- irrespective of plasma paracetamol level where the overdose is staggered (that is, taken over one hour or more) or there is doubt over the time of paracetamol ingestion
- where the timed plasma paracetamol concentration is on or above a single treatment line joining points of 100mg/L at 4 hours and 15mg/L at 15 hours on a revised overdose treatment nomogram, regardless of risk factors for hepatotoxicity.
The CHM has also made a number of other recommendations intended to reduce the risks to patients, including:
- an increase in the duration of administration of the first dose of intravenous acetylcysteine from 15 minutes to 1 hour
- the removal of hypersensitivity as a contraindication to treatment with acetylcysteine
- the provision of weight-based dosing tables for adults and children, removing the need to calculate the dose
- the inclusion of a Technical Information Leaflet for healthcare professionals in every pack of acetylcysteine, providing more detailed instructions on the preparation of acetylcysteine infusions.