Interventions for paracetamol (acetaminophen) overdose

Area of Science:

• Toxicology
• Clinical Pharmacology
• Evidence-Based Medicine

Background:

• Paracetamol (acetaminophen) overdose is a common cause of acute liver injury in high-income countries.
• Interventions for paracetamol poisoning aim to inhibit absorption, remove the drug, or detoxify its metabolites.
• Treatment strategies vary based on the patient's clinical status.

Purpose of the Study:

• To assess the benefits and harms of various interventions for paracetamol overdosage.
• To evaluate treatments irrespective of the cause of overdose.

Main Methods:

• Systematic review of randomized clinical trials (RCTs) identified through extensive database searches.
• Data extraction and analysis using fixed-effect and random-effects models.
• Assessment of risk of bias, trial sequential analysis, and GRADE for evidence quality.

Main Results:

• Eleven RCTs involving 700 participants were identified, but most were underpowered and at high risk of bias.
• Activated charcoal showed potential in reducing paracetamol absorption, with unclear clinical benefits.
• Acetylcysteine appeared superior to some antidotes and may reduce mortality in fulminant hepatic failure, though optimal regimens require further study.

Conclusions:

• There is a paucity of high-quality RCTs on paracetamol overdose interventions.
• Activated charcoal may be the best option for reducing absorption if given within four hours.
• Further rigorous RCTs are needed to establish optimal acetylcysteine regimens and compare different treatment strategies for paracetamol poisoning.