AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |
Back to Blog
Acetaminophen antidote iv3/2/2024 Notwithstanding these concerns, there may be a case to be made that children, particularly those 12 years old and younger, may be different in their responses to acetaminophen overdose and the administration of acetylcysteine. 15 The small percentage of young children in that trial may portend the difficulties in enrolling sufficient numbers of patients to study acetylcysteine and may reflect the prevalence of potential acetaminophen toxicity in this age group. In the largest multicenter, open-label trial of oral acetylcysteine in the United States to date, 2540 patients were prospectively studied, 3.3% of whom were less than 5 years of age, but no subgroup analysis was reported. 9, 13, 14 Pharmacokinetic data for acetylcysteine in children and adolescents are lacking. 12 The serum elimination half-life of acetylcysteine in preterm neonates is 11 hours compared to 2.5 to 5.6 hours in adults. 11 A study performed in the 1970s showed the proportion of acetaminophen metabolites following therapeutic doses of acetaminophen in newborn infants differed from that in children ages 3 to 9 and from those in 12 year olds and adults (which did not differ from each other). Evidence from a 2015 Australian study of acetaminophen overdose indicated that adolescents (12–17 years of age) are different than adults in several meaningful ways, for example, adolescents are more likely to ingest acetaminophen alone, without other drugs or alcohol will take an acute overdose rather than use supratherapeutic doses chronically and experience a histamine-release anaphylactoid reaction to IV acetylcysteine. The assessment and treatment of acetaminophen overdose is based principally on experiences in adults. 3, 10Ĭase series studies of the use of acetylcysteine for acetaminophen overdoses in pediatric patients, particularly patients who are preteenaged, preschool, and neonates, are sparse. 10 Some reasons for alternative regimens are to reduce treatment interruption resulting from adverse effects, to reduce drug administration errors resulting from complexity of the standard regimen, to reduce utilization of hospital resources and staff, and to tailor duration of therapy to patient-specific factors. The current 21-hour regimen in the United States is similar to the 20.25-hour regimen developed in the United Kingdom in 1979, except that the first dose is administered over 15 minutes in the UK instead of 60 minutes. 9 This regimen delivers 300 mg/kg acetylcysteine over 21 hours. The current US Food and Drug Administration-approved package insert for intravenous acetylcysteine (Acetadote Cumberland Pharmaceuticals, Nashville, TN) describes a “3-bag method” of administration in which a loading dose of 150 mg/kg in 200 mL of 5% dextrose is infused over 1 hour, followed by a second dose of 50 mg/kg in 500 mL infused over 4 hours, and a third dose of 100 mg/kg in 1000 mL infused over 16 hours. The authors' experience complements those of several other recent reports of alternative intravenous (IV) regimens administered to adult 5–7 and pediatric 8 patients. The paper by Pauley et al 4 in the current issue of The Journal describes an off-label regimen for the intravenous administration of acetylcysteine for treating acetaminophen overdose in pediatric patients. Although the use of acetylcysteine by oral or intravenous administration for the treatment of acetaminophen overdose is generally effective and safe, 1–3 there are aspects of its administration that may be “gray” and less than optimal for several reasons.
0 Comments
Read More
Leave a Reply. |