1
|
Patel A, Rine NI, Spiller HA, Hays H, Badeti J, Zhu M, Ding K, Smith GA. Loperamide cases reported to United States poison centers, 2010-2022. Inj Epidemiol 2023; 10:61. [PMID: 38001549 PMCID: PMC10668506 DOI: 10.1186/s40621-023-00473-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/20/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Intentional use of high doses of loperamide has been linked to serious cardiac toxicity. The objective of this study is to investigate the characteristics and trends of loperamide cases reported to United States (US) poison centers and to evaluate the changes in reported loperamide cases following US Food and Drug Administration (FDA) warnings, labeling requirements, and packaging restrictions for loperamide starting in 2016, with an emphasis on intentional exposures. METHODS Data from the National Poison Data System were analyzed. RESULTS There were 12,987 cases reported to US poison centers from 2010 to 2022, for which, loperamide was the most likely substance responsible for observed clinical effects. Although 46.1% of these cases were associated with minor or no effect, 13.4% resulted in a serious medical outcome, including 59 deaths (0.5%). Eight percent (8.1%) of cases were admitted to a critical care unit and 5.0% were admitted to a non-critical care unit. Among cases with a serious medical outcome, most were associated with loperamide abuse (38.0%), intentional-misuse (15.7%), or suspected suicide (27.5%). The majority (60.0%; n = 33) of fatalities were related to abuse, followed by suspected suicide (20.0%; n = 11) and intentional-misuse (5.5%, n = 3). The rate of loperamide cases per 100,000 US population reported to US PCs decreased from 0.44 in 2010 to 0.36 in 2015 (p = 0.0290), followed by an increase to 0.46 in 2017 (p = 0.0013), and then a trend reversal with a decrease to 0.28 in 2022 (p < 0.0001). The rate of serious medical outcomes related to loperamide increased from 0.03 in 2010 to 0.05 in 2015 (p = 0.0109), which subsequently increased rapidly to 0.11 in 2017 (p < 0.0001), and then demonstrated a trend reversal and decreased to 0.04 in 2022 (p < 0.0001). CONCLUSIONS FDA warnings, labeling requirements, and packaging restrictions may have contributed to the observed trend reversal and decrease in reports to US poison centers of loperamide cases related to intentional misuse, abuse, and suspected suicide. This demonstrates the potential positive effect that regulatory actions may have on public health. These findings contribute to the evidence supporting the application of similar prevention efforts to reduce poisoning from other medications associated with intentional misuse, abuse, and suicide.
Collapse
Affiliation(s)
- Aaditya Patel
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Kansas City University College of Osteopathic Medicine, Kansas City, MO, USA
| | - Natalie I Rine
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Henry A Spiller
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Hannah Hays
- Central Ohio Poison Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jaahnavi Badeti
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Motao Zhu
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kele Ding
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Gary A Smith
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
- Child Injury Prevention Alliance, Columbus, OH, USA.
| |
Collapse
|
2
|
Comparing characteristics of suicide to non-suicide drug poisoning deaths, by sex, in Ireland. J Affect Disord 2022; 306:80-89. [PMID: 35306124 DOI: 10.1016/j.jad.2022.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/17/2022] [Accepted: 03/10/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Suicide by drug poisoning is potentially preventable; however, evidence on associated risk factors by sex is limited. AIM To assist in understanding how individual and social contextual factors, and specific drugs, influence risk of suicide compared to non-suicide drug poisoning deaths, and how this differs by sex. METHODS Data were extracted from the National Drug-Related Deaths Index. Analysis included univariable and multivariable logistic regression to estimate unadjusted and adjusted odds ratios (OR) and 95% confidence intervals (CI) for factors associated with suicide drug poisoning deaths (SDPD) (primary outcome) compared with non-suicide drug poisoning deaths (NSDPD) and stratified by sex. RESULTS SDPD accounted for 240 (22%) of 1114 poisoning deaths, the majority among men (n = 147, 61%). Increasing age, mental ill health (AOR 7.85, 95% CI: 5.46-11.28), chronic pain (AOR 5.57, 95% CI: 3.28-9.46), and history of previous overdose (AOR 5.06, 95% CI: 3.39-7.56) were associated with increased odds of SDPD, with similar results for both sexes. The main drugs associated with SDPD were non-opioid analgesics (OR 4.06 [95% CI 2.66-6.18]), antipsychotics (OR 2.42 [95% CI 1.63-3.60]) and antidepressants (OR 2.18 [95% CI 1.59-2.97]). Pregabalin was associated with SDPD among women only. LIMITATIONS Secondary analysis of coronial data on drug poisoning deaths therefore findings may not be relevant to suicide deaths in general. CONCLUSIONS Ongoing monitoring for signs of suicidal intent in individuals with mental illness, chronic pain, overdose, and/or prescribed mental health medications may identify individuals in need of additional intervention.
Collapse
|
3
|
COVID-19 Medical and Pharmacological Management in the European Countries Compared to Italy: An Overview. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074262. [PMID: 35409942 PMCID: PMC8998583 DOI: 10.3390/ijerph19074262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/16/2022] [Accepted: 03/30/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: Italy accounts for more than 150,000 deaths due to the COVID-19 pandemic, leading the top rank in SARS-CoV-2-caused deceases in Europe. A survey on the different ways by which the COVID-19 pandemic emergency was managed in the foreign European countries compared to Italy is the purpose of this paper. (2) Methods: A literature search and various mathematical algorithms to approach a rank scoring scale were used to describe in detail the different approaches used by European countries to manage the COVID-19 pandemic emergency. (3) Results: The study showed that Italy stands at the bottom ranking for COVID-19 management due to its high mortality rate. Possible causes of the observed huge numbers of hospitalization and deaths were (a) the demographic composition of the European country; (b) its decentralized healthcare system organization; (c) the role of correct pharmacology in the early stages before hospitalization. Post-mortem examinations were of paramount importance to elucidate the etiopathogenesis of COVID-19 and to tailor a suitable and proper therapy in the early symptomatic stages of COVID-19, preventing hospitalization. (4) Conclusions: Factors such as the significant impact on elderly people, the public health organization prevalently state-owned and represented mainly by hospitals, and criticism of the home therapy approach toward SARS-CoV-2-infected people, may have concurred in increasing the number of COVID-19 deaths in Italy.
