Acetylcysteine treatment for non-acetaminophen-induced acute liver failure

OBJECTIVE: To evaluate the effectiveness of intravenous acetylcysteine in the treatment of non-acetaminophen-induced acute liver failure (ALF). DATA SOURCES: A search of MEDLINE (1966-March 2003), International Pharmaceutical Abstracts (1970-2003), and Cochrane Library (2003, issue 3) databases was conducted, using the search terms acetylcysteine, non-acetaminophen-induced hepatic failure, liver failure, intravenous, and treatment. DATA SYNTHESIS: All of the studies found were small and do not provide conclusive evidence that acetylcysteine benefits this subgroup of patients. Microvascular regional benefits were seen, but clinical outcomes have not been studied. CONCLUSIONS: Intravenous acetylcysteine should not be used routinely for treatment of non-acetaminophen-induced ALF. Further large-scale studies are needed to evaluate clinical outcomes.