Paracetamol adducts following overdose treated with a shorter acetylcysteine infusion: findings from the NACSTOP 2 trial.
Clin Toxicol (Phila)Apr 20, 2026 (epub)
Anselm Wong, Laura P James, Richard McNulty et al.
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In 30 seconds
The NACSTOP 2 trial investigated the effects of a 12-hour versus a 20-hour acetylcysteine infusion on paracetamol adducts in low-risk overdose patients. This randomized controlled trial found no significant difference in median alanine transaminase levels (13 U/L vs 14 U/L, P = 0.46) or adduct concentrations (0.18 µmol/L vs 0.17 µmol/L, P = 0.43) between the two regimens.
Key findings
- Median alanine transaminase levels were 13 U/L in the 12-hour group and 14 U/L in the 20-hour group, P = 0.46.
- Adduct concentrations were 0.18 µmol/L in the abbreviated group and 0.17 µmol/L in the control group, P = 0.43.
- Both treatment regimens resulted in similarly low adduct concentrations in low-risk patients.
Why it matters
This study suggests that a shorter acetylcysteine infusion may be as effective as the standard duration in managing paracetamol overdose in selected low-risk patients, potentially leading to more efficient treatment protocols.