Collapse
|
4
|
Cusimano JM. Intentional Overdose Prevention in the Era of the 90-Day Prescription. Psychiatr Serv 2021; 72:1361-1362. [PMID: 34734752 DOI: 10.1176/appi.ps.721104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Joseph M Cusimano
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, Virginia
| |
Collapse
|
5
|
Birchall E, Perry IJ, Corcoran P, Daly C, Griffin E. The impact of guidance on the supply of codeine-containing products on their use in intentional drug overdose. Eur J Public Health 2021; 31:853-858. [PMID: 34041521 PMCID: PMC8514187 DOI: 10.1093/eurpub/ckab082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Concerns about the misuse of codeine led to the introduction of guidance restricting the supply of over-the-counter (OTC) codeine-containing products in Ireland in 2010. The aim of this study was to examine the impact of this guidance on the national rate of hospital-presenting self-harm involving codeine-related intentional drug overdose (IDO). Methods Presentations involving IDO to Irish general hospitals between 1 January 2007 and 31 December 2013, as recorded by the National Self-Harm Registry Ireland, were analyzed. Event-based rates per 100 000 were calculated using national population data. Poisson regression models were used to assess rate changes between pre- and post-guidance periods and to calculate excess presentations. Results Between January 2007 and December 2013, a total of 57 759 IDOs were recorded, with 4789 (8.3%) involving a codeine-containing product. The rate of codeine-related IDOs was 20% lower in the period following implementation of the guidance (incidence rate ratio: 0.80; 95% CI: 0.75 to 0.85), representing a total of 509 (95% CI: −624, −387) fewer codeine-related IDOs in that period. Reductions were observed across all ages and were more pronounced for females (0.76, 0.71 to 0.82) than males (0.87, 0.79 to 0.97). The rate of IDOs involving other drugs decreased by 3% in the same period (0.97, 0.95 to 0.98). Conclusion Our findings indicate that the rate of codeine-related IDOs was significantly lower in the period following the implementation of the guidance. There is a large body of evidence supporting the restriction of potentially harmful medication as an effective strategy in suicide prevention.
Collapse
Affiliation(s)
- Emma Birchall
- School of Medicine, University College Cork, Cork, Ireland
| | - Ivan J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Paul Corcoran
- School of Public Health, University College Cork, Cork, Ireland.,National Suicide Research Foundation, Cork, Ireland
| | | | - Eve Griffin
- School of Public Health, University College Cork, Cork, Ireland.,National Suicide Research Foundation, Cork, Ireland
| |
Collapse
|
6
|
Robinson J, Witt K, Lamblin M, Spittal MJ, Carter G, Verspoor K, Page A, Rajaram G, Rozova V, Hill NTM, Pirkis J, Bleeker C, Pleban A, Knott JC. Development of a Self-Harm Monitoring System for Victoria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249385. [PMID: 33333970 PMCID: PMC7765445 DOI: 10.3390/ijerph17249385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/28/2020] [Accepted: 12/10/2020] [Indexed: 12/18/2022]
Abstract
The prevention of suicide and suicide-related behaviour are key policy priorities in Australia and internationally. The World Health Organization has recommended that member states develop self-harm surveillance systems as part of their suicide prevention efforts. This is also a priority under Australia’s Fifth National Mental Health and Suicide Prevention Plan. The aim of this paper is to describe the development of a state-based self-harm monitoring system in Victoria, Australia. In this system, data on all self-harm presentations are collected from eight hospital emergency departments in Victoria. A natural language processing classifier that uses machine learning to identify episodes of self-harm is currently being developed. This uses the free-text triage case notes, together with certain structured data fields, contained within the metadata of the incoming records. Post-processing is undertaken to identify primary mechanism of injury, substances consumed (including alcohol, illicit drugs and pharmaceutical preparations) and presence of psychiatric disorders. This system will ultimately leverage routinely collected data in combination with advanced artificial intelligence methods to support robust community-wide monitoring of self-harm. Once fully operational, this system will provide accurate and timely information on all presentations to participating emergency departments for self-harm, thereby providing a useful indicator for Australia’s suicide prevention efforts.
Collapse
Affiliation(s)
- Jo Robinson
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
- Correspondence: ; Tel.: +61-393-420-2866
| | - Katrina Witt
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Michelle Lamblin
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010 Australia; (M.J.S.); (J.P.)
| | - Greg Carter
- Centre for Brain and Mental Health Research, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia;
- Calvary Mater Newcastle, Callaghan, NSW 2308, Australia
| | - Karin Verspoor
- School of Computing and Information Systems, The University of Melbourne, Parkville, VIC 3052, Australia; (K.V.); (V.R.)
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, VIC 3000, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia;
| | - Gowri Rajaram
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Vlada Rozova
- School of Computing and Information Systems, The University of Melbourne, Parkville, VIC 3052, Australia; (K.V.); (V.R.)
| | - Nicole T. M. Hill
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
- Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010 Australia; (M.J.S.); (J.P.)
| | - Caitlin Bleeker
- Orygen, Parkville, VIC 3052, Australia; (K.W.); (M.L.); (G.R.); (N.T.M.H.); (C.B.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Alex Pleban
- Mid-West Area Mental Health Service, Emergency Department, Sunshine Hospital, Sunshine, VIC 3021, Australia;
| | - Jonathan C. Knott
- Centre for Integrated Critical Care, Melbourne Medical School, The University of Melbourne, Parkville, VIC 3010, Australia;
| |
Collapse
|
7
|
Casey D, Geulayov G, Bale E, Brand F, Clements C, Kapur N, Ness J, Patel A, Waters K, Hawton K. Paracetamol self-poisoning: Epidemiological study of trends and patient characteristics from the multicentre study of self-harm in England. J Affect Disord 2020; 276:699-706. [PMID: 32871703 DOI: 10.1016/j.jad.2020.07.091] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/18/2020] [Accepted: 07/05/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Paracetamol is frequently used for intentional self-poisoning, especially in the UK, despite pack size restrictions introduced in 1998. Knowing more about paracetamol self-poisoning may identify further approaches to prevention. METHODS We used data from the Multicentre Study of Self-harm in England for 2004-2014 to calculate incidence rates of presentations to Emergency Departments following self-poisoning with pure paracetamol alone. National estimates for England for 2011-2014 were extrapolated using indirect age-standardised rates. The characteristics of individuals taking paracetamol overdoses and the size of the overdoses were investigated. RESULTS A third of 54,863 intentional overdoses presenting to the five Emergency Departments involved paracetamol without other drugs (N = 18,011), taken by 13,171 individuals (63.4% female). The proportion of paracetamol self-poisonings was similar in the three centres. Extrapolation suggested there were approximately 50,000 paracetamol overdoses in England annually during 2011-2014. Females had higher rates of paracetamol overdose than males. Males and older individuals took larger overdoses. Nearly a quarter of individuals (24.2%) consumed more than 32 tablets. Alcohol was involved in 53.7% of paracetamol overdoses. LIMITATIONS Data were collected in three centres with predominantly urban populations. Extrapolation from local to national rates should be interpreted with caution. CONCLUSIONS Paracetamol overdose remains a major problem in the UK. It is more common in females and younger patients, but males and older patients consume larger overdoses. Consideration should be given to further restriction in pack sizes and sources of sales, in keeping with those of several other European countries.
