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Paracetamol is poisoned



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Paracetamol is a common source of pain relief. In Switzerland, the retail price of over-the-counter drugs is 500 mg tablets, and 1

,000 mg (1 gram) tablets can also be sold with a doctor’s prescription. Researchers at ETH Zurich have now studied whether the availability of high-dose tablets may be related to the increased incidence of acetaminophen poisoning, and therefore concluded.

Paracetamol is the most widely used pain reliever in the world. Andrea Burden, professor of drug epidemiology at ETH Zurich, said: “This is a very safe drug, but it is only used for short-term pain relief, as long as the daily dose does not exceed the recommended range.” For adults, the recommended maximum daily dose is 4,000 mg (4 grams), which equals at most four high-dose tablets or eight low-dose tablets. When used in overdose, paracetamol may cause severe poisoning and even lead to liver failure, leading to fatal consequences or requiring liver transplantation.

It is important to consult a professional

“One problem with acetaminophen is that it is not effective for all patients or for all forms of pain,” Burden explained. She said: “If this drug does not help relieve someone’s symptoms, they may increase the dose without going to a doctor. This is the real problem.” This is where the tablet size comes into play. Burden explained that taking only a small amount of 1,000 mg tablets can easily exceed the maximum daily dose, while for the lower dose of 500 mg tablets, the risk of accidental overdose is not great.

Her advice is as follows: “We recognize that the treatment of pain is challenging and that other drugs may have serious adverse effects. However, if paracetamol does not achieve the desired effect, it is important not to simply take more pills. On the contrary, People should seek professional medical advice in order to find the best treatment options.”

High-dose pills sell better

Since October 2003, Swiss people can use 1,000 mg acetaminophen tablets. Prior to this, the highest available dose was 500 mg tablets. Burden and her team analyzed the sales data of Pharmasuisse, the Swiss Association of Pharmacists, and the Tox Info Suisse Poison Control Center’s data on poisoning cases before and after high-dose tablets were launched.

From the sales data, scientists have observed that 1,000 mg tablets have rapidly become popular since they came out. In 2005, 1,000 mg tablets surpassed 500 mg tablets for the first time. Today, sales of 1,000 mg tablets are ten times that of 500 mg tablets.

During the same period, the number of cases of paracetamol poisoning reported to Tox Info Suisse increased. After 2005, the number of poisoning cases increased by 40% in three years, from 561 cases in 2005 to 786 cases in 2008. Milligram tablets,” said Stefan Weiler, co-author of the study and Tox Info Suisse’s scientific director. In the following years, the number of poisoning cases continued to increase, reaching 1,188 in 2018.

Can avoid poisoning

ETH professor Andrea Burden advocated strict scrutiny of how to formulate and dispense 1,000 mg tablets. She said: “At the very least, there should be a smaller number of tablets per 1,000 mg tablet package.” As more and more evidence shows that acetaminophen is not suitable for chronic pain treatment, there is almost no need for a package of 40 or 100 tablets. She also said that doctors should prescribe a lower 500 mg dose, which can be adjusted to 1,000 mg by taking two tablets as needed. This minimizes the risk of accidentally exceeding the daily limit.

By reducing the use of high-dose preparations, Burden believes that certain poisoning events can be avoided. At the same time, she said, pharmacists can help draw attention to the danger of exceeding the maximum daily dose when providing these high-dose pills to patients.


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More information:
Martinez-De la Torre A, Weiler S, BrämDS, Allemann SS, Kupferschmidt H, Burden AM: National Poisoning Center before and after the use of high-dose acetaminophen (acetaminophen) tablets in Switzerland: Time series analysis was interrupted. JAMA network is open, DOI: 10.1001/jamanetworkopen.2020.22897

Citation: Paracetamol poisoning incident (October 28, 2020) was retrieved from https://medicalxpress.com/news/2020-10-paracetamol-poisonings.html on October 29, 2020

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