A study reveals that acetaminophen use and over-dosing rise in cold/flu season in the US, primarily due to increased use of over-the-counter combination medications treating upper respiratory symptoms. Another study reports that acetaminophen is the most commonly used analgesic in France, with more high-dose tablets being consumed in recent years. The findings indicate that individuals should take special care to follow labelled dosing directions for acetaminophen-containing products.
Acetaminophen is an active ingredient present in hundreds of over-the-counter and prescription medications indicated for pain and fever, including medications used to treat symptoms associated with colds, flu, allergies, and sleeplessness. While safe when taken as directed, taking too much acetaminophen can harm the liver. To examine acetaminophen use and to estimate the prevalence of excess intake, a team led by Dr Saul Shiffman, of Pinney Associates and the University of Pittsburgh, and Dr David Kaufman, of Boston University Slone Epidemiology Centre, asked individuals to complete daily medication diaries for 7 days. For the study, 14,481 US adults who used acetaminophen in the preceding 30 days were sampled from multiple online research panels from 2011 to 2016.
The investigators found that 6.3% of acetaminophen users exceeded the maximum adult daily dose of 4 grams (4000 mg) on at least one day during a week they used acetaminophen. All told, the 4-gram limit was exceeded on 3.7% of the days that the participants used acetaminophen medications. Use patterns changed with the cold/flu season. Cold/flu symptoms were more likely to be experienced and treated with acetaminophen-containing medications during cold/flu season. The odds of taking more than 4 grams of acetaminophen in a day increased 24% in cold/flu season compared with the off-season (6.5% during cold/flu season versus 5.3% during the off-season). This was primarily due to increased use of over-the-counter combination medications designed to treat upper respiratory cold/flu symptoms.
"This is the first multi-year, year-round study that includes detailed data on how consumers used acetaminophen medications," said Shiffman. "The study findings suggest the importance of educating consumers about acetaminophen and counselling them about appropriate use and safe dosages of these medications."
Shiffman noted that Johnson and Johnson Consumer, which sponsored the study, has used these findings to develop education for both patients and health professionals. "Getting this message out is especially important during cold/flu season, when people may be more likely to treat illness symptoms with acetaminophen combination products, sometimes without even realizing they contain acetaminophen," Shiffman stressed. "As we are in the midst of a particularly severe cold/flu season, it's important for consumers to be aware of the limits on acetaminophen use."
Another study that examined trends in the use of pain medications in France found that over the last decade, acetaminophen – also known as paracetamol – remained the most-consumed analgesic in the country, while the use of oxycodone (an opioid) increased significantly.
"To our knowledge, this is the first published study analysing consumption trends for both non-opioids and opioids over the last decade in France. Long-term surveillance over the past 10 years has highlighted quantitative and qualitative changes in analgesic consumption patterns in France," said co-author Dr Philippe Cavalié, of the French National Agency for Medicines and Health Products Safety.
There was a 53% increase in the use of paracetamol between 2006 and 2015, and the 1000-mg tablets of paracetamol (which are not available in the US) were the most-used drug among adults since 2008. Their consumption increased over the 10-year period by 140%, whereas consumption of the 500-mg tablet pack decreased by 20%.
Also, despite sharing common regulations for medications, different patterns of pain medication use were observed across Europe in 2015. France ranked first and third place respectively for paracetamol and mild opioid consumption, but its use of strong opioids was among the lowest.
"The very widespread analgesics consumption that we have documented raises the concern of overuse and misuse, as well as addiction to opioids," said Cavalié. "It appears very useful to accurately monitor user profiles and trends of misuse and to carry out appropriate preventive measures – such as education of patients and health professionals to increase appropriate use of medications and early detection of misuse."
Abstract 1
Aims: To estimate prevalence of excess intake of acetaminophen, and investigate seasonal variations therein.
Methods: Between 2011 and 2016, 14,481 US adults who used acetaminophen in the preceding 30 days were sampled from national online panels and completed a detailed online daily diary of acetaminophen medication use for 7 days. Respondents were not told the study concerned acetaminophen. Cold/flu season (CFS), identified using Google© Trends data, was contrasted to off-season in symptoms, use of acetaminophen medications, and consumption exceeding 4 grams (the recommended daily maximum).
Results: Overall, 6.3% [95% CI: 6.0%-6.6%] of users exceeded 4 grams on at least one day; 3.7% [3.5%-3.9%] of usage days exceeded 4 grams. Cold/flu symptoms were more likely to be experienced and treated with acetaminophen in CFS than off-season. Acetaminophen users were more likely to exceed 4 grams during CFS (6.5% vs 5.3%; OR= 1.24, 1.04-1.48); days exceeding 4 grams also increased (3.9% vs 2.8%; OR= 1.37, 1.11-1.69). This was not due to differences in characteristics of individuals using acetaminophen in CFS, but primarily to increased use of over-the-counter (OTC) combination medications designed to treat upper respiratory cold/flu symptoms (33.2% of usage days in CFS vs 24.8% in off-season; OR=1.6, 1.5-1.7). When such medications were omitted, there was no statistically significant seasonal variation in exceeding 4 grams.
Conclusions: Acetaminophen use and over-dosing increases in CFS, primarily due to increased use of OTC combinations treating upper respiratory cold/flu symptoms. Pharmacists should warn users to follow labeled dosing directions, especially during CFS.
Authors
Saul Shiffman, Deena R Battista, Judith P Kelly, Mary K Malone, Rachel B Weinstein, David W Kaufman
Abstract 2
Aims: To describe consumption trends of three groups of analgesics (non-opioids, mild and strong opioids) between 2006 and 2015 in France and compare this pattern of use with six European countries in 2015.
Methods: Annual drugs sales were extracted from the French national authority's consumption database and from the IMS-MIDAS and national databases for European countries.
Results: The use of mild opioids in France decreased by 53% during the last 10 years due to the declining use of dextropropoxyphene combinations, along with an increase in the use of non-opioids and strong opioids (from 72 to 93 and 2 to 2.8 defined daily doses/1,000 inhabitants/day, respectively). Paracetamol, the most-consumed analgesic, has increased during the last 10 years, particularly for the adult high dosage (+140%). The use of tramadol and codeine combinations has also increased by 62% and 42%, respectively. Morphine remained the most-used strong opioid although there were also high increases in the consumption of oxycodone (+613%) and fentanyl (+263% and +72% for transmucosal and transdermal forms, respectively). A comparison of the patterns of use in Europe in 2015 showed a higher consumption of both mild and strong opioids in the UK. France ranked first and third place respectively for paracetamol and mild opioid consumption, while its strong opioid use was among the lowest.
Conclusions: Paracetamol consumption is clearly highest in France, while its use of strong opioids is amongst the lowest in Europe, although the consumption of oxycodone has increased significantly. Further studies are required specifically to monitor these drugs.
Authors
Karima Hider-Mlynarz, Philippe Cavalié, Patrick Maison
[link url="https://www.sciencedaily.com/releases/2018/03/180308160633.htm"]Wiley material[/link]
[link url="http://onlinelibrary.wiley.com/doi/10.1111/bcp.13551/abstract;jsessionid=BF0439E9D54DC5DC6F2AB1A1C2FB7CE7.f04t01"]British Journal of Clinical Pharmacology abstract 1[/link]
[link url="http://onlinelibrary.wiley.com/doi/10.1111/bcp.13564/abstract"]British Journal of Clinical Pharmacology abstract 2[/link]