Cysteamine, Methionine, and Penicillamine in the Treatment of Paracetamol Poisoning

Effect of N-acetylcysteine on the pulmonary response to endotoxin in the awake sheep and upon in vitro granulocyte function.

“…These highly reactive radicals will preferentially bind to glutathione, thereby converting it to a nontoxic conjugate of cysteine, but the detoxifying mechanisms can be exhausted ifcysteine or glutathione stores are depleted (22). The sulfhydryl bond of cysteine seems to be the important element because similar results have been obtained with methionine and cysteamine (23,24). These compounds, along with NAC, are thought to work by providing substrate to replenish glutathione stores, or by competitively binding directly to the free radical species.…”

AASLD position paper

“…13 N-acetylcysteine (NAC), the antidote for acetaminophen poisoning, has been shown to be effective and safe for this purpose in numerous controlled trials. [15][16][17][18] The standard acetaminophen toxicity nomogram 19 may aid in determining the likelihood of serious liver damage, but cannot be used to exclude possible toxicity due to multiple doses over time, or altered metabolism in the alcoholic or fasting patient. 20 Given these considerations, administration of NAC is recommended in any case of ALF in which acetaminophen overdose is a suspected or possible cause.…”

The third Lilly Prize Lecture. University of London, January, 1979. The nephrotoxicity and hepatotoxicity of antipyretic analgesics.

“…Dimercaprol and D-penicillamine did not prevent severe liver damage and in our experience intravenous L-methionine was less effective than cysteamine (Prescott et al, 1976). The use of oral Lmethionine has been recommended, but again, did not always prevent severe liver damage (Crome, Vale, Volans, Widdop & Goulding, 1976).…”