Supratherapeutic Dosing of Acetaminophen Among Hospitalized Patients

Abstract

Acetaminophen is one of the most commonly used drugs for pain relief and fever reduction.^1-3 At the same time, acetaminophen toxicity is the leading cause of acute liver failure (ALF).^4-7 A study of 22 specialty medical centers in the United States reported that the annual percentage of acetaminophen-related ALF rose from 28% in 1998 to 51% in 2003.⁴ Patients who took more than the recommended maximum dose (eg, 4 g/d for persons >12 years) of acetaminophen-containing products or who consumed alcohol while taking acetaminophen were at risk for hepatotoxicity, ranging from abnormalities in liver function blood tests,⁸ to ALF, and even death.^9,10 Other complications include coagulopathy¹⁰ and deafness.¹¹ The US Food and Drug Administration (FDA) has taken several steps to cut risks from acetaminophen, including asking manufactures of prescription acetaminophen combination products to limit the amount of acetaminophen to 325 mg per dosage unit and requiring a boxed warning on all products that highlights the potential risk for severe liver injury.^2,12