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Drug Interactions between acetylcysteine and charcoal / sorbitol

This report displays the potential drug interactions for the following 2 drugs:

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Minor

acetylcysteine charcoal

Applies to: acetylcysteine and charcoal / sorbitol

A number of studies have been conducted to determine whether activated charcoal absorbs N-acetylcysteine (NAC) and, if so, whether the interaction is clinically significant. No specific therapeutic blood level has been determined for NAC, so studies that show decreases in the area under the plasma concentration-time curve (AUC) may not be relevant. One study has indicated that a 6-gram charcoal dose would absorb 96.2% of an NAC dose. Other studies have found little difference in the AUC, C(max), or T(max) when NAC is administered alone or without charcoal. In vitro studies have suggested that NAC may reduce the adsorptive capacity of charcoal. The clinical significance of this finding is unclear. Much of the timing depends on the overdose situation. When the overdose has occurred within the last hour, it may be reasonable to give charcoal, then wait to administer NAC until the laboratory has determined blood acetaminophen levels.

References

  1. Mann KV "Treatment of acetaminophen overdose when oral acetylcysteine therapy is not tolerated." Clin Pharm 7 (1988): 563-4
  2. Holdiness MR "Clinical pharmacokinetics of N-acetylcysteine." Clin Pharmacokinet 20 (1991): 123-34
  3. Renzi FP, Donovan JW, Martin TG, Morgan L, Harrison EF "Concomitant use of activated charcoal and N-acetylcysteine." Ann Emerg Med 14 (1985): 568-72
  4. Watson WA, McKinney PE "Activated charcoal and acetylcysteine absorption: issues in interpreting pharmacokinetic data." DICP 25 (1991): 1081-4
  5. North DS, Peterson RG, Krenzelok EP "Effect of activated charcoal administration on acetylcysteine serum levels in humans." Am J Hosp Pharm 38 (1981): 1022-4
  6. Smilkstein MJ "A new loading dose for N-acetylcysteine? The answer is no." Ann Emerg Med 24 (1994): 538-9
  7. Spiller HA, Krenzelok EP, Grande GA, Safir EF, Diamond JJ "A prospective evaluation of the effect of activated charcoal before oral N-acetylcysteine in acetaminophen overdose." Ann Emerg Med 23 (1994): 519-23
  8. Brent J "Are activated charcoal-N-acetylcysteine interactions of clinical significance?" Ann Emerg Med 22 (1993): 1860-2
  9. Perrone J, Hoffman RS, Goldfrank LR "Special considerations in gastrointestinal decontamination." Emerg Med Clin North Am 12 (1994): 285-99
  10. Rose SR "Subtleties of managing acetaminophen poisoning." Am J Hosp Pharm 51 (1994): 3065-8
  11. Tenenbein PK, Sitar DS, Tenenbein M "Interaction between N-acetylcysteine and activated charcoal: implications for the treatment of acetaminophen poisoning." Pharmacotherapy 21 (2001): 1331-6
View all 11 references

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Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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