Other therapy
The following treatments for paraquat poisoning aim to reduce oxidative stress and the inflammatory response, and increase paraquat transport out of cells.
Acetylcysteine is used as antioxidant therapy and is widely available. Consult a clinical toxicologist regarding whether to use acetylcysteine for paraquat poisoning. If acetylcysteine is indicated, an extended regimen is recommended.
If indicated for adults, for the initial 20-hour acetylcysteine regimen, use:
acetylcysteine 200 mg/kg (up to 22 g) in crystalloid solution 500 mL intravenously, over 4 hours1 paraquat poisoning - initial regimen
FOLLOWED BY
acetylcysteine 100 mg/kg (up to 11 g) in crystalloid solution 1000 mL intravenously, over 16 hours1.
Following the initial 20-hour regimen, continue an extended acetylcysteine regimen for the duration of admission. For adults, use:
acetylcysteine 100 mg/kg (up to 11 g) in crystalloid solution 1000 mL intravenously, over 16 hours1. Repeat for the duration of admission. paraquat poisoning - extended regimen
If indicated for children, for the initial 20-hour acetylcysteine regimen, use:
acetylcysteine 200 mg/kg in crystalloid solution 7 mL/kg (up to 500 mL) intravenously, over 4 hours1
FOLLOWED BY
acetylcysteine 100 mg/kg in crystalloid solution 14 mL/kg (up to 1000 mL) intravenously, over 16 hours1.
Following the initial 20-hour regimen, continue an extended acetylcysteine regimen for the duration of admission. For children, use:
acetylcysteine 100 mg/kg in crystalloid solution 14 mL/kg (up to 1000 mL) intravenously, over 16 hours1.
For information on immediate immune-mediated (non-IgE) hypersensitivity reactions to acetylcysteine therapy, see Immediate immune-mediated (non-IgE) hypersensitivity reactions to acetylcysteine.
In addition to acetylcysteine, corticosteroids are recommended as anti-inflammatory drugs. Use:
methylprednisolone 1 g (child 20 mg/kg up to 1 g) intravenously over 1 hour, daily for 3 days paraquat poisoning methylprednisolone
FOLLOWED BY
dexamethasone 8 mg (child: 0.2 mg/kg up to 8 mg) orally, every 8 hours, for a minimum of 2 weeks. paraquat poisoning dexamethasone
If the patient is unable to swallow, instead of oral dexamethasone, use:
dexamethasone 8 mg (child 0.2 mg/kg up to 8 mg) intravenously or intramuscularly, every 8 hours. Switch to oral therapy when the patient is able to swallow. Treat for a minimum of 2 weeks (parenteral plus oral). dexamethasone