N-acetylcysteine (NAC) is the proven, standard antidote for acetaminophen overdose because it directly prevents liver damage when given promptly. Acetaminophen toxicity depletes glutathione, a key liver antioxidant, allowing toxic metabolites to injure liver cells. NAC works by restoring glutathione levels, neutralizing these toxins, and improving liver blood flow. It is highly effective when started early, especially within 8–10 hours, but still offers benefits even after liver injury begins. NAC can be given orally or intravenously, is well studied, and has a strong safety profile under medical supervision. Because it targets the root cause of toxicity and consistently reduces the risk of acute liver failure and death, NAC remains the global standard of care in emergency and toxicology settings.
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