Oral therapy should preferentially be considered in patients with asthma or atopic histories. Oral acetylcysteine administration has resulted in minimal anaphylactoid reactions and is safer than i.v. State pharmacy laws dictate whether extemporaneous compounding of acetylcysteine from the oral formulation is allowed. acetylcysteine from the oral preparation is less expensive than using premade i.v. acetylcysteine whose pretreatment serum acetaminophen levels were nontoxic. Several investigators found an increased rate of anaphylactoid reactions in patients treated with i.v.
Dosing errors and hyponatremia have occurred in pediatric patients receiving i.v. acetylcysteine have generally been reported in 3–6% of acetaminophen-poisoned patients. acetylcysteine appear to be equally effective when given within 8–10 hours of acetaminophen overdose. The efficacy, safety, and cost issues that should be considered when deciding on the appropriate route of acetylcysteine for the treatment of patients with acetaminophen poisoning are reviewed.
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