Hepatotoxicity risk factors and acetaminophen dose adjustment, do prescribers give this issue adequate consideration? A French university hospital study

Bacle, Astrid; Pronier, Charlotte; Gilardi, Helene; Polard, Élisabeth; Potin, Sophie; Scailteux, Lucie‐Marie

doi:10.1007/s00228-019-02674-5

Cited by 6 publications

(7 citation statements)

References 37 publications

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“…17 A French study reported that 50% (302/ 606) patients aged >75 years with 1 or more additional risk factor for toxicity (including low body weight or malnutrition) did not have their paracetamol dose reduced. 25 A recent study at a Swiss hospital reported that 1/3 (68/206) of patients aged >75 years with body weight <50 kg received >60 mg/kg/d. 26 In our study, in a majority (58.0%) of instances, the higher than recommended dose was initiated in hospital (either newly commenced in hospital or dose-increased after admission).…”

Section: Discussionmentioning

confidence: 99%

“…A study conducted in New South Wales, Australia, where there was a reduced‐dose policy for paracetamol dosing in older patients, found that 28% (196/274) patients aged ≥65 years received >3 g/d of paracetamol, but patients' frailty status and body weight was not reported 17 . A French study reported that 50% (302/606) patients aged >75 years with 1 or more additional risk factor for toxicity (including low body weight or malnutrition) did not have their paracetamol dose reduced 25 . A recent study at a Swiss hospital reported that 1/3 (68/206) of patients aged >75 years with body weight <50 kg received >60 mg/kg/d 26 …”

Section: Discussionmentioning

confidence: 99%

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Paracetamol dosing in hospital and on discharge for older people who are frail or have low body weight

Elliott

2022

Brit J Clinical Pharma

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Aims To describe paracetamol dosing and liver function test (LFT) monitoring in older hospital inpatients who are frail or have low body weight. Methods Retrospective observational study, at a 790‐bed metropolitan public health service in Australia. Patients aged ≥70 years, with body weight <50 kg or frailty index based on laboratory data (FI‐Lab) score ≥0.3, who were administered paracetamol during an admission with length‐of‐stay >72 hours, were included. Data were extracted from electronic medical records. Paracetamol doses administered in hospital, and doses prescribed on discharge, were compared against consensus guidelines that recommended ≤60 mg/kg/d for older people weighing <50 kg, and ≤3000 mg/d for frail older people. Results In total, 240 admissions (n = 229 patients, mean age 84.7 years) were analysed. During 150 (62.5%) admissions, higher than recommended paracetamol doses were prescribed. On 138 (57.5%) occasions, patients were prescribed paracetamol on discharge, and 112/138 (81.2%) doses were higher than recommended. Most discharge prescriptions (97/138, 70.3%) were for regular administration. The median daily dose on discharge for patients <50 kg was 83.7 mg/kg (interquartile range 73.6–90.9 mg/kg). For frail patients ≥50 kg, the median daily discharge dose was 3990 mg (interquartile range 3000–4000 mg). LFTs were measured in hospital for 151/200 (75.5%) and 93/166 (56.0%) patients who received paracetamol for >48 hours and >5 days, respectively. Conclusion Majority of paracetamol doses prescribed for frail or low‐weight older patients in hospital and on discharge were higher than recommended in consensus guidelines. LFTs were not measured for 44% patients who received paracetamol regularly for >5 days. Further studies are needed to explore long‐term outcomes of this practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Paracetamol dosing in hospital and on discharge for older people who are frail or have low body weight

Elliott

2022

Brit J Clinical Pharma

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“…2,17,18 In a French study, 50% of patients aged >75 years with risk factor for toxicity (low body weight or malnutrition) had their paracetamol dose not reduced. 17 In a recent Swiss study, the maximal daily dose of 60 mg/kg was exceeded in 30.1% of patients weighing <50 kg, as well as in 42.3% of patients weighing <60 kg. 18 In our hospital, paracetamol was the first drug taken in units.…”

