalizations increase when you take more medications.
Taking too much paracetamol can lead to yellow eyes and skin (jaundice), loss of coordination, liver damage and even death. It's important to get medical help as quickly as possible if you think you or your child have taken too much paracetamol, as the damage can happen even before you notice any symptoms.
Acute liver failure can happen in as little as 48 hours. It's important to seek medical treatment at the first signs of trouble.
Mucomyst (Acetylcysteine Solution) may also be used as an antidote for acetaminophen toxicity. Mucomyst (Acetylcysteine Solution) is available as a generic.