E-DRUG: Activated charcoal and methionine in paracetamol overdose
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[The moderator has identified a Cochrane review from 2006 which is probably the best reply to the problem: Brok J et al. Interventions for paracetamol (acetaminophen) overdose. http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003328/frame.html.\]
Dear E-druggers,
Currently we are experiencing a stockout of N-acetyl cysteine at the government hospitals in Sri Lanka. As methionine is still available we are using oral methionine for most patients with paracetamol overdose. However methionine is known to interact with activated charcoal which is also used in the management of paracetamol poisoning. According to the Martindale (2005) activated charcoal is best cleared from the stomach when a specific oral antidote such as methionine is given since adsorption of the antidote may decrease effectiveness. I would grately value any practical advice/literature on how to do this in clinical practice.
Dr.Ruwan Chandana MBBS MD
Lecturer in Clinical Pharmacology
Dept. of Pharmacology
Faculty of Medicine
University of Ruhuna
Sri Lanka
T.P. +94 77 3750381
ruwanprsd@yahoo.com