Population-Based Surveillance for Acute Liver Failure

Bower, William A.; Johns, Matthew C.; Margolis, Harold S.; Williams, Ian T.; Bell, Beth P.

doi:10.1111/j.1572-0241.2007.01388.x

Cited by 268 publications

(160 citation statements)

References 16 publications

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“…[7][8][9][10] Acetaminophen overdose is the leading cause of acute liver failure. [11][12][13] In 2009, the FDA convened a panel to review the existing evidence and characterize the problem of acetaminophen overdose. The panel concluded that 1) limited evidence is available, 2) the majority of overdoses appear unintentional, and 3) OTC drug labeling is a likely root cause.…”

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confidence: 99%

Risk of Unintentional Overdose with Non-Prescription Acetaminophen Products

et al. 2012

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BACKGROUND: There is increasing concern over the risk of consumer unintentional misuse of non-prescription (a.k.a. 'over-the-counter') medications containing acetaminophen, which could lead to acute liver failure. OBJECTIVE: To determine the prevalence of potential misuse and overdose of over-the-counter medications containing acetaminophen, either alone or in combination. DESIGN: Cross-sectional, structured interviews with literacy assessment. SETTING: One academic and one community-based general internal medicine practice in Chicago, IL, and one academic general internal medicine practice and a public hospital clinic in Atlanta, GA. PATIENTS: Five hundred adults seeking primary care, ages 18-80. MEASUREMENT: Demonstration of how and when patients would take over-the-counter medications containing acetaminophen, alone or in combination with one another, over a 24-hour period. RESULTS: Overall, 23.8 % of participants demonstrated they would overdose on a single over-the-counter acetaminophen product by exceeding a dose of four grams in a 24-hour period; 5.2 % made serious errors by dosing out more than six grams. In addition, 45.6 % of adults demonstrated they would overdose by 'double-dipping' with two acetaminophen-containing products. In multivariable analyses, limited literacy (Relative Risk Ratio (RR) 1.65, 95 % Confidence Interval (CI) 1.03-2.66) and heavy acetaminophen use in the past six months (RR 1.70, 95 % CI 1.10-2.64) were independently associated with overdosing over-the-counter products. CONCLUSION: Misunderstanding of the active ingredient and proper instructions for over-the-counter medications containing acetaminophen is common. The potential for errors and adverse events associated with unintentional misuse of these products is substantial, particularly among heavy users of acetaminophen and those with limited literacy.

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confidence: 99%

Risk of Unintentional Overdose with Non-Prescription Acetaminophen Products

et al. 2012

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“…Acetaminophen overdose has surpassed viral hepatitis as the leading cause of acute liver failure in the USA [1][2][3]. From 2000-2007, the American Association of Poison Control Centers reported a 70 % increase in cases of unintentional acetaminophen overdose, not including cases with suicidal intent These data were presented in a poster at the Health Literacy Annual Research Conference (HARC) in Bethesda, MD on Oct 22, 2012.…”

Section: Introductionmentioning

confidence: 99%

Variability in Acetaminophen Labeling Practices: a Missed Opportunity to Enhance Patient Safety

et al. 2015

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Confusion regarding a drug's active ingredient may lead to simultaneous use of multiple acetaminophen-containing prescriptions and increase the risk of unintentional overdose. The objective of this study was to examine prescription labeling practices for commonly prescribed acetaminophen-containing analgesics, specifically focusing on how active ingredient information and concomitant use warnings were conveyed. Patients with new acetaminophen-containing prescriptions were recruited upon discharge from an emergency department in Chicago or at an outpatient, hospital-based pharmacy in Atlanta. Label information was transcribed from prescription bottles and patients' knowledge of active ingredient was assessed by in-person interviews. Among the 245 acetaminophencontaining prescriptions, hydrocodone was the most common second active ingredient (n=208, 84.8 %) followed by oxycodone (n=28, 11.4 %). Acetaminophen was identified by its full name on 6.9 % (n=17) of labels; various abbreviations were used in 93.1 % of cases. One hundred forty-seven bottles used auxiliary warning labels with the majority of labels (n=130, 88.4 %) warning about maximum dose and 11.5 % (n=17) about concomitant use. Most of the study participants (n= 177, 72.2 %) were not able to identify acetaminophen as an active ingredient in their prescription. There was no significant association between the use of unabbreviated labels including warning information and patients' awareness of acetaminophen as an active ingredient (36.4 vs. 27.3 %, p=0.50). We noted high variability in labeling practices and warning information conveyed to patients receiving acetaminophen-containing prescriptions. Missed opportunities to adequately convey risk information may contribute to the burden of acetaminophenrelated liver injury.

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“…Though the injury is potentially reversible, the clinical course often culminates in multiple organ failure which is associated with a poor prognosis. The incidence is between 1 and 6 per million population per year [1]. However this data is predominantly from developed countries, data from developing countries where the etiology of ALF is very different is virtually absent.…”

Section: Introductionmentioning

confidence: 99%