Collapse
Affiliation(s)
- Deborah Casey
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Galit Geulayov
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Elizabeth Bale
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Fiona Brand
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust
| | - Caroline Clements
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - Navneet Kapur
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, UK; NIHR Patient Safety Translational Research Centre, University of Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jennifer Ness
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Anita Patel
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Keith Waters
- Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust.
| |
Collapse
|
8
|
Hopkins AG, Spiller HA, Kistamgari S, Zhu M, Michaels NL, Funk AR, Smith GA. Suicide‐related over‐the‐counter
analgesic exposures reported to United States poison control centers, 2000‐2018. Pharmacoepidemiol Drug Saf 2020; 29:1011-1021. [DOI: 10.1002/pds.4997] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/10/2020] [Accepted: 03/16/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Alexandra G. Hopkins
- Center for Injury Research and Policy The Abigail Wexner Research Institute at Nationwide Children's Hospital Columbus OH USA
- School of Medicine and Health Sciences University of North Dakota Grand Forks ND USA
| | - Henry A. Spiller
- Department of Pediatrics The Ohio State University College of Medicine Columbus OH USA
- Central Ohio Poison Center at Nationwide Children's Hospital Columbus OH USA
| | - Sandhya Kistamgari
- Center for Injury Research and Policy The Abigail Wexner Research Institute at Nationwide Children's Hospital Columbus OH USA
| | - Motao Zhu
- Center for Injury Research and Policy The Abigail Wexner Research Institute at Nationwide Children's Hospital Columbus OH USA
- Department of Pediatrics The Ohio State University College of Medicine Columbus OH USA
| | - Nichole L. Michaels
- Center for Injury Research and Policy The Abigail Wexner Research Institute at Nationwide Children's Hospital Columbus OH USA
- Department of Pediatrics The Ohio State University College of Medicine Columbus OH USA
| | - Alexandra R. Funk
- Central Ohio Poison Center at Nationwide Children's Hospital Columbus OH USA
| | - Gary A. Smith
- Center for Injury Research and Policy The Abigail Wexner Research Institute at Nationwide Children's Hospital Columbus OH USA
- Department of Pediatrics The Ohio State University College of Medicine Columbus OH USA
- Child Injury Prevention Alliance Columbus OH USA
| |
Collapse
|
9
|
Affiliation(s)
- Katrina Witt
- 1 Orygen, the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, VIC, Australia.,2 Turning Point, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jo Robinson
- 1 Orygen, the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, VIC, Australia
| |
Collapse
|
10
|
Graudins A, Wong A. Paracetamol overdose: limiting the potential for harm. Med J Aust 2019; 211:211-212. [DOI: 10.5694/mja2.50306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Andis Graudins
- Monash Health Melbourne VIC
- Monash University Melbourne VIC
| | - Anselm Wong
- Monash University Melbourne VIC
- Victorian Poisons Information CentreAustin Hospital Melbourne VIC
| |
Collapse
|
11
|
Daly C, Griffin E, Ashcroft DM, Webb RT, Perry IJ, Arensman E. Frequently used drug types and alcohol involvement in intentional drug overdoses in Ireland: a national registry study. Eur J Public Health 2019. [PMID: 29538652 DOI: 10.1093/eurpub/cky031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Intentional drug overdose (IDO) is the most common form of hospital-treated self-harm, yet no national study has systematically classified the range of drugs involved using a validated system. We aimed to determine the profile of patients engaging in overdose, to identify drugs frequently used and to quantify the contributions of multiple drug use and alcohol involvement. Methods Between 2012 and 2014, the National Self-Harm Registry, Ireland recorded 18 329 presentations of non-fatal IDO to Irish emergency departments. Information on demographic and overdose characteristics were obtained. Drugs were categorized using the Anatomical Therapeutic Chemical classification system. Results Analgesics (32.4%), antidepressants (21.9%), anxiolytics (21.2%) and hypnotics and sedatives (21.0%) were the most frequently used drugs types involved in overdose. Presentations involving analgesic and antidepressant medication were more common for females whereas males more often took illegal, anxiolytic and hypnotic and sedative drugs. Overdoses with drugs other than those which affect the nervous system were identified, including musculoskeletal drugs, taken in 12.0% of presentations. Paracetamol was the most frequently used drug, particularly among females (32.0%) and persons under 25 years (36.2%). Alcohol was most often present in overdoses involving anxiolytics and illegal drugs. Multiple drug use was a factor in almost half (47.1%) of presentations. Conclusions People who engage in IDO frequently take prescription only or sales restricted drugs, often involving alcohol and/or multiple drug use. These findings highlight the importance of addressing drug and alcohol misuse, potential inappropriate prescribing and the enforcement of legislation restricting specific drug sales.
Collapse
Affiliation(s)
- Caroline Daly
- National Suicide Research Foundation, School of Public Health, University College Cork, Cork, Ireland
| | - Eve Griffin
- National Suicide Research Foundation, School of Public Health, University College Cork, Cork, Ireland
| | - Darren M Ashcroft
- Division of Pharmacy & Optometry, Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Roger T Webb
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,Division of Psychology & Mental Health, Centre for Mental Health and Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Ivan J Perry
- National Suicide Research Foundation, School of Public Health, University College Cork, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - Ella Arensman
- National Suicide Research Foundation, School of Public Health, University College Cork, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| |
Collapse
|
12
|
Yesmin S, Zahan R, Hossain MM, Rahman ABMA, Khan A, Wahed MII, Naz T. Antioxidant Activity and Hepatoprotective Potential of <i>Piper chaba</i> Roots against Paracetamol-Induced Liver Injury. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/pp.2019.1011040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
13
|
Wu TK, Liu HC, Lin SY, Yu YL, Wei CW. Extracts from guava fruit protect renal tubular endothelial cells against acetaminophen‑induced cytotoxicity. Mol Med Rep 2018; 17:5544-5551. [PMID: 29393462 DOI: 10.3892/mmr.2018.8529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/17/2018] [Indexed: 11/06/2022] Open
Abstract
Acetaminophen (APAP) is an analgesic and antipyretic agent primarily used in the clinical setting. However, high doses of APAP can cause oxidative stress. Guavas have been reported to provide anti‑inflammatory, anti‑microbial, anti‑oxidative and anti‑diarrheal functions. In addition, guavas have been reported to prevent renal damage due to progression of diabetes mellitus. Therefore, the aim of the present study was to investigate whether guavas can reduce APAP‑induced renal cell damage. In the present study, extracts from guavas were obtained and added to APAP‑treated renal tubular endothelial cells. The present results demonstrated that APAP induces cytotoxicity in renal tubular endothelial cells, while guava extracts inhibited this cytotoxicity. In addition, the study demonstrated that the protective effects of guava extracts against APAP‑induced cytotoxicity may be associated with inhibition of oxidative stress and caspase‑3 activation.
