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There is a risk of liver damage, particularly in elderly, young children, patients with liver disease, chronic alcoholism, chronic malnutrition and in patients receiving enzyme inducers. Overdose may be fatal in these cases.
Acute toxicity symptoms generally appear within 24 hours and include: nausea, vomiting, anorexia, pallor, and abdominal pain. When administered in excessive dose, patients experience liver failure, metabolic acidosis, encephalopathy which may lead to coma and death. In particular, liver necrosis is caused by activating liver's transaminase, lactose dehydrogenase, and bilirubin.
Simultaneously, increased levels of hepatic transaminases (AST, ALT), lactate dehydrogenase and bilirubin are observed together with decreased prothrombin levels that may appear 12 to 48 hours after administration. Clinical symptoms of liver damage are usually evident initially after two days, and reach a maximum after 4 to 6 days.
Treatment for an overdose includes the oral or intravenous administration of the antidote N-acetylcysteine (NAC), if possible before the 10 hours. However, NAC may give some degree of protection even after 10 hours, and prolonged treatment should be given in this case.
