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February 2, 2026Clinical Toxicology0 citations

We need a standardized North American acetylcysteine dosing regimen for the treatment of paracetamol (acetaminophen) poisoning

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MTMILTON TENENBEIN

Key Points

  • To establish a standardized acetylcysteine dosing regimen for treating paracetamol poisoning in North America.
  • Commissioning an expert panel by North American clinical toxicology societies.
  • Reviewing existing studies and conducting a systematic review and meta-analysis.
  • Evaluating the differences between one-bag two-step and two-bag regimens.
  • No significant advantage found for the one-bag two-step regimen over the two-bag approach.
  • Evidence suggests that a two-bag regimen may have unique safety benefits.

Abstract

There is a need for a North American acetylcysteine regimen. The four North American clinical toxicology societies should commission an expert panel with the mandate to recommend a specific acetylcysteine dosing regimen for the treatment of paracetamol (acetaminophen) poisoning. The recent systematic review and meta-analysis, the lack of published data showing the advantage of the one-bag two-step regimen over the two-bag approach, and its unique hazard support a two-bag regimen.

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MILTON TENENBEIN (2026) studied this question.

synapsesocial.com/papers/6980fd60c1c9540dea80f102https://doi.org/10.1080/15563650.2025.2571457
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