When the Antidote Is Not Enough: Fomepizole’s Second Act in Acetaminophen Toxicity

This presentation explores the rationale for adjunctive fomepizole with N-acetylcysteine (NAC) in acetaminophen overdose. While NAC therapy is highly effective if given within 8 hours following acute acetaminophen overdose, there are multiple clinical situations in which NAC can be less effective: delayed presentation, massive ingestion, or altered pharmacokinetics. By examining fomepizole utilization, this presentation challenges the assumption that NAC alone is always sufficient and highlights why fomepizole may prevent liver failure.