Limited Knowledge of Acetaminophen in Patients with Liver Disease

Abstract

Background and Aims: Unintentional acetaminophen overdose remains the leading cause of acute liver failure in the United States. Patients with underlying liver disease are at higher risk of poor outcomes from acetaminophen overdose. Limited knowledge of acetaminophen may be a preventable contributor to elevated rates of overdose and thus acute liver failure. The purpose of this study is to assess knowledge of acetaminophen dosing and presence of acetaminophen in common combination products in patients with liver disease.Methods: We performed a cross-sectional study of patients with liver disease at the Pfleger Liver Institute at the University of California, Los Angeles between June 2015 and August 2016. Patients completed a demographic questionnaire and an acetaminophen knowledge survey. Additional information was obtained from the medical record.Results: Of 401 patients with liver disease, 30 (15.7%) were able to correctly identify that people without liver disease can safely take up to 4 g/day of acetaminophen. The majority of patients (79.9%–86.8%) did not know that Norco® (hydrocone/acetaminophen), Vicodin® (hydrocone/acetaminophen) and Percocet® (oxycodone/acetaminophen) contained acetaminophen. Only 45.3% of the patients knew that Tylenol® #3 contained acetaminophen.Conclusions: We conclude that patients with liver disease have critically low levels of knowledge of acetaminophen, putting them at risk both of acetaminophen overdose, as well as undermedication, and inadequate management of chronic pain. We recommend an increase in education efforts regarding acetaminophen dosage and its safety in the setting of liver disease. Increasing education for those at risk of low acetaminophen knowledge is essential to minimizing acetaminophen overdose rates and optimizing pain management.

Medicine use and medicine-related problems in patients with liver cirrhosis: a systematic review of quantitative and qualitative studies

“…Patients widely reported poor knowledge and understanding about the disease and its risk factors, associated complications and treatment. This lack of awareness has also been reported previously in an American study which suggested that patients with liver disease have limited knowledge about the safety of acetaminophen for pain management that can put them at risk of undermedication or overdose [64]. Another American study that involved liver transplant patients suggested that patients with a better understanding of their treatment and medication regimen were more likely to adhere to their treatment and can avoid the risk of hospitalisation [65].…”

Assessing the performance of ChatGPT in answering questions regarding cirrhosis and hepatocellular carcinoma

“…Although the internet may serve as a source of health information for patients, the complexity of the primary literature, and potential misinformation may result in confusion rather than clarity. A survey of 401 patients with chronic liver disease showed that only 15.7% of patients were aware of the safe dose of acetaminophen, and less than 20% reported awareness that medications such as Norco, Vicodin, and Percocet contain acetaminophen [ 15 ]. Another study showed that online resources available to patients through health platforms and hepatology centers were lengthy and complex, highlighting the limited availability of easy-to-understand information for this patient population [ 16 ].…”

Acetaminophen: A Liver Killer or Thriller

“…Considering the extensive available safety data, when used at appropriate dosage (up to 2-3g/day), acetaminophen should be the preferred first-line analgesic, antipyretic medication in patients with all forms of liver disease. However, research suggests limited awareness among clinicians and patients regarding acetaminophen's role in liver disease [26,27]. In a study encompassing over 2,000 healthcare providers, 40% of the participants were reluctant to endorse acetaminophen usage in patients with compensated cirrhosis.…”

“…NSAIDs are particularly discouraged in patients with liver disease, especially in cases of cirrhosis, due to their heightened potential for causing kidney problems, gastrointestinal issues, and impairing platelet function [26][27][28][29]. NSAID-induced idiosyncratic hepatotoxicity has been extensively documented as well [27].…”