There are a number of dosing protocols for the administration of IV N-acetylcysteine (NAC) following a toxic paracetamol ingestion. Commonly, a three-bag, 21-hour regimen was used. More recently, a simplified, two-bag, 20-hour regimen was suggested. In February 2025, Nakatsu and colleagues published their systematic review and meta-analysis of studies comparing the two regimens. Eligible studies included more than 7600 patients. Their findings concluded that the 2-bag protocol was associated with fewer non-allergic anaphylactic reactions and other adverse events and was non-inferior in terms of preventing hepatic injury. Whatever regimen is used, the aim is to give 300mg/kg IV of NAC in the first 20-24 hours.

Read the abstract here.