SNAP out of hepatotoxicity with NAC
Paracetamol is one of the widely available medications and its poisoning is common across the world. N- acetyl cysteine (NAC) is being used as an antidote for the same. The conventional protocol for NAC is an infusion of 300mg/Kg over 21 hours. The downfall of this regimen is because of the higher incidence of dose related adverse effects.
SNAP regimen or Scottish and Newcastle Acetylcholine Protocol was developed to maintain constant concentration of NAC in the plasma and reduce initial peaking of drug concentration hence decreasing dose dependent adverse reaction.
SNAP regimen delivers 300mg/Kg NAC over 12 hours and it is said that at the end of 12 hours additional 200m/Kg can be given over next 10 hours.
Randomised controlled studies have sound that SNAP regimen is non inferior to 21hour conventional regimen and also the incidence anaphylactoid reaction and vomiting are less with SNAP regimen (probably because of lack of initial high peak of plasma NAC ).