Collapse
Affiliation(s)
- Tsai-Kun Wu
- The Ph.D. Program for Cancer Biology and Drug Discovery, China Medical University and Academia Sinica, Taichung 404, Taiwan, R.O.C
| | - Hsiao-Chun Liu
- Department of Nursing, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan, R.O.C
| | - Shu-Yu Lin
- Department of Nutrition, Master Program of Biomedical Nutrition, Hungkuang University, Taichung 433, Taiwan, R.O.C
| | - Yung-Luen Yu
- The Ph.D. Program for Cancer Biology and Drug Discovery, China Medical University and Academia Sinica, Taichung 404, Taiwan, R.O.C
| | - Chyou-Wei Wei
- Department of Nutrition, Master Program of Biomedical Nutrition, Hungkuang University, Taichung 433, Taiwan, R.O.C
| |
Collapse
|
14
|
Westerlund T, Barzi S, Bernsten C. Consumer views on safety of over-the-counter drugs, preferred retailers and information sources in Sweden: after re-regulation of the pharmacy market. Pharm Pract (Granada) 2017; 15:894. [PMID: 28503226 PMCID: PMC5386627 DOI: 10.18549/pharmpract.2017.01.894] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/07/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The availability of over-the-counter drugs (OTCs) has increased in Sweden since a re-regulation of the pharmacy market in 2009, through which non-pharmacy retailers became permitted to provide certain OTCs. OBJECTIVE To examine the adult general public's views on safety, purchasing and information channels, storage and disposal of OTCs in Sweden, three years after the re-regulation of the pharmacy market. METHODS A questionnaire study in 2012-13 in a stratified, random sample of all inhabitants in Sweden ≥ 18 years old. RESULTS Totally 8,302 people (42%) answered the questionnaire. Seven percent found OTCs completely harmless regardless of how they are being used, 18% felt they should be used only on health professionals' recommendation. Differences in how OTCs are perceived were however found with regards to respondents' country of birth, family type, educational level and income. The pharmacy was still the preferred OTC drug retailer by 83% of the respondents and preferred information source by 80% Reasons for preferred retailers were primarily due to out of habit (45%), counseling provided (35%), the product range (34%) and the confidence in staff (27%). Analgesics are the most common OTCs to have at home (90%). The bathroom cabinet is the primary site for storage (42%) and 16% throw their OTC leftovers in the trash. CONCLUSIONS The study population does not consider OTCs as harmless regardless of how they are used, but on the other hand feels they should not be taken on health professionals' recommendation only. The pharmacy is still the preferred retailer and information source, and there is room for further improvement in the storage and disposal of OTCs. A return of OTC drug leftovers to the pharmacy should be further encouraged. Due to several limitations, great caution should however be observed when generalizing the results to the adult population of Sweden.
Collapse
Affiliation(s)
- Tommy Westerlund
- MSc (Pharm), MSc, PhD. Associate Professor. Department of Use of Medical Products, Medical Products Agency, Uppsala; Sahlgrenska Academy, Institute of Medicine, Epidemiology and Social Medicine (EPSO), University of Gothenburg, Göteborg; & Department of Biomedical Science, Faculty of Health and Society, Malmö University, Malmö (Sweden).
| | - Sahra Barzi
- MSc(Pharm). Department of Use of Medical Products, Medical Products Agency. Uppsala (Sweden).
| | - Cecilia Bernsten
- MSc(Pharm), PhD. Associate Professor. Department of Use of Medical Products, Medical Products Agency, Uppsala; Department of Public Health and Caring Sciences, Uppsala University. Uppsala (Sweden).
| |
Collapse
|
15
|
Pace JB, Nave V, Moulis M, Bourdelin M, Coursier S, Jean-Bart É, Leroy B, Bonnefous JL, Bontemps H, Coutet J, Eyssette C, Pont E. [Prescription of acetaminophen in five French hospitals: What are the practices?]. Therapie 2017; 72:579-586. [PMID: 28336157 DOI: 10.1016/j.therap.2017.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/12/2017] [Indexed: 02/03/2023]
Abstract
AIM Acetaminophen is widely used in hospital settings and often considered as nontoxic. We conducted a multicentric study in order to evaluate its proper use. METHOD Prescriptions from five general hospitals were analyzed, according to dose adjustments required in renal or liver failure, weight or chronic alcoholism, determined using a literature review. Other criteria have been assessed: indication for parenteral access, accuracy of administration time and pain assessment. RESULTS Among the 1256 analyzed prescriptions, 21% are non-compliants. The main causes of non-compliance (NC) are adjustments to weight and renal failure. Higher NC rates concern chronic alcoholism and liver failure. CONCLUSION Misuse of acetaminophen seems related to a lack of official recommendations concerning dose adjustments. Hospital pharmacists have an important role to play in the promotion of proper use of acetaminophen. Therefore we established a prescribing aid.
Collapse
Affiliation(s)
- Jean-Baptiste Pace
- Service pharmacie, centre hospitalier Pierre-Oudot, 30, avenue du Médipôle, BP 40348, 38300 Bourgoin-Jallieu, France.
