Wednesday, May 23, 2012

DDW-Patients May Receive Too Much Acetaminophen in Hospital

WEDNESDAY, May 23 (HealthDay News)

Roughly 2.5 percent of admitted hospital patients may receive more than the safe daily cumulative dose of the pain-reliever acetaminophen, best known as Tylenol, on at least one day, according to a new U.S. study.

Patients on more than one drug containing acetaminophen often consume more than the recommended 4 grams per day of the drug, the researchers from Thomas Jefferson University Hospital in Philadelphia found.

Together, two tablets of extra-strength Tylenol contain 1 gram of acetaminophen, commonly used to relieve pain and reduce fever.

Over the course of two years, researchers led by Dr. Jesse Civan examined 46,000 hospital admissions and the medications those patients were given. They found that on at least one day of hospitalization, roughly 1,100 patients received more than 4 grams of acetaminophen in the form of Tylenol, Percocet and similar drugs.

The study authors also assessed the effects the acetaminophen had on the patients' livers and found only a small minority were given a blood test to check their liver function. The investigators noted that this test is typically used only when a doctor has a specific concern about possible problems with a patient's liver.

In the small number of patients who did have the blood test of liver function, the researchers noted that there were no serious liver injuries. They said there wasn't enough information to determine if abnormal test results were the result of excessive exposure to acetaminophen.

Civan and colleagues concluded that more research is needed to determine if new recommendations for the safe daily dosing of acetaminophen are necessary. They added that patients need better education on acetaminophen safety, particularly for use of the drug after they leave the hospital, when patients may try to duplicate the medications and doses they were given during their admission.

The study was presented Monday at the Digestive Disease Week meeting in San Diego. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information
The U.S. Food and Drug Administration has more about acetaminophen.

Dr. Orman will present these data on Monday, May 21 at 4 p.m. PT in Halls C-G of the San Diego Convention Center.

Patterns of Usage of Acetaminophen in Excess of Four Grams Daily in a Hospitalized Population at a Tertiary Care Center (Abstract #743)

Hospitalized patients who receive multiple orders of medication containing acetaminophen are likely to receive a higher than intended dose of the drug, even when provided by physicians, according to new research from Thomas Jefferson University Hospital, Philadelphia, PA.

Reviewing 46,000 hospital admissions over a two-year period, investigators led by Jesse Civan, MD, GI fellow, division of gastroenterology, Thomas Jefferson University Hospital, found that about 1,100 individuals received more than 4 grams of acetaminophen on at least one day. In other words, about 2.5 percent of all patients admitted to the hospital received more than what is currently considered the safe cumulative daily dose on at least one calendar day.

Investigators sought to determine exactly how much acetaminophen was being dispensed in a large tertiary-care hospital and how it compared to the generally accepted safe maximum dose. They reviewed a computer database tracking every patient admitted to their hospital and every dose of medicine prescribed and received. This allowed them to calculate exactly how much medication patients were exposed to, including any medication containing acetaminophen, such as Tylenol®, Percocet® and other similar medicines, and to generate a list of all patients who received more than 4 grams of acetaminophen on at least one calendar day.

Researchers also reviewed liver function and injury, which are reported in the same database, to determine potential detrimental effects of acetaminophen use on patients. By reviewing a specific blood test — the alanine amino-transferase (ALT) test, which is generally used to screen for liver injury possibly related to acetaminophen — Dr. Civan and his colleagues found that only a small minority of patients were administered an ALT test. They attribute this finding to the fact that the blood test is only usually checked when a physician is particularly concerned about a possible liver problem. 

In the small minority of patients who did have an ALT checked, there was insufficient data to do a “formal cause analysis” to determine whether an abnormal ALT could be blamed on the acetaminophen exposure. Because of the paucity of ALT monitoring, no conclusion could be reached about whether the acetaminophen exposure might have had any detectable detrimental consequences.

Dr. Civan added that these findings could have implications on public health and the need to improve patient education regarding safe dosages at home, since many patients will likely attempt to emulate the medications provided at the hospital once they get home. He concluded that further study in this closely monitored population in which every dose of acetaminophen-containing medication administered is recorded might shed light on the ongoing discussion at the U.S. Food and Drug Administration and elsewhere regarding new recommendations for maximum safe daily dosing. Dr Civan stressed that although it remains unclear whether blood test abnormalities may have resulted from acetaminophen use, he did not find any evidence of any cases of serious liver injury.

Acetaminophen has been under increasing scrutiny in the U.S. — it is the leading cause of acute liver failure and emergent liver transplant, and previous studies have suggested that unintentional overdose is a significant problem. There has also been debate in the medical literature about whether a less severe form of acetaminophen-induced liver injury due to unintentional overdose may be important.

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