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N-acetylcysteine (NAC)

Presentation

2g in 10ml ampoule

Role

  • Management of toxic paracetamol exposure as per the 2019 MJA guideline for the management of paracetamol poisoning in Australia and New Zealand1.
  • Management of other selected drug exposures (e.g. paraquat, amatoxin, clove oil).

Dose

  • 1st bag – 200mg/kg of NAC in 500mL crystalloid over 4 hours
  • 2nd bag –100mg/kg of NAC in 1000mL crystalloid over 16 hours
  • If paracetamol level is more than twice the nomogram and >100mg/L use a double strength 2nd bag: 200mg/kg of NAC in 1000mL crystalloid over 16 hours
N-acetylcysteine (NAC)

Stocking recommendations

Tertiary centre Regional centre Rural centre Remote centre
40 ampoules (at least) 40 ampoules 20 ampoules (at least) 20 ampoules

Rationale

Paracetamol is the most commonly taken drug in overdose in Australia. Its antidote, acetylcysteine, should be stocked at all Queensland Health facilities.

At least 20 ampoules are recommended as this is sufficient for a single treatment course in a 110kg patient.

At remote sites where paracetamol levels are not available, it is often preferable to treat patients who have ingested a toxic dose of paracetamol, rather than organise transfer for levels.

Disclaimer

Fact sheet developed by Queensland Poisons Information Centre, Updated: July 2020.

This fact sheet is about the use of these antidotes in Australia, and may not apply to other countries. Children’s Health Queensland Hospital and Health Service cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this fact sheet.

References

  1. Chiew A et al. Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand. MJA 2019 doi:10.5694/mja2.50428

CHQ