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Você está assistindo: De quanto em quanto tempo pode tomar paracetamol

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Background

Paracetamol (acetaminophen) is the most widely supplied non‐prescription analgesic in ns world. Paracetamol is generally taken in overdose either deliberately or unintentionally. In high‐income countries, paracetamol toxicity is der common cause of acute liver injury. There are various interventions come treat paracetamol poisoning, depending on the clinical status of ns person. These interventions incorporate inhibiting the absorption of paracetamol em ~ the gastrointestinal tract (decontamination), removed of paracetamol em ~ the vaso sanguíneo system, e antidotes come prevent a formation of, or to detoxify, metabolites.

Objectives

To assess ns benefits e harms that interventions para paracetamol overdosage regardless of of ns cause of ns overdose.

Search methods

We searched a Cochrane Hepato‐Biliary group Controlled Trials registro (January 2017), centro (2016, problem 11), MEDLINE (1946 to January 2017), Embase (1974 to January 2017), and Science citation Index expanded (1900 to January 2017). We also searched ns World health and wellness Organization internacional Clinical Trials it is registered Platform e ClinicalTrials.gov database (US nacional Institute of Health) para any continuous or completed trials (January 2017). Us examined ns reference list of pertinent papers established by the search e other released reviews.

Selection criteria

Randomised clinical trials assessing benefits and harms that interventions in people who have ingested der paracetamol overdose. A interventions might have been gastric lavage, ipecacuanha, or activated charcoal, or assorted extracorporeal treatments, or antidotes. Ns interventions can have to be compared com placebo, no decorrer intervention, or come each various other in differing regimens.

Data collection and analysis

Two review authors individually extracted dia from the included trials. We offered fixed‐effect and random‐effects Peto odds ratios (OR) com 95% to trust intervals (CI) for analysis that the análise outcomes. We used a Cochrane "Risk of bias" device to assess the risks of prejudice (i.e. Methodical errors leading to overestimation the benefits and underestimation of harms). We supplied Trial Sequential evaluation to ao controle risks of random errors (i.e. Toque of chance) e GRADE to assess a quality of a evidence e constructed "Summary that findings" tables using harrow software.

Main results

We figured out 11 randomised clinical trials (of which uma acetylcysteine trial era abandoned due to low number recruited), assessing several different interventions in 700 participants. A variety that interventions studied consisted of decontamination, extracorporeal measures, e antidotes to detoxify paracetamol"s toxicity metabolite; which contained methionine, cysteamine, dimercaprol, or acetylcysteine. There were no decorrer randomised clinical trials of agente that inhibit cytochrome P‐450 come decrease a activation of the toxic metabolismo N‐acetyl‐p‐benzoquinone imine.

Of ns 11 trials, só two had two common outcomes, and hence, us could only meta‐analyse two comparisons. Every of a remaining comparisons consisted of outcome dia from 1 trial only e hence their results estão presented as explained in the trials. Todos trial analyses lack power to accessibility efficacy. Furthermore, todos the trials to be at high risk of bias. Accordingly, a quality the evidence ser estar low or really low for all comparisons. Interventions that protect against absorption, such together gastric lavage, ipecacuanha, or caused charcoal were compared with placebo or durante intervention and with each various other in uma four‐armed randomised clinical trial entailing 60 participants com an uncertain randomisation procedure e hence very low quality. A trial presented results on lowering plasma paracetamol levels. Caused charcoal seemed to reduce the absorption of paracetamol, but ns clinical services were unclear. Set off charcoal seemed to have the best risk:benefit ratio amongst gastric lavage, ipecacuanha, or supportive therapy if given within four hours of ingestion. There seemed to be durante difference between gastric lavage and ipecacuanha, but gastric lavage and ipecacuanha seemed more effective than durante treatment (very low quality of evidence). Extracorporeal interventions consisted of charcoal haemoperfusion compared with conventional therapy (supportive treatment including gastric lavage, intravenous fluids, e fresh frozen plasma) in one trial com 16 participants. The mean cumulative amount that paracetamol removed era 1.4 g. One participant são de the haemoperfusion group who had ingested 135 g the paracetamol, died. There were no decorrer deaths in a conventional treatment group. Accordingly, we found no decorrer benefit of charcoal haemoperfusion (very low top quality of evidence). Acetylcysteine appeared superiores to placebo and had fewer adverse impacts when compared with dimercaprol or cysteamine. Acetylcysteine superiority come methionine ser estar unproven. One small trial (low high quality evidence) uncovered that acetylcysteine may reduce mortality in people com fulminant hepatic failure (Peto OR 0.29, 95% CI 0.09 come 0.94). The most current randomised clinical trials studied various acetylcysteine regimens, with the primary outcome being adverse events. It was unclear i beg your pardon acetylcysteine treatment protocol offered ns best efficacy, as many trials to be underpowered come look in ~ this outcome. One trial proved that naquela modified 12‐hour acetylcysteine regimen with naquela two‐hour acetylcysteine 100 mg/kg bodyweight loading dose was associated with significantly fewer adverse reactions contrasted with a traditional three‐bag 20.25‐hour regimen (low quality of evidence). Tudo de Trial Sequential Analyses showed lack of enough power. Crianças were not included in a majority that trials. Hence, ns evidence pertains só to adults.

Authors" conclusions

These results highlight the paucity that randomised clinical trials comparing various interventions ao paracetamol overdose e their courses of administration and the low or an extremely low level high quality of the evidence the is available. Proof from der single trial found activated charcoal seemed the best choice to reduce absorption that paracetamol. Acetylcysteine should be provided to civilization at threat of toxicity including human being presenting com liver failure. Additional randomised clinical trials com low danger of bias and adequate number of participants ~ ~ required to recognize which regimen results in the fewest adverse effects with the best efficacy. Existing management that paracetamol poisoning an international involves the administration the intravenous or oral acetylcysteine which is based mainly on observational studies. Results são de these observational studies suggest that treatment with acetylcysteine appears to result in der decrease in morbidity and mortality, However, further evidence em ~ randomised clinical trials comparing various treatments estão needed.