The American College of Medical Toxicology Discusses the Potential for Errors with Both IV Acetaminophen and Its Treatment, N-acetylcysteine

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The American College of Medical Toxicology recognizes the potential for dosing errors with both intravenous acetaminophen as well as with N-acetylcysteine, the antidote to acetaminophen poisoning. Leading clinicians and governmental agencies participated in a webinar to discuss the current concerns and potential solutions.

American College of Medical Toxicology

The American College of Medical Toxicology joined with leading clinicians and scientists to discuss the potential for overdose of intravenous acetaminophen, particularly in children, as well as concerns over the complicated dosing regimen for N-acetylcysteine, the currently used therapy for acetaminophen overdose.

Medical toxicologists, who specialize in the diagnosis and management of human poisoning, have long been involved with the management of patients with acetaminophen poisoning. Acetaminophen has been available for decades in oral form, and was recently introduced in the United States in an intravenous formulation for use in medical facilities. The antidote for oral or intravenous acetaminophen poisoning, N-acetylcysteine, is also prone to inaccurate dosing due to its complicated administration regimen.

A recent webinar hosted by the American College of Medical Toxicology examined the root causes of these errors and discussed mechanisms to prevent them in the future. The conference included experts from the Institute for Safe Medication Practices, Food and Drug Administration, and Centers for Disease Control and Prevention, as well as many thought leaders in the specialty of medical toxicology.

Intravenous acetaminophen is available in a single dose formulation of one gram that is appropriate for a typical patient, but is excessive for small adults and children if not properly scaled for their weight. Acetaminophen overdose can cause liver injury, although if recognized and treated early this can be prevented with administration of N-acetylcysteine. A recommended solution to reduce the risk of intravenous acetaminophen overdose in children is creating a pediatric formulation containing a dose appropriate for a small child.

The antidote to acetaminophen poisoning, N-acetylcysteine, is highly effective as noted above. However the current dosing instructions approved by the FDA require three different weight-based doses to be administered over different time frames over a 20 hour time period. Although the manufacturer provides clear dosing instructions on their website, the webinar participants recommended that this complicated dosing regimen should be clarified, or simplified, without any expected loss of efficacy.

The American College of Medical Toxicology (ACMT) is a professional, nonprofit association of physicians with recognized expertise in medical toxicology. The College is dedicated to advancing the science and practice of medical toxicology to improve the care of poisoned patients.

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