It may also be effective up to and possibly beyond 24 hours. It has near 100% efficacy in preventing paracetamol-induced hepatotoxicity if given within the first 8 hours from ingestion of overdose. A cetylcysteine IV (N-acetylcysteine, Parvolex ®, NAC) is the treatment of choice.
In overdose the potential risk of a patient having significant liver damage is directly proportional to the amount of paracetamol ingested. TOXBASE (password required) should continue to be used as a clinical decision support resource in conjunction with the National Poisons Information Service (NPIS, 03). While the MHRA has not yet approved its use, TOXBASE now lists the regime as a recognised treatment period.
The same dose of N-acetylcysteine is administered in this regime but over a 12-hour ( not 21-hour) treatment period. This guideline reflects the local NHSGGC policy on acetylcysteine use in adult paracetamol overdoses and is based on the Scottish and Newcastle Anti-emetic Pre-treatment for Paracetamol Poisoning (SNAP) regime.
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