Recommendations for the paracetamol treatment nomogram and side effects of N-acetylcysteine

A. Koppen*, A. van Riel, I. de Vries, J. Meulenbelt

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review


    Treatment of paracetamol intoxication consists of administration of N-acetylcysteine, preferably shortly after paracetamol ingestion. In most countries, the decision to treat patients with N-acetylcysteine depends on the paracetamol plasma concentration. In the literature, different arguments are given regarding when to treat paracetamol overdose. Some authors do not recommend treatment with N-acetylcysteine at low paracetamol plasma concentrations since unnecessary adverse effects may be induced. But no treatment with N-acetylcysteine at higher paracetamol plasma concentrations may lead to unnecessary severe morbidity and mortality. In this review, we provide an overview on the severity and prevalence of adverse side effects after N-acetylcysteine administration and the consequences these side effects may have for the treatment of paracetamol intoxication. The final conclusion is to continue using the guidelines of the Dutch National Poisons Information Centre for N-acetylcysteine administration in paracetamol intoxication.

    Original languageEnglish
    Pages (from-to)251-257
    Number of pages7
    JournalNetherlands Journal of Medicine
    Issue number5
    Publication statusPublished - 1 Jun 2014


    • Acetylcysteine
    • Adverse effects
    • Nomogram
    • Paracetamol


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