Adverse Effects of Intravenous N-Acetylcysteine

Sanaei‐Zadeh, Hossein; Taghaddosinejad, Fakhreddin; Jalali, Naser; H, Kariman

doi:10.2165/00044011-200323020-00006

Cited by 5 publications

(1 citation statement)

References 16 publications

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“…Paracetamol is the most common cause of drug poisoning in the world [ 1 ] and the single most commonly taken drug in overdoses that lead to hospital presentation and admission [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

A cost effectiveness analysis of the preferred antidotes for acute paracetamol poisoning patients in Sri Lanka

et al. 2012

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BackgroundAcute paracetamol poisoning is a rapidly increasing problem in Sri Lanka. The antidotes are expensive and yet no health economic evaluation has been done on the therapy for acute paracetamol poisoning in the developing world. The aim of this study is to determine the cost effectiveness of using N-acetylcysteine over methionine in the management of acute paracetamol poisoning in Sri Lanka.MethodsEconomic analysis was applied using public healthcare system payer perspective.Costs were obtained from a series of patients admitted to the National Hospital of Sri Lanka with a history of acute paracetamol overdose. Evidence on effectiveness was obtained from a systematic review of the literature. Death due to hepatotoxicity was used as the primary outcome of interest. Analysis and development of decision tree models was done using Tree Age Pro 2008.ResultsAn affordable treatment threshold of Sri Lankan rupees 1,537,120/death prevented was set from the expected years of productive life gained and the average contribution to GDP. A cost-minimisation analysis was appropriate for patients presenting within 10 hours and methionine was the least costly antidote. For patients presenting 10-24 hours after poisoning, n-acetylcysteine was more effective and the incremental cost effectiveness ratio of Sri Lankan rupees 316,182/life saved was well under the threshold. One-way and multi-way sensitivity analysis also supported methionine for patients treated within 10 hours and n-acetylcysteine for patients treated within 10-24 hours as preferred antidotes.ConclusionsPost ingestion time is an important determinant of preferred antidotal therapy for acute paracetamol poisoning patients in Sri Lanka. Using n-acetylcysteine in all patients is not cost effective. On economic grounds, methionine should become the preferred antidote for Sri Lankan patients treated within 10 hours of the acute ingestion and n-acetylcysteine should continue to be given to patients treated within 10-24 hours.

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“…Paracetamol is the most common cause of drug poisoning in the world [ 1 ] and the single most commonly taken drug in overdoses that lead to hospital presentation and admission [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

A cost effectiveness analysis of the preferred antidotes for acute paracetamol poisoning patients in Sri Lanka

et al. 2012

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Pharmacological Basis for Abrogating Myocardial Reperfusion Injury Through a Multi-Target Combined Antioxidant Therapy

et al. 2022

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Ungewöhnliche Ursache einer PCT-Erhöhung

Vogelbacher

Thimme

2021

Dtsch Med Wochenschr

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Zusammenfassung Zusammenfassung Procalcitonin (PCT) ist ein etablierter Marker für bakterielle Infektionen. Erhöhungen des PCT können jedoch aufgrund vielfältiger Ursachen auftreten und sind nicht spezifisch, wie wir in dem vorliegenden Fall kurz skizzieren möchten. Anamnese Wir berichten über eine 29-jährige Patientin, die bei unklaren abdominellen Schmerzen sowie seit 2 Tagen bestehender Übelkeit und Erbrechen von der psychiatrischen Klinik vorgestellt wurde. Die Anamnese war zunächst nicht zielführend. Untersuchung und Diagnose Klinisch ergaben sich keine wegweisenden Befunde. Die Patientin war afebril. Laborchemisch zeigten sich deutlich erhöhte Transaminasen sowie ein massiv erhöhtes PCT. Sonografisch stellten sich keine Auffälligkeiten dar, die Hepatitis-Serologie fiel negativ aus. Entnommene Blutkulturen blieben steril, die weitere Infektfokussuche war blande. Therapie und Verlauf Im Verlauf des stationären Aufenthalts berichtete die Patientin, 2 Tage zuvor kumulativ ca. 40 g Paracetamol in suizidaler Absicht eingenommen zu haben. Eine Therapie mit N-Acetylcystein (NAC) wurde eingeleitet. Die Transaminasen und das PCT zeigten sich in den Folgetagen fallend. Auf eine antibiotische Therapie wurde verzichtet. Folgerung Der Fall zeigt, dass eine PCT-Erhöhung keinesfalls spezifisch für bakterielle Infektionen ist und der Laborwert immer in Korrelation mit der Anamnese und Klinik betrachtet werden muss.

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Adverse Effects of Intravenous N-Acetylcysteine

Cited by 5 publications

References 16 publications

A cost effectiveness analysis of the preferred antidotes for acute paracetamol poisoning patients in Sri Lanka

A cost effectiveness analysis of the preferred antidotes for acute paracetamol poisoning patients in Sri Lanka

Pharmacological Basis for Abrogating Myocardial Reperfusion Injury Through a Multi-Target Combined Antioxidant Therapy

Ungewöhnliche Ursache einer PCT-Erhöhung

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