Acetadote

Adult Dosing .

Dosage forms:  INJ

acetaminophen overdose

[acute ingestion period <24h]

Dose: 150 mg/kg/dose IV x1 over 60min, then 50 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; Info: refer to Rumack-Matthew nomogram to determine need for tx based on post-ingestion time; see pkg insert for dilution based on wt/fluid status; if pt >41 kg, may consider 200 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; use 100 kg dosing wt for pts >100 kg; may cont. tx at rate at least 6.25 mg/kg/h IV until acetaminophen level <10 mcg/mL, INR <2, ALT/AST return to baseline or decr. from peak by 25-50%, and pt clinically well; consider incr. dose if high-risk ingestion

[acute ingestion period unknown or >24h]

Dose: 150 mg/kg/dose IV x1 over 60min, then 50 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; Start: if acetaminophen level >10 mcg/mL or ALT/AST abnormal; Info: see pkg insert for dilution based on wt/fluid status; if pt >41 kg, may consider 200 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; use 100 kg dosing wt for pts >100 kg; may cont. tx at rate at least 6.25 mg/kg/h IV until acetaminophen level <10 mcg/mL, INR <2, ALT/AST return to baseline or decr. from peak by 25-50%, and pt clinically well; consider incr. dose if high-risk ingestion

[repeated supratherapeutic ingestion period >24h]

Dose: 150 mg/kg/dose IV x1 over 60min, then 50 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; Start: if acetaminophen level at least 20 mcg/mL or ALT/AST abnormal; Info: see pkg insert for dilution based on wt/fluid status; if pt >41 kg, may consider 200 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; use 100 kg dosing wt for pts >100 kg; may cont. tx at rate at least 6.25 mg/kg/h IV until acetaminophen level <10 mcg/mL, INR <2, ALT/AST return to baseline or decr. from peak by 25-50%, and pt clinically well

renal dosing

[see below]

renal impairment: no adjustment

HD: incr. continuous infusion rate to at least 12.5 mg/kg/h during dialysis; supplement not defined; PD: not defined

hepatic dosing

[not defined]

Peds Dosing .

Dosage forms:  INJ

acetaminophen overdose

[acute ingestion period <24h, >5 kg]

Dose: 150 mg/kg/dose IV x1 over 60min, then 50 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; Info: refer to Rumack-Matthew nomogram to determine need for tx based on post-ingestion time; see pkg insert for dilution based on wt/fluid status; if pt >41 kg, may consider 200 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; use 100 kg dosing wt for pts >100 kg; may cont. tx at rate at least 6.25 mg/kg/h IV until acetaminophen level <10 mcg/mL, INR <2, ALT/AST return to baseline or decr. from peak by 25-50%, and pt clinically well; consider incr. dose if high-risk ingestion

[acute ingestion period unknown or >24h, >5 kg]

Dose: 150 mg/kg/dose IV x1 over 60min, then 50 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; Start: if acetaminophen level >10 mcg/mL or ALT/AST abnormal; Info: see pkg insert for dilution based on wt/fluid status; if pt >41 kg, may consider 200 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; use 100 kg dosing wt for pts >100 kg; may cont. tx at rate at least 6.25 mg/kg/h IV until acetaminophen level <10 mcg/mL, INR <2, ALT/AST return to baseline or decr. from peak by 25-50%, and pt clinically well; consider incr. dose if high-risk ingestion

[repeated supratherapeutic ingestion period >24h, >5 kg]

Dose: 150 mg/kg/dose IV x1 over 60min, then 50 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; Start: if acetaminophen level at least 20 mcg/mL or ALT/AST abnormal; Info: see pkg insert for dilution based on wt/fluid status; if pt >41 kg, may consider 200 mg/kg/dose IV x1 over 4h, then 100 mg/kg/dose IV x1 over 16h; use 100 kg dosing wt for pts >100 kg; may cont. tx at rate at least 6.25 mg/kg/h IV until acetaminophen level <10 mcg/mL, INR <2, ALT/AST return to baseline or decr. from peak by 25-50%, and pt clinically well

renal dosing

[see below]

renal impairment: no adjustment

HD: incr. continuous infusion rate to at least 12.5 mg/kg/h during dialysis; supplement not defined; PD: not defined

hepatic dosing

[not defined]