Tier 1 — highest

Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985)

M J Smilkstein, G L Knapp, K W Kulig, B H Rumack
N Engl J Med 1988 319(24):1557-1562

Bibliography

PubMed
PMID 3059186
DOI
10.1056/NEJM198812153192401
Funding
Funding disclosure was not located in the indexed record reviewed; consult the source publication for the full funding statement.
Competing interests
Competing-interest disclosure was not located in the indexed record reviewed; consult the source publication for the full declaration.

Study snapshot

DesignNational multicenter clinical study
ModelHuman
SampleMore than 2,500 evaluable poisoned patients within a program reporting over 11,000 cases
InterventionOral NAC loading dose 140 mg/kg followed by 70 mg/kg every 4 hours for 17 doses
Duration72-hour oral antidote protocol
EndpointsHepatotoxicity; Timing of treatment; Survival

What the study showed, in plain terms

Foundational evidence establishing oral NAC as an antidote for acetaminophen overdose.

Key findings

Early NAC treatment strongly reduced hepatotoxicity risk, with benefit declining as treatment was delayed.

What this study can and cannot tell us

Historical multicenter treatment cohort rather than a modern placebo-controlled overdose trial; medical antidote dosing is not comparable with supplement dosing.

Editorial review

Reviewed by the Biohack Blueprint research team

Last verified

Dr. Khaled Mahmoud, MBBChCritical Care Medicine, Longevity Science & Editorial Direction Dr. Amr Yasser, PhDCardiometabolic, Musculoskeletal, Gut & Bioavailability Dr. Abdulla Mostafa, PhDCellular Senescence, Neurological, Mitochondrial & Brain-Ageing Biology