The Use of Fomepizole with N-Acetylcysteine for Acetaminophen Overdose: A Scoping Review

Abstract

Specific Aims: N-acetylcysteine (NAC) has been the treatment of choice for acetaminophen toxicity but fomepizole’s mechanism of action can play a potential role. This systematic review aims to evaluate the use of fomepizole in acetaminophen overdose. Methods: This systematic review examined the use of fomepizole in acetaminophen overdose and included 13 publications. Medline, EMBASE, PubMed ePubs, and The Cochrane Library were used to locate articles and we used the PRISMA guidelines. For the articles that qualified, data was gathered using a review tool completed by all five independent reviewers. The criteria required that the studies mentioned acetaminophen toxicity; the control groups received NAC and fomepizole or another antidote; the study trial duration was greater than a day; and outcomes related to survival were reported. Results: This systematic review had a total of 42 patients with cases of acetaminophen overdose. Of the 42 patients, 36 of them survived their overdose when given fomepizole and NAC as treatment. The 7 patients who did not survive were not overdosing on solely acetaminophen. Kusnik et al. included a case of a 58-year-old female who presented with an APAP level of 126.3 μg/ml and was given fomepizole and NAC treatment. She survived and her kidney function greatly improved after 80 hours from admission. Conclusion: There are still no human studies available to indicate fomepizole’s safety and efficacy as adjunct therapy in acetaminophen overdose and further research is necessary. Current data has shown it may be an effective adjunct therapy to acetaminophen overdose.