Which treatment is indicated for an acetaminophen overdose?

In cases of acetaminophen overdose, the treatment of choice is acetylcysteine. Acetylcysteine works primarily as a precursor to glutathione, which helps the liver to detoxify and eliminate the toxic metabolite of acetaminophen, N-acetyl-p-benzoquinone imine (NAPQI). Early administration of acetylcysteine can significantly reduce the risk of liver damage and improve patient outcomes, especially when given within 8 to 10 hours of the overdose.

While activated charcoal is sometimes used to limit the absorption of certain toxins if administered shortly after ingestion, it is not specific to or particularly effective for acetaminophen overdose in clinical practice compared to acetylcysteine. Flumazenil and naloxone are antidotes used for benzodiazepine and opioid overdoses, respectively, but they do not address the toxic effects of acetaminophen. Therefore, acetylcysteine stands out as the primary and most effective treatment option for managing acetaminophen toxicity.