A Cochrane review [Abstract] 1 included 11 studies with 700 participants. One trial (n=60) found that the mean percentage fall in plasma paracetamol concentration was significantly greater with activated charcoal compared with gastric lavage or ipecacuanha if given within four hours after ingestion (P=0.03). There was no significant difference between gastric lavage and ipecacuanha (P=0.081), although both were more effective than no treatment at limiting the absorption of paracetamol.
Acetylcysteine appeared superior to placebo and had fewer adverse effects when compared with dimercaprol or cysteamine. Acetylcysteine superiority to methionine was unproven. One small trial (low quality evidence) found that acetylcysteine may reduce mortality in people with fulminant hepatic failure (Peto OR 0.29, 95% CI 0.09 to 0.94). It is not clear which N-acetylcysteine treatment protocol offers the best efficacy.
Comment: The quality of evidence is downgraded by study limitations (lack of/unclear allocation concealment) and imprecise results (few patients and outcome events). .
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