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| |  Refinement Recommended For Acetaminophen Overdose Treatment HERSHEY, PA -- March 19, 1998 --The typical length of treatment for acetaminophen overdose is three days, and often the use of the antidote, N-acetylcysteine, is not used after 24 hours. J. Ward Donovan, M.D. associate professor of medicine at Penn State's College of Medicine, says this treatment method needs to be closely examined and, in some cases, changed. "Many facilities will not use N-acetylcysteine after 24 hours for fear of toxicity. We have found it to be between 20 and 40 percent effective after 24 hours and we feel it can be used at anytime," Donovan said. "We have also found that some patients need only one day of treatment rather than three days. It is really a case-by-case situation, but we are suggesting that there can be some variability in treatment." Donovan, who is the chief of medical toxicology at Hershey Medical Center, which is part of the Penn State Geisinger Health System, said physicians here have treated more patients with the intravenous form of N-acetylcysteine than anywhere else in the country. Donovan says several studies were done based on work with 250 patients and he estimates that another 100 have been treated here over the past 10 years. Donovan will discuss his treatment for acetaminophen poisoning at the International Toxicology Congress, European Association of Clinical Toxicologists in Zurich, Switzerland on March 25, 1998. Acetaminophen is the active ingredient in Tylenol and other pain relievers. In 1996 there were approximately 73,000 cases in the United States of pure acetaminophen poisoning. According to Donovan, while some of these cases involved children who got into the drug accidentally, the vast majority were suicide attempts. Of those 73,000 cases, 580 resulted in major liver damage. Donovan's research shows that treating patients eight hours or less after the ingestion of acetaminophen with N-acetylcysteine is nearly 100 percent effective in preventing any liver damage. He says treatment from eight to 16 hours after ingestion is about 60 percent effective. After 16 hours the percent of effectiveness continues to decline. "While many facilities may be concerned about the threat of toxicity after 24 hours, we have found N-acetylcysteine to be effective,” Donovan added. “And, while some patients can be treated in a day, we have had other cases where the treatment has lasted four or five days. Treatment depends on a number of factors so we think three days of treatment may not be appropriate in all cases."
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