Cochrane · systematic review · CD003328
Interventions for paracetamol (acetaminophen) overdose
Chiew, AL, Gluud, C, Brok, J, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
Hepato-BiliaryAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
24
current version
GRADE rated
22
No studies
2
Included studies
NR
No studies 2 · 8.3%Ungraded 0 · 0%Very low 14 · 58.3%Low 8 · 33.3%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Methionine and supportive treatment compared with supportive treatment for paracetamol (acetaminophen) overdose
Population: people with paracetamol (acetaminophen) overdose
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Methionine and supportive treatment vs supportive treatment | Peto OR 0.14 [0, 6.82] | 1 study · 26 participants | Very low Downgraded: risk of bias, imprecision |
Hepatotoxicity Methionine and supportive treatment vs supportive treatment | OR 0.05 [0.01, 0.53] | 1 study · 26 participants | Low Downgraded: risk of bias, imprecision |
Cysteamine compared with no intervention for paracetamol (acetaminophen) overdose
Population: people with paracetamol (acetaminophen) overdose
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Cysteamine vs no intervention | Peto OR 0.53 [0.05, 5.22] | 2 studies · 65 participants | Very low Downgraded: risk of bias, imprecision |
Hepatotoxicity (aspartate aminotransferase > 1000 IU/L) Cysteamine vs no intervention | OR 0.09 [0.02, 0.35] | 2 studies · 65 participants | Low Downgraded: risk of bias, imprecision |
Cysteamine compared with dimercaprol for paracetamol (acetaminophen) overdose
Population: people with paracetamol (acetaminophen) overdose
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Cysteamine vs dimercaprol | Peto OR 0.14 [0, 6.82] | 1 study · 52 participants | Very low Downgraded: risk of bias, imprecision |
Mean maximum alanine aminotransferase (IU/L) Cysteamine vs dimercaprol | no estimate extracted | 1 study · 52 participants | Low Downgraded: imprecision |
Cysteamine compared with methionine (randomised trials) for paracetamol (acetaminophen) overdose
Population: people with paracetamol (acetaminophen) overdose
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Cysteamine vs methionine (randomised trials) | no estimate extracted | 1 study · 27 participants | Very low Downgraded: risk of bias, imprecision |
Hepatotoxicity (aspartate aminotransferase > 1000 U/L) Cysteamine vs methionine (randomised trials) | OR 0.92 [0.05, 16.46] | 1 study · 27 participants | Very low Downgraded: risk of bias, imprecision |
Standard intravenous acetylcysteine regimen (20.5 hour) compared with shorter intravenous acetylcysteine regimen (12 hour) for paracetamol (acetaminophen) overdose
Population: people with paracetamol (acetaminophen) overdose
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Standard intravenous acetylcysteine regimen (20.5 hour) vs shorter intravenous acetylcysteine regimen (12 hour) | no estimate extracted | 1 study · 222 participants | Very low Downgraded: imprecision, indirectness |
Hepatotoxicity Standard intravenous acetylcysteine regimen (20.5 hour) vs shorter intravenous acetylcysteine regimen (12 hour) | OR 0.67 [0.11, 4.08] | 1 study · 202 participants | Very low Downgraded: imprecision, indirectness |
Vomiting, retching, or antiemetics from 0‐2 hours Standard intravenous acetylcysteine regimen (20.5 hour) vs shorter intravenous acetylcysteine regimen (12 hour) | OR 0.3 [0.17, 0.53] | 1 study · 217 participants | Low Downgraded: imprecision, indirectness |
Vomiting, retching, or antiemetics 0‐12 hours Standard intravenous acetylcysteine regimen (20.5 hour) vs shorter intravenous acetylcysteine regimen (12 hour) | OR 0.4 [0.22, 0.75] | 1 study · 203 participants | Low Downgraded: imprecision, indirectness |
Anaphylactoid symptoms Standard intravenous acetylcysteine regimen (20.5 hour) vs shorter intravenous acetylcysteine regimen (12 hour) | OR 0.39 [0.21, 0.7] | 1 study · 208 participants | Low Downgraded: imprecision, indirectness |
Oral compared with intravenous acetylcysteine for paracetamol (acetaminophen) overdose
Population: people with paracetamol (acetaminophen) overdose
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Oral vs intravenous acetylcysteine | no estimate extracted | 1 study · 66 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Hepatotoxicity Oral vs intravenous acetylcysteine | no estimate extracted | NR | No studies |
Nausea Oral vs intravenous acetylcysteine | OR 2.71 [1, 7.38] | 1 study · 66 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Vomiting Oral vs intravenous acetylcysteine | OR 2.1 [0.62, 7.12] | 1 study · 66 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Intravenous acetylcysteine compared with placebo in people with fulminant hepatic failure for paracetamol (acetaminophen) overdose
Population: people with fulminant hepatic failure secondary to paracetamol (acetaminophen) overdose
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Intravenous acetylcysteine vs placebo | Peto OR 0.29 [0.09, 0.94] | 1 study · 50 participants | Low Downgraded: risk of bias, imprecision |
Initial infusion rate of intravenous acetylcysteine over 15 minutes compared with 60 minutes for paracetamol (acetaminophen) overdose
Population: people with paracetamol (acetaminophen) overdose
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Initial infusion rate of intravenous acetylcysteine over 15 minutes vs 60 minutes | no estimate extracted | 1 study · 180 participants | Very low Downgraded: risk of bias, imprecision |
Hepatotoxicity Initial infusion rate of intravenous acetylcysteine over 15 minutes vs 60 minutes | OR 1.34 [0.39, 4.56] | 1 study · 175 participants | Very low Downgraded: risk of bias, imprecision |
Any adverse event Initial infusion rate of intravenous acetylcysteine over 15 minutes vs 60 minutes | OR 0.51 [0.27, 0.96] | 1 study · 180 participants | Low Downgraded: risk of bias, imprecision |
Oral plus intravenous acetylcysteine compared with intravenous acetylcysteine for paracetamol (acetaminophen) overdose
Population: people with paracetamol (acetaminophen) overdose
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Oral plus intravenous acetylcysteine vs intravenous acetylcysteine | no estimate extracted | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Hepatotoxicity Oral plus intravenous acetylcysteine vs intravenous acetylcysteine | no estimate extracted | NR | No studies |
Charcoal haemoperfusion compared with no intervention for paracetamol (acetaminophen) overdose
Population: people with paracetamol (acetaminophen) overdose
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Charcoal haemoperfusion vs no intervention | Peto OR 7.39 [0.15, 372.38] | 1 study · 16 participants | Very low Downgraded: risk of bias, imprecision, indirectness |