| | - Viviane Nave
- Service pharmacie, centre hospitalier Pierre-Oudot, 30, avenue du Médipôle, BP 40348, 38300 Bourgoin-Jallieu, France
| | - Mélanie Moulis
- Service pharmacie, centre hospitalier Pierre-Oudot, 30, avenue du Médipôle, BP 40348, 38300 Bourgoin-Jallieu, France
| | - Magali Bourdelin
- Service pharmacie, hôpital Nord-Ouest, 69655 Villefranche-sur-Saône, France
| | - Sandra Coursier
- Service pharmacie, hôpital Nord-Ouest, 69655 Villefranche-sur-Saône, France
| | - Élodie Jean-Bart
- Service pharmacie, hôpital Fleyriat, 01012 Bourg-en-Bresse, France
| | - Bertrand Leroy
- Service pharmacie, centre hospitalier William-Morey, 71100 Chalon-sur-Saône, France
| | | | - Hervé Bontemps
- Service pharmacie, hôpital Nord-Ouest, 69655 Villefranche-sur-Saône, France
| | - Jérôme Coutet
- Service pharmacie, centre hospitalier William-Morey, 71100 Chalon-sur-Saône, France
| | - Carine Eyssette
- Service pharmacie, hôpital Les Charmes, 71604 Paray-Le-Monial, France
| | - Emmanuelle Pont
- Service pharmacie, centre hospitalier Pierre-Oudot, 30, avenue du Médipôle, BP 40348, 38300 Bourgoin-Jallieu, France
| |
Collapse
|
16
|
Zalsman G, Hawton K, Wasserman D, van Heeringen K, Arensman E, Sarchiapone M, Carli V, Höschl C, Barzilay R, Balazs J, Purebl G, Kahn JP, Sáiz PA, Lipsicas CB, Bobes J, Cozman D, Hegerl U, Zohar J. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry 2016; 3:646-59. [PMID: 27289303 DOI: 10.1016/s2215-0366(16)30030-x] [Citation(s) in RCA: 946] [Impact Index Per Article: 118.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/27/2016] [Accepted: 03/30/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Many countries are developing suicide prevention strategies for which up-to-date, high-quality evidence is required. We present updated evidence for the effectiveness of suicide prevention interventions since 2005. METHODS We searched PubMed and the Cochrane Library using multiple terms related to suicide prevention for studies published between Jan 1, 2005, and Dec 31, 2014. We assessed seven interventions: public and physician education, media strategies, screening, restricting access to suicide means, treatments, and internet or hotline support. Data were extracted on primary outcomes of interest, namely suicidal behaviour (suicide, attempt, or ideation), and intermediate or secondary outcomes (treatment-seeking, identification of at-risk individuals, antidepressant prescription or use rates, or referrals). 18 suicide prevention experts from 13 European countries reviewed all articles and rated the strength of evidence using the Oxford criteria. Because the heterogeneity of populations and methodology did not permit formal meta-analysis, we present a narrative analysis. FINDINGS We identified 1797 studies, including 23 systematic reviews, 12 meta-analyses, 40 randomised controlled trials (RCTs), 67 cohort trials, and 22 ecological or population-based investigations. Evidence for restricting access to lethal means in prevention of suicide has strengthened since 2005, especially with regard to control of analgesics (overall decrease of 43% since 2005) and hot-spots for suicide by jumping (reduction of 86% since 2005, 79% to 91%). School-based awareness programmes have been shown to reduce suicide attempts (odds ratio [OR] 0·45, 95% CI 0·24-0·85; p=0·014) and suicidal ideation (0·5, 0·27-0·92; p=0·025). The anti-suicidal effects of clozapine and lithium have been substantiated, but might be less specific than previously thought. Effective pharmacological and psychological treatments of depression are important in prevention. Insufficient evidence exists to assess the possible benefits for suicide prevention of screening in primary care, in general public education and media guidelines. Other approaches that need further investigation include gatekeeper training, education of physicians, and internet and helpline support. The paucity of RCTs is a major limitation in the evaluation of preventive interventions. INTERPRETATION In the quest for effective suicide prevention initiatives, no single strategy clearly stands above the others. Combinations of evidence-based strategies at the individual level and the population level should be assessed with robust research designs. FUNDING The Expert Platform on Mental Health, Focus on Depression, and the European College of Neuropsychopharmacology.
Collapse
Affiliation(s)
- Gil Zalsman
- Geha Mental Health Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA.
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, UK
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | | | - Ella Arensman
- National Suicide Research Foundation, Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Via De Santis Campobasso and National Institute for Health, Migration and Poverty, Roma, Italy
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Cyril Höschl
- National Institute of Mental Health, Klecany, Czech Republic
| | - Ran Barzilay
- Geha Mental Health Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- Department of Developmental and Clinical Child Psychology, Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
| | - György Purebl
- Institute of Behavioral Sciences, Semmelweis University Budapest, Budapest, Hungary
| | - Jean Pierre Kahn
- Université de Lorraine, Pôle de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy-Laxou, Nancy-Laxou, France
| | - Pilar Alejandra Sáiz
- Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, Spain
| | - Cendrine Bursztein Lipsicas
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, Spain
| | - Doina Cozman
- Department of Clinical Psychology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Joseph Zohar
- Psychiatry Department, Sheba Health Center and Sackler School of Medicine, Tel Aviv University, Tel Avis, Israel
| |
Collapse
|
17
|
Stine JG, Lewis JH. Current and future directions in the treatment and prevention of drug-induced liver injury: a systematic review. Expert Rev Gastroenterol Hepatol 2015; 10:517-36. [PMID: 26633044 PMCID: PMC5074808 DOI: 10.1586/17474124.2016.1127756] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
While the pace of discovery of new agents, mechanisms and risk factors involved in drug-induced liver injury (DILI) remains brisk, advances in the treatment of acute DILI seems slow by comparison. In general, the key to treating suspected DILI is to stop using the drug prior to developing irreversible liver failure. However, predicting when to stop is an inexact science, and commonly used ALT monitoring is an ineffective strategy outside of clinical trials. The only specific antidote for acute DILI remains N-acetylcysteine (NAC) for acetaminophen poisoning, although NAC is proving to be beneficial in some cases of non-acetaminophen DILI in adults. Corticosteroids can be effective for DILI associated with autoimmune or systemic hypersensitivity features. Ursodeoxycholic acid, silymarin and glycyrrhizin have been used to treat DILI for decades, but success remains anecdotal. Bile acid washout regimens using cholestyramine appear to be more evidenced based, in particular for leflunomide toxicity. For drug-induced acute liver failure, the use of liver support systems is still investigational in the United States and emergency liver transplant remains limited by its availability. Primary prevention appears to be the key to avoiding DILI and the need for acute treatment. Pharmacogenomics, including human leukocyte antigen genotyping and the discovery of specific DILI biomarkers offers significant promise for the future. This article describes and summarizes the numerous and diverse treatment and prevention modalities that are currently available to manage DILI.