Section: Resultsmentioning

confidence: 99%

“…As paracetamol is not associated with significant adverse effects than traditional nonsteroidal anti‐inflammatory drugs, paracetamol is recommended as first‐line therapy for the management of pain in older adults. Likewise, some studies reported paracetamol regimens in older adults that involved administrations >3 or 4 g/d 2,17,18 . In a French study, 50% of patients aged >75 years with risk factor for toxicity (low body weight or malnutrition) had their paracetamol dose not reduced 17 .…”

Section: Discussionmentioning

confidence: 99%

Paracetamol prescriptions in older people hospitalized in a French geriatric hospital

Baud,

Ladjouzi,

Ben Hassen

et al. 2023

Health Science Reports

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“…24,25 Quanto a generalização dos resultados, é possível iniciar uma discussão de implementação de medidas regulatórias para a retirada desses medicamentos do acesso livre dos consumidores, como por exemplo, remoção das prateleiras próximas ao caixa, redução da quantidade por embalagens ou blisters, colocação de alertas sobre dano hepático no rótulo e de dose máxima em texto nas embalagens do medicamento, tendem a reduzir o número de intoxicações e lesões associadas. 3,[26][27][28] Nos EUA, metade dos casos de insuficiência hepática aguda associam-se ao uso do paracetamol. 22 intoxicações por paracetamol associados a outros medicamentos, oito apresentam interações medicamentosa grave.…”

Section: Discussionunclassified

Interações medicamentosas graves em intoxicações por paracetamol no Brasil: estudo transversal baseado no Sistema Nacional de Agravos de Notificação

Lagemann¹,

Okuyama²,

Silva³

2021

Rev Bras Farm Hosp Serv Saude

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Objetivo: Descrever as intoxicações de paracetmol associadas a outros medicamentos e analisar os fatores associados às interações medicamentosas graves. Métodos: Foram analisados os casos de intoxicação envolvendo paracetamol disponíveis no Sistema de Informação de Agravos de Notificação de 2017. Foram excluídos os registros contendo associação com agrotóxicos, alimentos, álcool e drogas de abusos. Os medicamentos relacionados às intoxicações foram identificados, codificados e agrupados de acordo com a classificação Anatomical Therapeutic Chemical. A intensidade da interação foi analisada para determinar a gravidade de acordo com o Micromedex®. Para investigar os fatores associados às interações medicamentosas graves, estimamos as razões de prevalência (RP) por regressão de Poisson, a qual considerou as seguintes variáveis: região, faixa-etária, sexo, etnia, mês de ocorrência, dia da semana, associação com analgésicos, associação com antiinflamatórios e tentativas de suicídio. Resultados: Em 2017, foram identificadas 763 notificações de intoxicações por paracetamol com outros medicamentos. Ocorreram 5,6 casos de tentativa suicídio por um caso não intencional. A análise multivariada indicou que as interações medicamentosas graves foram mais frequentes na idade maior que 37 anos (RP = 2,73; IC 95% 1,35-5,54), usuários de analgésicos (RP= 2,56; IC 95% 1,52-4,3) e usuários de antiinflamtórios (RP = 4,04; IC 95% 2,41-6,78). Conclusão: Interações medicamentosas graves em casos de intoxicação por paracetamol têm sido associadas a analgésicos, anti inflamatórios, adultos e tentativas de suicídio.

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Hepatotoxicity risk factors and acetaminophen dose adjustment, do prescribers give this issue adequate consideration? A French university hospital study

Abstract: Hepatotoxicity risk factors and acetaminophen dose adjustment, do prescribers give this issue adequate consideration? a French university hospital study.

Cited by 6 publications

References 37 publications

Paracetamol dosing in hospital and on discharge for older people who are frail or have low body weight

Paracetamol dosing in hospital and on discharge for older people who are frail or have low body weight

Paracetamol prescriptions in older people hospitalized in a French geriatric hospital

Interações medicamentosas graves em intoxicações por paracetamol no Brasil: estudo transversal baseado no Sistema Nacional de Agravos de Notificação

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