IV N-Acetylcysteine Is Safe and Effective

Acetaminophen is the most common drug of overdose and N-acetylcysteine (NAC) the antidote most frequently used in the U.S. Oral NAC -- currently the only FDA-approved route -- is fraught with problems: it tastes terrible, it can cause refractory emesis, and its uptake can be limited by GI bleeding or obstruction or the need for gastric decontamination. Researchers from the Rocky Mountain Poison and Drug Center report on adverse events associated with intravenous NAC.

Of 266,720 toxic exposures during a two-year period, 1,131 patients received NAC. Of these, 76 received the oral preparation IV; 4 adverse events were reported (5.3%). All occurred during initial NAC infusion; 2 required no treatment and 2 allergic reactions resolved after diphe…