N‐acetylcysteine in Acute Organophosphorus Pesticide Poisoning: A Randomized, Clinical Trial

Abstract

Organophosphorus poisoning is a major global health problem with hundreds of thousands of deaths each year. Research interest in N-acetylcysteine has grown among increasing evidence of the role of oxidative stress in organophosphorus poisoning. We aimed to assess the safety and efficacy of N-acetylcysteine as an adjuvant treatment in patients with acute organophosphorus poisoning. This was a randomized, controlled, parallel-group trial on 30 patients suffering from acute organophosphorus poisoning, who were admitted to the Poison Control Center of Tanta University Emergency Hospital, Tanta, Egypt, between April and September 2014. Interventions included oral N-acetylcysteine (600 mg three times daily for 3 days) as an added treatment to the conventional measures versus only the conventional treatment. Outcome measures included mortality, total dose of atropine administered, duration of hospitalization and the need for ICU admission and/or mechanical ventilation. A total of 46 patients were screened and 30 were randomized. No significant difference was found between both groups regarding demographic characteristics and the nature or severity of baseline clinical manifestations. No major adverse effects to N-acetylcysteine therapy were reported. Malondialdehyde significantly decreased and reduced glutathione significantly increased only in the NAC-treated patients. The patients on NAC therapy required less atropine doses than those who received only the conventional treatment; however, the length of hospital stay showed no significant difference between both groups. The study concluded that the use of N-acetylcysteine as an added treatment was apparently safe, and it reduced atropine requirements in patients with acute organophosphorus pesticide poisoning.Organophosphorus (OP) insecticides are among the most important pesticides, and poisoning induced by them represents a major global health problem with hundreds of thousands of deaths each year, mostly in developing countries [1].Organophosphorus pesticides inhibit esterase enzymes, especially acetylcholinesterase, which results in accumulation of acetylcholine at cholinergic synapses and overstimulation of cholinergic receptors of the autonomic nervous system, central nervous system (CNS) and neuromuscular junctions [2].Acute toxicity produces a range of clinical manifestations, known as the acute cholinergic crisis. Depending on the type of receptors and their location, the clinical features may include muscarinic (bronchospasm,

Neurotoxicity in acute and repeated organophosphate exposure

“…N-acetylcysteine (NAC) is an antioxidant compound used in the treatment of acetaminophen overdose, which may also be a useful adjunct to the traditional standard of care after acute OP exposure. In a randomized, controlled, parallel-group clinical trial, intravenous NAC was shown to reduce the amount of atropine required for symptomatic relief after acute organophosphate poisoning (El-Ebiary et al, 2016). Recently it has also been shown that the essential omega-3 polyunsaturated fatty acid alpha-linolenic acid can rescue soman induced behavior deficits in rats and to reduce rates of corresponding cell death in multiple brain regions (Pan et al, 2015).…”

Common Drugs with Effective Off-Label Uses

“…D) Organophosphate Poisoning: NAC is safe and it can be used as an adjuvant to treatment in patients suffering from organophosphate poisoning, also there is no adverse effects were reported with its use. However, NAC had no significant effect on length of hospitalization and its use may provide an extra benefit through the reduction of atropine requirements and hence the proposed adverse effects resulting from a large dose of atropine used in these cases of poisonings [49]. E) Prevention of Contrast-Induced Nephropathy: one randomized double-blind study shown that oral NAC 600 mg twice daily on the day before and the day of the CT scan compare to placebo indicate that acute renal failure occurred in 21% of placebo subjects compared with 2% in the NAC group.…”

Trends in the Recent Patent Literature on Cholinesterase Reactivators (2016–2019)

“…Furthermore, these substances have remarkable importance for agricultural purposes. For instance, pesticides play an important role in combating the pests that cause damages to agricultural crops so that it is possible to enhance productivity [2]. Despite the important application of these compounds, their toxic effects are extremely harmful to humans, animals, and the environment, with high contamination rates.…”