Collapse
Affiliation(s)
- Jonathan G. Stine
- University of Virginia Health System, Department of Medicine, Division of Gastroenterology and Hepatology, JPA and Lee Street, MSB 2145, PO Box 800708, Charlottesville VA 22908
| | - James H. Lewis
- Georgetown University Medical Center, Department of Medicine, Division of Gastroenterology and Hepatology, 3800 Reservoir Rd NW, Washington, DC 20007
| |
Collapse
|
18
|
Lewis JH. The Art and Science of Diagnosing and Managing Drug-induced Liver Injury in 2015 and Beyond. Clin Gastroenterol Hepatol 2015; 13:2173-89.e8. [PMID: 26116527 DOI: 10.1016/j.cgh.2015.06.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 12/13/2022]
Abstract
Drug-induced liver injury (DILI) remains a leading reason why new compounds are dropped from further study or are the subject of product warnings and regulatory actions. Hy's Law of drug-induced hepatocellular jaundice causing a case-fatality rate or need for transplant of 10% or higher has been validated in several large national registries, including the ongoing, prospective U.S. Drug-Induced Liver Injury Network. It serves as the basis for stopping rules in clinical trials and in clinical practice. Because DILI can mimic all known causes of acute and chronic liver disease, establishing causality can be difficult. Histopathologic findings are often nonspecific and rarely, if ever, considered pathognomonic. A daily drug dose >50-100 mg is more likely to be hepatotoxic than does <10 mg, especially if the compound is highly lipophilic or undergoes extensive hepatic metabolism. The quest for a predictive biomarker to replace alanine aminotransferase is ongoing. Markers of necrosis and apoptosis such as microRNA-122 and keratin 18 may prove useful in identifying patients at risk for severe injury when they initially present with a suspected acetaminophen overdose. Although a number of drugs causing idiosyncratic DILI have HLA associations that may allow for pre-prescription testing to prevent hepatotoxicity, the cost and relatively low frequency of injury among affected patients limit the current usefulness of such genome-wide association studies. Alanine aminotransferase monitoring is often recommended but has rarely been shown to be an effective method to prevent serious DILI. Guidelines on the diagnosis and management of DILI have recently been published, although specific therapies remain limited. The LiverTox Web site has been introduced as an interactive online virtual textbook that makes the latest information on more than 650 agents available to clinicians, regulators, and drug developers alike.
Collapse
Affiliation(s)
- James H Lewis
- Hepatology Section, Division of Gastroenterology, Georgetown University Hospital, Washington, District of Columbia.
| |
Collapse
|
19
|
Timescale analysis of a mathematical model of acetaminophen metabolism and toxicity. J Theor Biol 2015; 386:132-46. [PMID: 26348886 DOI: 10.1016/j.jtbi.2015.08.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/03/2015] [Accepted: 08/26/2015] [Indexed: 01/13/2023]
Abstract
Acetaminophen is a widespread and commonly used painkiller all over the world. However, it can cause liver damage when taken in large doses or at repeated chronic doses. Current models of acetaminophen metabolism are complex, and limited to numerical investigation though provide results that represent clinical investigation well. We derive a mathematical model based on mass action laws aimed at capturing the main dynamics of acetaminophen metabolism, in particular the contrast between normal and overdose cases, whilst remaining simple enough for detailed mathematical analysis that can identify key parameters and quantify their role in liver toxicity. We use singular perturbation analysis to separate the different timescales describing the sequence of events in acetaminophen metabolism, systematically identifying which parameters dominate during each of the successive stages. Using this approach we determined, in terms of the model parameters, the critical dose between safe and overdose cases, timescales for exhaustion and regeneration of important cofactors for acetaminophen metabolism and total toxin accumulation as a fraction of initial dose.
Collapse
|
20
|
Yiang GT, Yu YL, Lin KT, Chen JN, Chang WJ, Wei CW. Acetaminophen induces JNK/p38 signaling and activates the caspase-9-3-dependent cell death pathway in human mesenchymal stem cells. Int J Mol Med 2015; 36:485-92. [PMID: 26096646 PMCID: PMC4501662 DOI: 10.3892/ijmm.2015.2254] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 06/05/2015] [Indexed: 02/05/2023] Open
Abstract
Acetaminophen (APAP) is a widely used analgesic and antipyretic drug. Generally, the therapeutic dose of APAP is clinically safe, however, high doses of APAP can cause acute liver and kidney injury. Therefore, the majority of previous studies have focussed on elucidating the mechanisms of APAP-induced hepatotoxicity and nephrotoxicity, in addition to examining ways to treat these conditions in clinical cases. However, few studies have reported APAP-induced intoxication in human stem cells. Stem cells are important in cell proliferation, differentiation and repair during human development, particularly during fetal and child development. At present, whether APAP causes cytotoxic effects in human stem cells remains to be elucidated, therefore, the present study aimed to investigate the cellular effects of APAP treatment in human stem cells. The results of the present study revealed that high-dose APAP induced more marked cytotoxic effects in human mesenchymal stem cells (hMSCs) than in renal tubular cells. In addition, increased levels of hydrogen peroxide (H2O2), phosphorylation of c-Jun N-terminal kinase and p38, and activation of caspase-9/-3 cascade were observed in the APAP-treated hMSCs. By contrast, antioxidants, including vitamin C reduced APAP-induced augmentations in H2O2 levels, but did not inhibit the APAP-induced cytotoxic effects in the hMSCs. These results suggested that high doses of APAP may cause serious damage towards hMSCs.
Collapse
Affiliation(s)
- Giou-Teng Yiang
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan, R.O.C
| | - Yung-Lung Yu
- Graduate Institute of Cancer Biology and Center for Molecular Medicine, China Medical University, Taichung 404, Taiwan, R.O.C
| | - Ko-Ting Lin
- Department of Nutrition, Master Program of Biomedical Nutrition, Hungkuang University, Shalu, Taichung 433, Taiwan, R.O.C
| | - Jen-Ni Chen
- Department of Nutrition, Master Program of Biomedical Nutrition, Hungkuang University, Shalu, Taichung 433, Taiwan, R.O.C
| | - Wei-Jung Chang
- Graduate Institute of Cancer Biology and Center for Molecular Medicine, China Medical University, Taichung 404, Taiwan, R.O.C
| | - Chyou-Wei Wei
- Department of Nutrition, Master Program of Biomedical Nutrition, Hungkuang University, Shalu, Taichung 433, Taiwan, R.O.C
| |
Collapse
|
21
|
Gulmez SE, Larrey D, Pageaux GP, Bernuau J, Bissoli F, Horsmans Y, Thorburn D, McCormick PA, Stricker B, Toussi M, Lignot-Maleyran S, Micon S, Hamoud F, Lassalle R, Jové J, Blin P, Moore N. Liver transplant associated with paracetamol overdose: results from the seven-country SALT study. Br J Clin Pharmacol 2015; 80:599-606. [PMID: 26017643 DOI: 10.1111/bcp.12635] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/24/2015] [Accepted: 03/03/2015] [Indexed: 02/05/2023] Open
Abstract
AIMS Acute drug overdose, especially with paracetamol, may cause acute liver failure leading to registration for transplantation (ALFT). Population statistics and between-country differences for ALFT related to overdose have been poorly described. The aim of the present study was to evaluate overdose ALFT in the multi-country Study of Acute Liver Transplantation (SALT). METHODS All adult overdose-related ALFT, with or without suicidal intent, in France, Greece, Ireland, Italy, the Netherlands, Portugal and the UK between 2005 and 2007 were identified from liver transplant registries and hospital records. These were compared with whole-country and per capita use of paracetamol. RESULTS Six hundred cases of ALFT were identified in 52 of 57 eligible transplant centres, of which 114 involved overdose (72 intentional, 10 non-intentional, 32 uncertain). Overdose represented 20% of all-cause ALFT: Ireland 52%, UK 28%, France 18%, the Netherlands 8%, and Italy 1%. Overdose ALFT were mostly females (61%), mean age 33.6 ± 10.9 years. A total of 111 (97%) of the overdoses involved paracetamol. Event rates ranged from one ALFT for 20.7 tons of paracetamol in Ireland, to one for 1074 tons in Italy and one case in 60 million inhabitants over 3 years in Italy to one case in 286 000 inhabitants per year in Ireland. Per-country event rates for non-overdose ALFT exposed to paracetamol were between 2.5 and 4.0 per million treatment-years sold. CONCLUSIONS Paracetamol overdose was found to represent one-sixth of all-cause ALFT. There was a 50-fold difference in Europe in the rates of paracetamol overdose ALFT, and a 200-fold difference per million inhabitants.
