High doses of paracetamol associated with increased poisonings: JAMA

Switzerland: The availability of 1000-mg acetaminophen (paracetamol) should be re-evaluated in order to minimize the potential for accidental poisonings, suggests a recent study in the journal JAMA Network Open. According to the study, there was a significant increase acetaminophen dispensing and acetaminophen-related poisonings after the approval of 1000-mg tablets in 2003.

Paracetamol is among the most widely used pain killers globally. While it is considered safe within the therapeutic range, intake when exceeds 4000 mg/d can lead to hepatotoxicity. Previous evidence has shown limited availability of large quantities of acetaminophen to be associated with decreased mortality and poisoning related to paracetamol. In Switzerland, 500-mg tablets are available over-the-counter (OTC) and, as of October 2003, 1000-mg tablets are available with prescription.

Adrian Martinez-De la Torre, wiss Federal Institute of Technology Zurich, Zurich, Switzerland, and colleagues evaluated the association of adding 1000-mg acetaminophen tablets to the Swiss market with utilization and poisonings.

For the purpose, the researchers evaluated 15 790 acetaminophen poison records from January 1, 2000, to December 31, 2018 using a quasi-experimental interrupted time series analysis. It included all calls for acetaminophen-related poisonings identified from the National Swiss Poisons Centre and all sales for oral acetaminophen tablets (prescription and OTC) dispensed between January 2000 and December 2018.