Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

The debate over acetaminophen and acute liver failure

21.07.2004


One expert questions the acceptability of the current level of acetaminophen-related injury and death, while another suggests that acetaminophen overdoses are misunderstood

Acetaminophen overdose causes more than 450 deaths due to acute liver failure each year in the United States and this number appears to be on the rise. In 2001, the U.S. Acute Liver Failure (ALF) Study found acetaminophen responsible for 39 percent of cases. In 2003, the number had risen to 49 percent.

William M. Lee, M.D., of the University of Texas Southwestern Medical Center in Dallas, Texas and a principal investigator of the NIH-funded U.S. Acute Liver Failure Group, suggests that the FDA should consider a more aggressive and broader approach toward regulating the pain reliever to lessen the incidence of such poisonings. Lee’s article is one of two in the July issue of Hepatology that considers acetaminophen-related injury and death in the U.S.



Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD), published by John Wiley & Sons, Inc. is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/hepatology.

A counterpoint article, by Barry H. Rumack, M.D. of Rocky Mountain Poison and Drug Center at the University of Colorado, says that therapeutic doses of the drug do not place patients at risk, even when factors such as fasting and alcohol consumption are considered. He suggests that most acetaminophen-related injuries and deaths may be due to intentional overdose.

More than 50 percent of the country’s cases of acute liver failure are related to acetaminophen, according to the ALF Study, reports Lee. While acetaminophen overdose is a fairly common way to attempt suicide, most suicidal patients receive medical care within four hours and can be protected by the acetaminophen antidote.

However, Lee reports that people who ingest large quantities of the drug over several days – usually to relieve pain and often in conjunction with other narcotics – are typically not aware of the potential harm and only seek treatment after symptoms of toxicity have appeared and their prognosis is poor. These unintentional cases constitute roughly half of all cases that develop liver failure and 30 percent of all these cases are fatal.

"We must remain skeptical of ’accidental’ or ’unintentional’ overdosages in adults," writes Rumack. He suggests that cases recorded as unintentional may have actually been suicide attempts. "It is not possible to calculate the true rate, as we do not know how many patients took overdosages and did not seek treatment nor how many misrepresented what they actually did," he says.

The U.S. Food and Drug Administration regulates acetaminophen, and in 2002, its Non-prescription Drugs Advisory Committee considered evidence on related acute liver failure. The committee recommended changing package labeling to include a prominent warning that excess quantities of the drug might lead to liver injury and requiring the display of the generic name on the front of the package to avoid accidental overdose from the use of multiple acetaminophen-containing products. However, the FDA has not yet acted on that recommendation.

When the United Kingdom began aggressively working to limit acetaminophen overdosing by limiting available quantities and requiring blister packaging, the country saw a 10 percent decline in related hospital admissions, a 19 percent reduction in related deaths and a 56 percent reduction in related liver transplants. In this country, a similar limit to package size and the use of blister packaging might prevent a significant number of overdoses, says Lee.

"Changing more than the package label would also send the message that this medicine, like most others, is not globally safe, as its marketers claim," he says. "For a pain reliever with only mild-to-moderate efficacy, it would seem prudent to move toward limiting these needless deaths."

David Greenberg | EurekAlert!
Further information:
http://www.wiley.com

More articles from Health and Medicine:

nachricht A 'half-hearted' solution to one-sided heart failure
24.11.2017 | Boston Children's Hospital

nachricht New study points the way to therapy for rare cancer that targets the young
22.11.2017 | Rockefeller University

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: New proton record: Researchers measure magnetic moment with greatest possible precision

High-precision measurement of the g-factor eleven times more precise than before / Results indicate a strong similarity between protons and antiprotons

The magnetic moment of an individual proton is inconceivably small, but can still be quantified. The basis for undertaking this measurement was laid over ten...

Im Focus: Frictional Heat Powers Hydrothermal Activity on Enceladus

Computer simulation shows how the icy moon heats water in a porous rock core

Heat from the friction of rocks caused by tidal forces could be the “engine” for the hydrothermal activity on Saturn's moon Enceladus. This presupposes that...

Im Focus: Nanoparticles help with malaria diagnosis – new rapid test in development

The WHO reports an estimated 429,000 malaria deaths each year. The disease mostly affects tropical and subtropical regions and in particular the African continent. The Fraunhofer Institute for Silicate Research ISC teamed up with the Fraunhofer Institute for Molecular Biology and Applied Ecology IME and the Institute of Tropical Medicine at the University of Tübingen for a new test method to detect malaria parasites in blood. The idea of the research project “NanoFRET” is to develop a highly sensitive and reliable rapid diagnostic test so that patient treatment can begin as early as possible.

Malaria is caused by parasites transmitted by mosquito bite. The most dangerous form of malaria is malaria tropica. Left untreated, it is fatal in most cases....

Im Focus: A “cosmic snake” reveals the structure of remote galaxies

The formation of stars in distant galaxies is still largely unexplored. For the first time, astron-omers at the University of Geneva have now been able to closely observe a star system six billion light-years away. In doing so, they are confirming earlier simulations made by the University of Zurich. One special effect is made possible by the multiple reflections of images that run through the cosmos like a snake.

Today, astronomers have a pretty accurate idea of how stars were formed in the recent cosmic past. But do these laws also apply to older galaxies? For around a...

Im Focus: Visual intelligence is not the same as IQ

Just because someone is smart and well-motivated doesn't mean he or she can learn the visual skills needed to excel at tasks like matching fingerprints, interpreting medical X-rays, keeping track of aircraft on radar displays or forensic face matching.

That is the implication of a new study which shows for the first time that there is a broad range of differences in people's visual ability and that these...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Ecology Across Borders: International conference brings together 1,500 ecologists

15.11.2017 | Event News

Road into laboratory: Users discuss biaxial fatigue-testing for car and truck wheel

15.11.2017 | Event News

#Berlin5GWeek: The right network for Industry 4.0

30.10.2017 | Event News

 
Latest News

Heidelberg Researchers Study Unique Underwater Stalactites

24.11.2017 | Earth Sciences

Species may appear deceptively resilient to climate change

24.11.2017 | Ecology, The Environment and Conservation

Lightning, with a chance of antimatter

24.11.2017 | Earth Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>