Intravenous Acetaminophen

Abstract

Hospitals are subject to more economic pressures than ever before. On the one hand, cost containment or cost reduction is paramount, particularly in relation to costly branded pharmaceuticals. On the other hand, quality measures and value-based reimbursement penalizes poor patient care. Multimodal analgesia sits squarely in this quandary, since its very nature requires use of multiple drugs with their associated costs, though this approach has the potential to improve quality of care. We undertook a comprehensive review of the pharmacoeconomics of IV acetaminophen, a new drug useful as part of a multimodal analgesic approach. While this new branded drug adds to direct drug costs, there is clear potential for IV acetaminophen to reduce the incidence of opioid-related adverse events and, in so doing, result in net hospital savings. This review describes many clinical studies showing significant improvements in postoperative nausea and vomiting, excessive sedation and pruritus. In addition, we describe studies demonstrating faster recovery times in the post-anesthesia care unit, intensive care unit and total hospital length of stay. Lastly, we summarize many studies demonstrating the robust effect of IV acetaminophen on patient satisfaction. A holistic view of total hospital performance should be adopted when reviewing drugs rather than a silo mentality within the pharmacy. While IV acetaminophen adds to drug costs, the body of evidence indicates this drug has the potential to improve outcomes and hospital efficiency.

Biocharacterization of Heat Shock Protein 90 in Acetaminophen-Treated Livers Without Conspicuous Drug Induced Liver Injury

“…In toxicological mechanism, APAP-induced hepatocellular impairment can be originated from its metabolite toxin of N-acetyl-p-benzoquinonimine which impairs to liver cells in turn [17-19]. In recent years, ever-increasing evidences have showed APAP induced visible liver injury as elucidated in proposed biological signaling pathways and molecular mechanisms [20, 21].…”

Population pharmacokinetics of paracetamol across the human age‐range from (pre)term neonates, infants, children to adults

“…Indications for paracetamol administration were medical (traumatic delivery, necrotizing enterocolitis, prostaglandin E2 administration, fever) or surgical (eg, cardiac, thoracic, abdominal). Samples were collected in the first 48 hours after loading dose with a non-uniform non-sparse sampling scheme with a median (range) number of samples per individual of 7 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11).…”

“…1 More recently, an intravenous formulation of paracetamol has become available, which was approved for use in term neonates, children and adults in Europe, even though the USFDA only approved its use for the treatment of acute pain and fever in adults and children aged 2 years and older. While intravenous paracetamol is now being used regularly as an analgesic in neonates, children and adults, 2,3 in the last few years, intravenous paracetamol in a dose as high as 60 mg/kg has also been proposed as an off-label treatment of patent ductus arteriosus in preterm neonates. [4][5][6] To derive evidence based dosing guidelines for intravenous paracetamol across age ranges including preterm neonates, term neonates, and infants, information is needed on its pharmacokinetics.…”

Estimating the Effect of Intravenous Acetaminophen for Postoperative Pain Management on Length of Stay and Inpatient Hospital Costs

“…Although not all studies of perioperative use of IV APAP have demonstrated reductions in opioid use and LOS, recent economic impact studies have shown reduced costs associated with IV APAP [26, 27]. These findings are supported by a pharmacoeconomic review of IV APAP, which concluded the body of evidence shows the drug has the potential to improve outcomes and hospital efficiency [28]. Up to an estimated 7% of patients who receive prescription opioids following surgery end up using these medications long-term [29–33], which can result in tolerance, dependence, and addiction [34].…”