- The specific antidote for acute paracetamol toxicity is N-acetylcysteine, which acts by replenishing hepatic glutathione stores.
- This allows detoxification of the toxic metabolite N-acetyl-p-benzoquinone imine (NAPQI), preventing hepatic cellular injury and fulminant liver failure.
- Early administration (preferably within 8–10 hours) significantly reduces morbidity and mortality.
- Methionine is an alternative but less commonly used. Atropine and flumazenil have no role in paracetamol poisoning management.

Reference: Davidson’s Principles and Practice of Medicine, 23rd Edition, Chapter: Disorders of Liver Function, Page 684.