What is the antidote for acetaminophen overdose?

What is the antidote for acetaminophen overdose?

• A. N-acetylcysteine (Mucomyst)
• B. Flumazenil (Romazicon)
• C. Naloxone (Narcan)
• D. Activated charcoal

Answer: (A)

N-acetylcysteine is the antidote because it replenishes hepatic glutathione and provides a sulfhydryl group that directly conjugates with the toxic metabolite of acetaminophen (NAPQI). In overdose, glutathione stores are depleted, allowing NAPQI to bind liver cells and cause hepatocellular injury. NAC restores glutathione, enabling safer detoxification of NAPQI and reducing liver damage. It’s most effective when started early but can still help if given after some time. The other agents aren’t antidotes for acetaminophen toxicity: flumazenil reverses benzodiazepines, naloxone reverses opioids, and activated charcoal can limit absorption if given soon after ingestion but does not treat the toxin itself.

N-acetylcysteine is the antidote because it replenishes hepatic glutathione and provides a sulfhydryl group that directly conjugates with the toxic metabolite of acetaminophen (NAPQI). In overdose, glutathione stores are depleted, allowing NAPQI to bind liver cells and cause hepatocellular injury. NAC restores glutathione, enabling safer detoxification of NAPQI and reducing liver damage. It’s most effective when started early but can still help if given after some time.

The other agents aren’t antidotes for acetaminophen toxicity: flumazenil reverses benzodiazepines, naloxone reverses opioids, and activated charcoal can limit absorption if given soon after ingestion but does not treat the toxin itself.