A number of subscribers have asked about IV NAC (N-acetylcysteine). IV NAC is not FDA approved. It has been shown to reduce morbidity and mortality in acetaminophen-induced hepatic failure (note-this is only in hepatic failure caused by acetaminophen overdose). I would certainly administer IV NAC in this setting.
For 20 years, NAC has been administered as a 20 hour IV protocol (for acute acetaminophen overdose) in Canada and Europe. This shortened protocol has the distinct advantage of shortened hospital stay (23 hour observation). It is quite safe. Allergic reactions and hypotension occur only when administered too rapidly or in too large of a dose. Unfortunately, lack of FDA approval prevents this practice.
In the US, a 36 hour oral treatment protocol is undergoing clinical trials. Oral administration is much less of a problem now that Zofran is available to control vomiting. One does not have to administer Zofran with each dose. Usually if you administer Zofran once or twice and the NAC is retained, further Zofran administration is not required.
As always, if there are any questions, call the MTPC.
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