Collapse
Affiliation(s)
- Sinem Ezgi Gulmez
- CIC Bordeaux CIC1401 Pharmaco-épidémiologie, Université de Bordeaux, F-33076, Bordeaux, France
| | | | | | | | - Franco Bissoli
- Department of Internal Medicine, Clinica San Gaudenzio, Novara, Italy
| | - Yves Horsmans
- Department of Gastroenterology, Louvain Catholic University, Louvain, Belgium
| | | | - P Aiden McCormick
- Liver Unit, St Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Bruno Stricker
- Department of Epidemiology, Erasmus University, Rotterdam, Netherlands
| | | | | | - Sophie Micon
- CIC Bordeaux CIC1401 Pharmaco-épidémiologie, Université de Bordeaux, F-33076, Bordeaux, France
| | - Fatima Hamoud
- CIC Bordeaux CIC1401 Pharmaco-épidémiologie, Université de Bordeaux, F-33076, Bordeaux, France
| | - Régis Lassalle
- CIC Bordeaux CIC1401 Pharmaco-épidémiologie, Université de Bordeaux, F-33076, Bordeaux, France
| | - Jérémy Jové
- CIC Bordeaux CIC1401 Pharmaco-épidémiologie, Université de Bordeaux, F-33076, Bordeaux, France
| | - Patrick Blin
- CIC Bordeaux CIC1401 Pharmaco-épidémiologie, Université de Bordeaux, F-33076, Bordeaux, France
| | - Nicholas Moore
- CIC Bordeaux CIC1401 Pharmaco-épidémiologie, Université de Bordeaux, F-33076, Bordeaux, France
| |
Collapse
|
22
|
Abstract
In 1998 the United Kingdom limited the availability of paracetamol sold over-the-counter in an effort to reduce serious paracetamol overdose. Since that time debate has continued on the effectiveness of this policy in reducing what is acknowledged as a major public health problem. This commentary reviews recent publications on this topic which suggest that the effects were small. Reasons for this are discussed using data from recent work.
Collapse
|
23
|
Herndon CM, Dankenbring DM. Patient perception and knowledge of acetaminophen in a large family medicine service. J Pain Palliat Care Pharmacother 2014; 28:109-16. [PMID: 24813653 DOI: 10.3109/15360288.2014.908993] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The use of acetaminophen is currently under increased scrutiny by the US Food and Drug Administration (FDA) due to the risk of intentional and more concerning, unintentional overdose-related hepatotoxicity. Acetaminophen is responsible for an estimated 48% of all acute liver failure diagnoses. The purpose of this study is to evaluate patient perception and knowledge of the safe use and potential toxicity of acetaminophen-containing products. The authors conducted a descriptive, 2-week study using a convenience sample from a large family medicine clinic waiting room. Survey questions assessed ability to identify acetaminophen, knowledge of the current recommended maximum daily dose, respondent acetaminophen use patterns, common adverse effects associated with acetaminophen, and respondent self-reported alcohol consumption. Acetaminophen safety information was provided to all persons regardless of participation in the study. Of the 102 patients who chose to participate, 79% recognized acetaminophen as a synonym of Tylenol, whereas only 9% identified APAP as a frequently used abbreviation. One third of respondents thought acetaminophen was synonymous with ibuprofen and naproxen. Approximately one fourth of patients correctly identified the then maximum recommended daily acetaminophen dose of 4 g. Seventy-eight percent of patients correctly identified hepatotoxicity as the most common serious adverse effect. We conclude that patient deficiencies in knowledge of acetaminophen recognition, dosing, and toxicity warrant public education by health professionals at all levels of interaction. Current initiatives are promising; however, further efforts are required.
Collapse
|
24
|
Chalhoub WM, Sliman KD, Arumuganathan M, Lewis JH. Drug-induced liver injury: what was new in 2013? Expert Opin Drug Metab Toxicol 2014; 10:959-80. [PMID: 24746272 DOI: 10.1517/17425255.2014.909408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The year 2013 continued to highlight numerous aspects of drug-induced liver injury (DILI), with new information communicated via > 1500 publications. New reports of DILI were described and FDA warnings and alerts were issued for a number of products, emphasizing the risks related to hepatotoxicity. AREAS COVERED We provide a summary of the year's published reports of new causes of DILI, along with reviews and reports of established hepatotoxins, new and expanded DILI registries and the continuing emphasis placed on genetic and other risk factors. Several new analyses of data generated from the US DILI Network are included. EXPERT OPINION The clinical usefulness of pharmacogenetic testing remains to be determined; the number of patients who must be tested is large and the overall risk of DILI is quite small. The role that dose and hepatic metabolism play in causing idiosyncratic DILI was reviewed; daily doses > 50 - 100 mg of medications with high lipophilicity appear to be most predictive of severe DILI, but not in all cases. Restricting access to paracetamol in certain parts of the UK continues to demonstrate a successful reduction in the number of acute liver failure cases and patients listed for liver transplant.
