Paracetamol Dosing Errors in People Aged 12 Years and Over: An Analysis of Over 14,000 Cases Reported to an Australian Poisons Information Centre.

Autor: Chidiac AS; School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. achi0859@uni.sydney.edu.au.; New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia. achi0859@uni.sydney.edu.au., Buckley NA; School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.; New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia., Noghrehchi F; School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia., Cairns R; School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.; New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Jazyk: angličtina
Zdroj: Drug safety [Drug Saf] 2024 Dec; Vol. 47 (12), pp. 1293-1306. Date of Electronic Publication: 2024 Sep 02.
DOI: 10.1007/s40264-024-01472-y
Abstrakt: Introduction: Paracetamol dosing errors can cause acute liver injury, with potentially toxic doses only slightly above the therapeutic range. This study aimed to characterise unintentional paracetamol overdose reported to an Australian poisons centre, including time trends, demographics, types of dosing errors, and outcomes.
Methods: Records regarding paracetamol dosing errors for individuals aged ≥12 years were extracted from the New South Wales Poisons Information Centre database, January 2017 to June 2023. Data from 2021 underwent an in-depth screening of free text case notes to examine: dose, duration, products involved, reasons for ingestion and outcomes including hospitalisation, treatment, liver transplantations and deaths. Where possible, complete outcome data were obtained from medical records of New South Wales hospitalised cases in 2021.
Results: There were 14,380 exposures due to paracetamol dosing errors (predominantly self-administered, median age 43 years, 62.6% female), with an average yearly increase of 2.5% (95% CI 1.6-3.8%; p < 0.0001). The in-depth analysis of exposures recorded during 2021 revealed 1899 exposures (median age 46 years, 63.4% female) with 26.8% requiring hospitalisation. Immediate- and modified-release formulations were highly implicated. Multiple paracetamol-containing products were ingested in approximately 20% of exposures. Hospitalised exposures were associated with paracetamol use for dental pain and ingested higher doses for longer durations. Over half of those hospitalised (52%) were treated with the antidote (N-acetylcysteine), and 6% of exposures developed hepatotoxicity.
Conclusion: Paracetamol dosing errors continue to occur, with relatively high rates of hospitalisation and liver injury. Many hospitalisations involved use for dental pain. Possible preventative measures include ingredient name prominence and increased education on appropriate dosing.
Competing Interests: Declarations Funding Open Access funding enabled and organized by CAUL and its Member Institutions. RC is supported by an NHMRC Investigator Grant (ID: 1196516), NAB is supported by an NHMRC Investigator Grant (ID: 2007726). RC is the recipient of an untied educational grant from Reckitt Benckiser to study over-the-counter medicine poisonings, which includes a PhD stipend for ASC. Conflicts of interest ASC is supported by a PhD scholarship funded by Reckitt Benckiser, as part of an untied educational grant awarded to RC. RC has also received conference speaker fees/honoraria from Reckitt Benckiser and The Pharmacy Guild of Australia. These funders had no role in the design, conduct, or interpretation of the study’s findings. NAB is an Editorial Board member of Drug Safety. NAB was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. FN has no conflicts of interest to be declared. Availability of data and material The data supporting this study’s findings are not publicly available due to the sensitive nature of the contents. Select data is available on request to the NSW Poisons Information Centre. For access, please email rose.cairns@sydney.edu.au Ethics approval This study was approved by the Sydney Children’s Hospitals Network Human Research Ethics Committee (2021/ETH00165). Consent for participation Not applicable. Consent for publication Not applicable. Code availability R code used for the Wilcoxon Rank Sum test is available on request. For access, please email firouzeh.noghrehchi@sydney.edu.au Author contributions RC and NAB contributed to the design of the study. Data cleaning and extraction was performed by ASC. ASC and FN performed the data analysis. The first draft of the manuscript was written by ASC and all authors commented on subsequent versions of the manuscript. All authors read and approved the final version of the manuscript.
(© 2024. The Author(s).)
Databáze: MEDLINE
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