Paracetamol dosing in hospital and on discharge for older people who are frail or have low body weight

Elliott, Rohan A

doi:10.1111/bcp.15394

Cited by 6 publications

(8 citation statements)

References 49 publications

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“…Our research suggests dose adjustment of acetaminophen was uncommon when our data were collected in 2019. Our findings are comparable with another Australian study in 2019 that reported 150 (62.5%) of 240 older hospital inpatients were prescribed acetaminophen at higher than recommended doses (> 3000 mg/day or ≥ 60 mg/kg/day for patients with a body weight < 50 kg) [ 35 ]. Overall, 18.8% of residents received opioid doses > 60 MME/day.…”

Section: Discussionsupporting

confidence: 88%

Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services

et al. 2023

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Background Ensuring safe and effective analgesic use in residential aged care services is important because older adults are susceptible to analgesic-related adverse drug events (ADEs). Objective The aim of this study was to identify the proportion and characteristics of residents of aged care services who may benefit from analgesic review based on indicators in the 2021 Society for Post-Acute and Long-Term Care Medicine (AMDA) Pain Management Guideline. Methods Cross-sectional analyses of baseline data from the Frailty in Residential Sector over Time (FIRST) study ( N = 550 residents) across 12 South Australian residential aged care services in 2019 were conducted. Indicators included the proportion of residents who received > 3000 mg/day of acetaminophen (paracetamol), regular opioids without a documented clinical rationale, opioid doses > 60 mg morphine equivalents (MME)/day, more than one long-acting opioid concurrently, and a pro re nata (PRN) opioid on more than two occasions in the previous 7 days. Logistic regression was performed to investigate factors associated with residents who may benefit from analgesic review. Results Of 381 (69.3%) residents charted regular acetaminophen, 176 (46.2%) were charted > 3000 mg/day. Of 165 (30%) residents charted regular opioids, only 2 (1.2%) had no prespecified potentially painful conditions in their medical record and 31 (18.8%) received > 60 MME/day. Of 153 (27.8%) residents charted long-acting opioids, 8 (5.2%) received more than one long-acting opioid concurrently. Of 212 (38.5%) residents charted PRN opioids, 10 (4.7%) received more than two administrations in the previous 7 days. Overall, 196 (35.6%) of 550 residents were identified as potentially benefiting from analgesic review. Females (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.20–2.91) and residents with prior fracture (OR 1.62, 95% CI 1.12–2.33) were more likely to be identified. Observed pain (OR 0.50, 95% CI 0.29–0.88) was associated with a lower likelihood of being identified compared with residents with no observed pain. Overall, 43 (7.8%) residents were identified based on opioid-related indicators. Conclusions Up to one in three residents may benefit from a review of their analgesic regimen, including 1 in 13 who may benefit from a specific review of their opioid regimen. Analgesic indicators represent a new approach to target analgesic stewardship interventions. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-023-01025-5.

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Section: Discussionsupporting

confidence: 88%

Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services

et al. 2023

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“…As paracetamol is not associated with significant adverse effects than traditional nonsteroidal anti‐inflammatory drugs, paracetamol is recommended as first‐line therapy for the management of pain in older adults. Likewise, some studies reported paracetamol regimens in older adults that involved administrations >3 or 4 g/d 2,17,18 . In a French study, 50% of patients aged >75 years with risk factor for toxicity (low body weight or malnutrition) had their paracetamol dose not reduced 17 .…”

Section: Discussionmentioning

confidence: 99%

“…As paracetamol was considered safe at therapeutic doses, it has been recommended as a first‐line drug in pain management guidelines, especially for aged and frail patients 4 . However, the pharmacokinetic of paracetamol may be influenced by physiological and pathological changes in older patients, especially those who are underweight or frail 2 . Studies have reported a reduction of paracetamol clearance with aging and frailty, resulting in an increase of paracetamol serum levels 5,6 .…”

Section: Introductionmentioning

confidence: 99%

“… 4 However, the pharmacokinetic of paracetamol may be influenced by physiological and pathological changes in older patients, especially those who are underweight or frail. 2 Studies have reported a reduction of paracetamol clearance with aging and frailty, resulting in an increase of paracetamol serum levels. 5 , 6 Moreover, liver damage caused by paracetamol at high dose can occur particularly into older patients who are malnourished or weigh <50 kg.…”

Section: Introductionmentioning

confidence: 99%

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BACKGROUNDParacetamol is one of the most widely used drug in the world for the management of pain or fever, in particular among older people aged 60 years or older. 1,2 In France, the consumption of the drug is currently the highest in Europe, with an increase of 53% from 2006 to 2015. 3 As paracetamol was considered safe at therapeutic doses, it has been recommended as a first-line drug in

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mentioning

confidence: 99%

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