Trends in rates of acetaminophen‐related adverse events in the United States

Major, Jacqueline M.; Zhou, Esther H.; Wong, Hui-Lee; Trinidad, James P.; Pham, Tracy; Mehta, Hina; Ding, Yu; Staffa, Judy A.; Iyasu, Solomon; Wang, Cunlin; Willy, Mary E.

doi:10.1002/pds.3906

Cited by 47 publications

(39 citation statements)

References 22 publications

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“…2,3 Because of its over-the-counter availability and frequent use, intentional and unintentional paracetamol overdosing is common in clinical practice, and paracetamol-induced liver failure is indeed the leading cause of liver transplantations in the United States. 1,4 Zhou and colleagues recently investigated the frequency of unintentional paracetamol overdosing in a tertiary care hospital and reported that 6Á6% of paracetamol users exceeded the recommended maximum dose of 4 g/day. 5 Civan et al performed a similar analysis and reported overdosing in 2Á6%.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Paracetamol overdosing in a tertiary care hospital: implementation and outcome analysis of a preventive alert programme

et al. 2016

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WHAT IS KNOWN AND OBJECTIVES Paracetamol is a frequently used antipyretic and analgesic drug, but also a dose-dependent hepatotoxin. Unintentional paracetamol overdosing is a common medication error in hospitals. The present study aimed at (i) analysis of unintentional paracetamol overdosing in hospitalized patients; (ii) development, implementation and outcome analysis of an alert algorithm for the prevention of relevant paracetamol overdosing. METHODS All patients who received paracetamol in a Swiss tertiary care hospital during 2011 to 2014 were analysed to detect cases of paracetamol overdosing in a local pharmacoepidemiological database. In 2014, an automated algorithm screened the hospital's electronic prescribing system for patients at risk of overdosing, followed by expert validation. When imminent relevant overdosing was confirmed, alerts were issued to prescribers. Relevance was defined as prescriptions that permitted repeated daily paracetamol exposure of 5 g. RESULTS AND DISCUSSION From 2011 to 2013, relevant overdosing occurred in 11 patients (5-8 g/day for 3 to 5 days), which corresponds to 0·4 % of all patients exposed to any paracetamol overdosing (mean n = 988 per year). In 2014, alerts were issued by experts in 23 cases with subsequent changes to prescriptions in 21 (91·3 %) thereof. Although the occurrence of any paracetamol overdosing declined only marginally in 2014 (n = 914), no relevant overdosing occurred anymore. WHAT IS NEW AND CONCLUSION Unintentional paracetamol overdosing was frequent but only a small fraction thereof was deemed relevant. This proof of concept study analysed local hospital data and developed a preventive system combining sensitive automated detection with subsequent specific expert validation. The resulting alerts achieved high compliance and prevented relevant paracetamol overdosing. SUMMARYWhat is known and objectives: Paracetamol is a frequently used antipyretic and analgesic drug, but also a dose-dependent hepatotoxin. Unintentional paracetamol overdosing is a common medication error in hospitals. The present study aimed at 1)Analysis of unintentional paracetamol overdosing in hospitalized patients; 2)Development, implementation and outcome of an alert algorithm for the prevention of considerable paracetamol overdosing. Methods:All patients who received paracetamol in a Swiss tertiary care hospital during 2011 to 2014 were analysed to detect cases of paracetamol overdosing in a local pharmacoepidemiological database. In 2014 an algorithm screened the hospital's electronic prescribing system for patients at risk of considerable overdosing, followed by expert validation. When such overdosing was confirmed as imminent, alerts were issued to prescribers. Considerable overdosing was defined as prescriptions that permitted repeated daily paracetamol exposure of ≥ 5 g. Results and What is new and Conclusion:This proof of concept demonstrates that analyzing local hospital data allows the development of alert algorithms that successfully prevent relevant medi...

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Section: What Is Known and Objectivementioning

confidence: 99%

Paracetamol overdosing in a tertiary care hospital: implementation and outcome analysis of a preventive alert programme

et al. 2016

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“…Un estudio realizado en Chile documentó que las intoxicaciones por medicamentos corresponden al 0,5% del total de admisiones en los servicios de urgencias, y de ellas, el 6,8% son debidas a intoxicación por acetaminofén (9,10), es decir, la frecuencia de la intoxicación se presenta de manera similar en Chile y Estados Unidos.…”

Section: Epidemiologíaunclassified

Actualización en la comprensión y manejo de la intoxicación por acetaminofén

et al. 2018

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La intoxicación por acetaminofén es una de las causas más frecuentes de falla hepática aguda fulminante y una de las principales causas de atención en los servicios de urgencias, por intoxicación debida a medicamentos. Recientemente, se han registrado avances en la comprensión fisiopatológica, diagnóstico y tratamiento de esta entidad clínica. Los mecanismos de estrés oxidativo y daño del ADN mitocondrial explican los daños producidos en esta intoxicación. En esta revisión se presentan aspectos referentes a la epidemiología, mecanismos fisiopatológicos, diagnóstico y tratamiento de la intoxicación por acetaminofén.

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“…In this issue of PDS, Major et al report their analysis of three data sets to assess trends in acetaminophen events and liver injury from 2009 to 2012 . They found a decrease in the number of events during the study period in two categories: poison center cases and acetaminophen‐related hospitalizations, and an increase in emergency department visits.…”

Section: Editorialmentioning

confidence: 99%