Knowledge of appropriate acetaminophen doses and potential toxicities in an adult clinic population

Stumpf, Janice L.; Skyles, Amy J.; Alaniz, Cesar; Erickson, Steven R.

doi:10.1331/1544-3191.47.1.35.stumpf

Cited by 39 publications

(27 citation statements)

References 17 publications

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“…A few studies suggest many adults misinterpret OTC product instructions or not carefully heed them. [3][4][5][6] Recent attention has been focused on the unintentional misuse of OTC pain medication, and acetaminophen specifically, which is the most commonly-used OTC product in the U.S. with 19 % of adults reporting taking the drug in a given week. [7][8][9][10] Acetaminophen overdose is the leading cause of acute liver failure.…”

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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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“…9 Previous studies have shown that many patients lack general knowledge regarding acetaminophen dosing recommendations and recognition of products containing acetaminophen. 10,11 It has also been demonstrated that many individuals do not read OTC labeling information and have misconceptions related to the dangers of nonprescription pain medication in general. 12 Intentional acetaminophen overdose is frequently recognized early and treatment with N-acetylcysteine within 12 hours of ingestion can reduce progression to ALF.…”

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confidence: 99%

Survey of Physician Knowledge and Counseling Practices Regarding Acetaminophen

Hornsby

Przybylowicz

Andrus

et al. 2010

Journal of Patient Safety

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Objective: To assess physician knowledge regarding acetaminophen dosing, toxicity, and recognition of acetaminophen-containing products and counseling practices when prescribing acetaminophen-containing medications.Methods: Resident and faculty physicians at 1 internal medicine and 2 family medicine residency programs in Alabama were asked to participate in a voluntary survey. Participants completed a 7-item selfadministered questionnaire. Questions were designed to assess physician knowledge of acetaminophen dosing and toxicity, recognition of prescription and over-the-counter products containing acetaminophen, and education provided to patients when prescribing acetaminophencontaining products. Questions were formatted as multiple choice, yes/no, true/false, and short answer. Certain items contained an answer choice of Bunsure.[ Results:Of the 76 physicians who completed the survey, only 76% were aware of the maximum daily dose of acetaminophen. Although 93% recognized Lortab and 90% Percocet as acetaminophen-containing products, only 83% identified Lorcet and 75% Darvocet. More than 90% of physicians correctly identified nonacetaminophen prescription medications with the exception of OxyContin (84%) and Ultram (79%). Knowledge of over-the-counter products was generally less accurate. Ninety-eight percent recognized hepatotoxicity as the primary toxicity. Although 72% of physicians stated they provide specific instructions to patients when prescribing acetaminophen-containing medications, the information provided was limited.Conclusions: Many physicians are unaware of acetaminophen dosing and toxicity issues and have some difficulty identifying acetaminophencontaining products. Information provided by physicians when prescribing acetaminophen products was limited. How this may contribute to unintentional acetaminophen overdose is unclear but should raise concern. These results reinforce the importance of public awareness, patient counseling, and physician education regarding acetaminophen toxicity issues.

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“…Stumpf et al (2007) found that, while nearly 80% of their 104 subjects reported using a drug product containing acetaminophen during the past 6 months, and while 18.3% were taking an acetaminophen-containing medicine at least once a day, nearly 70% of the patients underestimated the maximum recommended daily dose of regular-strength acetaminophen. Only 2 patients (2%) knew the correct dose of regular-strength acetaminophen, only 3 knew the correct dose of extra-strength acetaminophen, and 28 patients were not sure of the maximum dose of either formulation of acetaminophen.…”

Section: Public Knowledge About Otc Analgesicsmentioning

confidence: 99%

“…Yet research reveals that 44% of US adults who take OTC pain relievers admit to ignoring label warnings and exceeding the recommended dose (National Consumers League 2003), and only about 2% of adults actually know the correct daily dose of popular analgesics that they take on a regular basis (Stumpf et al 2007). …”

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confidence: 99%

Compliance packaging for over-the-counter drug products

Weiss

2009

J Public Health

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Background In view of the serious health risks and high costs to the health-care system of misuse and abuse of overthe-counter (OTC) analgesics, this article describes a rationale and prototype for new safety or compliance packaging for OTC drug products that are sold in pill form (e.g., tablets, caplets and gelcaps) inside blister packs. The proposed packaging is not simply promoting the use of blister packs for pills; that utility is already well known. It is an integrated system in which blister packs of pills can, themselves, be packaged, labeled and sold, offering a dosedirected unit-of-use design with enhanced warnings and directions to help prevent consumers from taking more than the instructed dose of pill-form medicines. Method Literature and information searches were conducted in publicly available databases and websites to (1) assess safety problems (serious adverse events and fatalities) associated with OTC analgesics and (2) determine public perceptions and knowledge about their use. Results Each year in the US, there are an estimated 100,000 hospitalizations and 16,500 deaths due to NSAID overdosing, and 26,000 hospitalizations and 1,600 acute liver failure cases due to acetaminophen poisoning. Many adults take more than the recommended dose and in some cases use multiple products containing acetaminophen and ibuprofen. Risk factors, such as alcohol use or pre-existing liver disease, exacerbate problems associated with acetaminophen misuse and abuse. In pediatric cases, dosing errors are often related to confusion over different product formulations, dosing strengths, and the use of inappropriate dosing devices. Consumers are often unaware of the active ingredients in, and correct doses of, drugs they are taking; they underestimate the risks associated with misuse of OTC medicines, and they frequently discard the packaging on which the drug's directions, warnings and dosing instructions are located. Conclusion Optimal compliance packaging should (1) keep the instructions, warnings and dosing directions attached to the blister card of pills at all times, thus avoiding the problem of cartons and package inserts being thrown away once the package is opened; (2) increase the surface area of the packaging, without adding bulk, to provide space for the use of larger font sizes and enhanced directions and warnings that are more conspicuous, explicit and memorable; (3) organize the pills into logical, unit-of-use (per-dose maximum and perday maximum) sets or rows; (4) limit the number of pills in a unit-of-use package to coincide with the instructed maximum dose and maximum days of use for a specific product.

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Knowledge of appropriate acetaminophen doses and potential toxicities in an adult clinic population

Cited by 39 publications

References 17 publications

Risk of Unintentional Overdose with Non-Prescription Acetaminophen Products

Risk of Unintentional Overdose with Non-Prescription Acetaminophen Products

Survey of Physician Knowledge and Counseling Practices Regarding Acetaminophen

Compliance packaging for over-the-counter drug products

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