The NACSTOP 2 trial: Investigation of the early cessation of N-acetylcysteine in patients following paracetamol overdose.

Paracetamol overdose is one of the most common presentations to emergency departments and is treated with a medication called N-acetylcysteine (NAC), which protects the liver from damage. The current standard treatment involves a continuous intravenous infusion over 20–21 hours, which typically means an overnight hospital stay. This is burdensome for patients and costly for the health system. Research suggests that many patients who took a paracetamol overdose — particularly those who arrive at hospital quickly and who have normal liver function after 12 hours of NAC — are very unlikely to develop any liver problems at all. The NACSTOP 2 trial is testing whether it is safe to stop NAC treatment after just 12 hours in these lower-risk patients, rather than continuing for the full 20–21 hours. All participants will remain in hospital for the standard 20-hour period so their liver function can be monitored. You may be eligible if you have taken a paracetamol overdose and have normal liver function tests and low paracetamol levels after 12 hours of NAC treatment. Patients with pre-existing liver disease, those who took modified-release paracetamol, those who took more than 10 grams over 24 hours, or those who used alcohol or sedating drugs alongside the paracetamol would not qualify.