Effect of antidotal N-acetylcysteine on the pharmacokinetics of acetaminophen in dogs

Species comparison of oral bioavailability, first-pass metabolism and pharmacokinetics of acetaminophen

Species differences in oral bioavailability, first-pass metabolism and pharmacokinetics of biopharmaceutics classification system (BCS) class I compound acetaminophen were studied. The absolute bioavailability was 42.2%, 39.0%, 44.5%, 75.5% and 91.0% in chickens, turkeys, dogs, pigs and horses, respectively. After hydrolysis of metabolites by beta-glucuronidase/sulfatase, apparent bioavailability increased significantly in all species (turkeys: 72.4%, dogs: 100.5%, pigs: 102.2%), except horses (91.6%). Mean metabolic ratios of [acetaminophen glucuronide]/[acetaminophen] between 0 and 1h were significantly higher after oral dosing in turkeys, dogs and pigs, revealing the role of first-pass metabolism in incomplete bioavailability. Evidence of species differences in acetaminophen metabolism is provided by differences in plasma clearance, which was inversely proportional to bioavailability. In conclusion, differences in BA appeared to originate predominantly from differences in first-pass metabolism, demonstrating that the BCS high permeability classification of acetaminophen is consistent across the mammalian species studied. In turkeys, however, incomplete absorption additionally seemed to contribute to the low BA.

S-adenosyl-L-methionine (SAMe) for the treatment of acetaminophen toxicity in a dog

An 8-month-old, spayed female Shetland sheepdog presented 48 hours after ingesting acetaminophen (1 gm/kg body weight). On presentation, the dog was laterally recumbent and hypovolemic. The dog had brown mucous membranes, severe Heinz-body hemolytic anemia, bleeding tendencies, and a red blood cell (RBC) glutathione (GSH) concentration that was 10% of reference values, despite a regenerative erythroid response. Treatment with s-adenosyl-l-methionine (SAMe) as a GSH donor successfully rescued this dog, despite the animal's late presentation after drug ingestion. A loading dose (40 mg/kg body weight) of a stable SAMe salt per os was followed by a maintenance dose (20 mg/kg body weight) sid for 7 days. Additional therapeutic interventions included an intravenous (i.v.) infusion of one unit of packed RBCs (on admission), i.v. fluid support (3 days), and famotidine (7 days) to reduce gastric acidity. Sequential assessment of RBC GSH concentrations and RBC morphology documented response to antidote administration within 72 hours. This case suggests that SAMe may provide a therapeutic option for treatment of acetaminophen toxicosis in dogs capable of retaining an orally administered antidote and maintaining adequate hepatic function for metabolism of SAMe to its thiol substrates.

Comparative pharmacokinetics of paracetamol (acetaminophen) and its sulphate and glucuronide metabolites in desert camels and goats

Paracetamol was administered at dosages of 5 mg/kg to camels and 10 mg/kg to goats by the intravenous and intramuscular routes. Parent paracetamol had a significantly slower clearance (21.9 +/- 1.4 mL/min.kg. vs. 52.8 +/- 7.3 mL/min.kg) (P < 0.01) in camels than in goats. In camels the predominant metabolite in plasma was the sulphate, although the ratios of glucuronide:paracetamol and sulphate:paracetamol were similar (5.20 +/- 0.50 vs. 6.59 +/- 0.51) following intravenous administration. In goats the glucuronide metabolite was the predominant moiety in plasma, and the area under the curve (AUC) of the sulphate was only 3.89% of that of the glucuronide conjugate. The apparent AUC for paracetamol in the camel following intramuscular administration was larger than that following intravenous administration, however, when the bioavailability (F) was determined, with correction for altered half-life, within the animal and between study phases it was 71 +/- 17% in goats and 105 +/- 26% in camels.