Shorter Acetaminophen-Poisoning Regimen Less Likely to Induce Discomfort — Physician’s First Watch
Shorter Acetaminophen-Poisoning Regimen Less Likely to Induce Discomfort
By Joe Elia
A shorter acetylcysteine treatment regimen for acetaminophen poisoning carries a lower risk for early vomiting than standard therapy, a Lancet study finds.
Researchers randomized some 220 patients with acetaminophen overdose to either standard or modified regimens; they were further randomized to receive pretreatment with the antiemetic ondansetron or placebo. The modified acetylcysteine regimen infused a total dose of 300 mg/kg over 12 hours, versus roughly 20 hours; it used a lower initial dose (100 mg/kg over 2 hours, vs. 150 mg/kg over 15 minutes in the U.K. and 1 hour in the U.S.).
The primary outcome — vomiting, retching, or the need for rescue antiemetics within 2 hours — was less frequent with the modified regimen (odds ratio, 0.26); it was also lower with ondansetron (OR, 0.41). Anaphylactoid reactions were also significantly lower with the modified regimen. Although the study was not powered to show noninferiority, increases in alanine aminotransferase were more common among those receiving ondansetron (OR, 3.30).
The authors and commentators call for confirmation of these findings before putting them into wider use.