Table of Contents
ISRN Toxicology
Volume 2013, Article ID 494357, 5 pages
Research Article

Impact of Amending the Acetylcysteine Marketing Authorisation on Treatment of Paracetamol Overdose

1Acute Medical Unit, York Teaching Hospital NHS Foundation Trust, Wigginton Road, York YO31 8HE, UK
2Emergency Department, York Teaching Hospital NHS Foundation Trust, UK

Received 24 May 2013; Accepted 30 June 2013

Academic Editors: G. Borbély and B. A. Wilson

Copyright © 2013 G. Thompson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


In September 2012, the Medicines and Healthcare products Regulatory Agency (MHRA) substantially amended the Marketing Authorisation for acetylcysteine following an extensive review. The present study examined the impact of this license change on patterns of acetylcysteine use in patients presenting to hospital after paracetamol (acetaminophen) overdose. Between September 2011 and April 2013, 785 consecutive patients presented to York Hospital due to paracetamol overdose, and a before-after analysis was used to compare outcomes. There were 483 patients before and 302 patients after the license amendment, and age, gender, acute or staggered overdose pattern, and dose were similar in both groups. In the patients with paracetamol concentrations between the “100-line” and “200-line,” a significantly higher proportion received acetylcysteine treatment (51% before versus 98% after, ), as expected. A modest increase was also observed in relation to late or staggered overdose or cases where the time of ingestion was uncertain (53% versus 74%, ). The median duration of hospital stay increased across the entire study population, from 15 to 24 hours ( ) due to the increased proportion of patients requiring acetylcysteine treatment. The findings indicate that the MHRA amendment is a financially costly intervention, and further studies are needed to examine clinical outcomes so that its cost effectiveness might be addressed.