Evaluation of Dosing Strategies of N-acetylcysteine for Acetaminophen Toxicity in Patients Greater than 100 Kilograms: Should the Dosage Cap Be Used?

Baum, Regan A.; Woolum, Jordan A.; Bailey, Abby M.; Howell, Molly; Weant, Kyle A.; Geraghty, LeeAnn; Mohan, Sanjay; Webb, Ashley N.; Su, Mark; Akpunonu, Peter; Dugan, Adam J.; Atchison, Leanne; DeWitt, Kyle M.; Doolin, Meagan; Howland, Mary Ann; Lingenfelter, Erin; Neitzel, Tara; Sloan, C; Wong, Paul C.

doi:10.1007/s13181-021-00822-x

Cited by 6 publications

(3 citation statements)

References 15 publications

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“…These include body surface area, metabolic capacity, and characteristics of the drug (lipophilicity and hydrophilicity). Enzyme activity, such as UGT, which is upregulated in the presence of hepatic steatosis is relevant as well [49]. Another relevant aspect such as genderbased pharmacology data must be considered and would merit a specific overview.…”

Section: Discussionmentioning

confidence: 99%

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Drug dosing in children with obesity: a narrative updated review

et al. 2022

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Childhood obesity and its associated comorbidities are highly prevalent diseases that may add to any other possible health problem commonly affecting the pediatric age. Uncertainties may arise concerning drug dosing when children with obesity need pharmacologic therapies. In general, in pediatric practice, there is a tendency to adapt drug doses to a child’s total body weight. However, this method does not consider the pharmacological impact that a specific drug can have under a two-fold point of view, that is, across various age and size groups as well. Moreover, there is a need for a therapeutic approach, as much as possible tailored considering relevant interacting aspects, such as modification in metabolomic profile, drug pharmacokinetics and pharmacodynamics. Taking into account the peculiar differences between children with overweight/obesity and those who are normal weight, the drug dosage in the case of obesity, cannot be empirically determined solely by the per kg criterion. In this narrative review, we examine the pros and cons of several drug dosing methods used when dealing with children who are affected also by obesity, focusing on specific aspects of some of the drugs most frequently prescribed in real-world practice by general pediatricians and pediatric subspecialists.

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Section: Discussionmentioning

confidence: 99%

“…N-acetylcysteine (NAC) is the antidote to paracetamol poisoning, but currently there are no data to support its use for patients > 100 kg. A recent study of patients with obesity treated with this antidote has shown that increasing the dose did not cause liver damage, defined as an AST or ALT ≥100 IU/L [49].…”

Section: Analgesicsmentioning

confidence: 98%

Drug dosing in children with obesity: a narrative updated review

et al. 2022

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“…The study by Baum et al in this issue of the Journal comparing "capped" versus "uncapped" dosing strategies of Acetadote® in obese patients with an acetaminophen overdose demonstrates the challenges we continue to face managing acetaminophen poisoned patients and the issues that we tussle with [2]. Much has changed managing these patients; much is still unknown.…”

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confidence: 99%