Collapse
Affiliation(s)
- Walid M Chalhoub
- Georgetown University Hospital, Department of Medicine, Division of Gastroenterology, Hepatology Section , 3800 Reservoir Road, NW, Washington, DC 20007 , USA
| | | | | | | |
Collapse
|
25
|
Yu YL, Yiang GT, Chou PL, Tseng HH, Wu TK, Hung YT, Lin PS, Lin SY, Liu HC, Chang WJ, Wei CW. Dual role of acetaminophen in promoting hepatoma cell apoptosis and kidney fibroblast proliferation. Mol Med Rep 2014; 9:2077-84. [PMID: 24682227 PMCID: PMC4055434 DOI: 10.3892/mmr.2014.2085] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 02/28/2014] [Indexed: 12/19/2022] Open
Abstract
Acetaminophen (APAP), is a safe analgesic and antipyretic drug at therapeutic dose, and is widely used in the clinic. However, high doses of APAP can induce hepatotoxicity and nephrotoxicity. Most studies have focused on high‑dose APAP‑induced acute liver and kidney injury. So far, few studies have investigated the effects of the therapeutic dose (1/10 of the high dose) or of the low dose (1/100 of the high dose) of APAP on the cells. The aim of this study was to investigate the cellular effects of therapeutic- or low‑dose APAP treatment on hepatoma cells and kidney fibroblasts. As expected, high‑dose APAP treatment inhibited while therapeutic and low‑dose treatment did not inhibit cell survival of kidney tubular epithelial cells. In addition, therapeutic-dose treatment induced an increase in the H2O2 level, activated the caspase‑9/‑3 cascade, and induced cell apoptosis of hepatoma cells. Notably, APAP promoted fibroblast proliferation, even at low doses. This study demonstrates that different cellular effects are exerted upon treatment with different APAP concentrations. Our results indicate that treatment with the therapeutic dose of APAP may exert an antitumor activity on hepatoma, while low‑dose treatment may be harmful for patients with fibrosis, since it may cause proliferation of fibroblasts.
Collapse
Affiliation(s)
- Yung-Luen Yu
- Graduate Institute of Cancer Biology and Center for Molecular Medicine, China Medical University, Taichung 404, Taiwan, R.O.C
| | - Giou-Teng Yiang
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan, R.O.C
| | - Pei-Lun Chou
- Division of Allergy‑Immunology‑Rheumatology, Department of Internal Medicine, Saint Mary's Hospital Luodong, Yilan 265, Taiwan, R.O.C
| | - Hsu-Hung Tseng
- Division of General Surgery, Taichung Hospital, Ministry of Health and Welfare, Taichung 403, Taiwan, R.O.C
| | - Tsai-Kun Wu
- 2The Ph.D. Program for Cancer Biology and Drug Discovery, China Medical University, Taichung 404, Taiwan, R.O.C
| | - Yu-Ting Hung
- Department of Nutrition, Master Program of Biomedical Nutrition, Hungkuang University, Taichung 433, Taiwan, R.O.C
| | - Pei-Shiuan Lin
- Department of Nutrition, Master Program of Biomedical Nutrition, Hungkuang University, Taichung 433, Taiwan, R.O.C
| | - Shu-Yu Lin
- Department of Nutrition, Master Program of Biomedical Nutrition, Hungkuang University, Taichung 433, Taiwan, R.O.C
| | - Hsiao-Chun Liu
- Department of Nursing, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan, R.O.C
| | - Wei-Jung Chang
- Graduate Institute of Cancer Biology and Center for Molecular Medicine, China Medical University, Taichung 404, Taiwan, R.O.C
| | - Chyou-Wei Wei
- Department of Nutrition, Master Program of Biomedical Nutrition, Hungkuang University, Taichung 433, Taiwan, R.O.C
| |
Collapse
|
26
|
Murphy OC, Kelleher C, Malone KM. Demographic trends in suicide in the UK and Ireland 1980–2010. Ir J Med Sci 2014; 184:227-35. [DOI: 10.1007/s11845-014-1092-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 02/14/2014] [Indexed: 11/24/2022]
|
27
|
Carthy ER, Ellis SDP. Paracetamol poisoning in the UK: a meeting report from Pharmacology 2013. Expert Rev Clin Pharmacol 2014; 7:147-9. [DOI: 10.1586/17512433.2014.889564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
28
|
Gunnell D, Hawton K, Bennewith O, Cooper J, Simkin S, Donovan J, Evans J, Longson D, O'Connor S, Kapur N. A multicentre programme of clinical and public health research in support of the National Suicide Prevention Strategy for England. PROGRAMME GRANTS FOR APPLIED RESEARCH 2013. [DOI: 10.3310/pgfar01010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
ObjectivesTo carry out a programme of linked research studies aimed at improving the management of self-harm, reducing the incidence of suicide and providing reliable data to evaluate the impact of theNational Suicide Prevention Strategy for England(2002).MethodsThere were four research streams: (1) we studied inquest records from 12 coroners and Ministry of Justice data to assess the accuracy of official suicide statistics; (2) we used Office for National Statistics mortality statistics, data from the Multicentre Study of Self-harm in England, national liver unit data, prescription data and patient interviews to assess (a) the impact of paracetamol (acetaminophen) pack size restrictions (1998), (b) the impact of withdrawal of co-proxamol in 2007 and (c) the relative toxicity in overdose of commonly used antidepressants; (3) we carried out 3-month audits of self-harm management in 32 hospitals to investigate variations between hospitals and the impact of management on repeat self-harm; and (4) we developed and piloted letter-based contact interventions aimed at reducing self-harm.Key findings(1) Between 1990 and 2005, the proportion of researcher-defined suicides given a verdict of suicide by the 12 coroners studied decreased by almost 7%, largely because of the increased use of misadventure/accident verdicts for deaths thought, on clinical review, to be suicides. Use of narrative verdicts increased markedly. Coroners who gave more narrative verdicts also gave fewer suicide verdicts, and geographical variations in the use of narrative verdicts appeared to distort reliable assessment of small-area differences in suicide rates. 2(a) UK legislation to reduce pack sizes of paracetamol was followed by a 43% reduction in number of deaths and a 61% reduction in registrations for liver transplantation over the next 11 years. Paracetamol overdoses were often impulsive and some were influenced by media (including the internet); sales outlets appeared mostly to be adhering to sales guidance. Smaller pack sizes of paracetamol for sale in Ireland compared with England did not result in a smaller number of tablets being taken in overdose. There was no clear evidence of an effect of the legislation on prescribing of non-steroidal anti-inflammatory drugs, nor on resulting gastrointestinal bleeds. 2(b) Withdrawal of co-proxamol from use in the UK resulted in approximately 600 fewer deaths than predicted between 2005 and 2010 based on previous trends, with no evidence of substitution by poisoning with other analgesics. 2(c) Of the tricyclic antidepressants, dosulepin and doxepin had the greatest toxicity. Citalopram was more toxic than other selective serotonin reuptake inhibitors. (3) There was marked variation between hospitals in the management of self-harm; effects of this variation on patient outcomes were unclear, although psychosocial assessment may have been associated with reduced repetition. Levels of specialist assessment remained static between 2001–2 and 2010–11, but service quality appeared to improve. (4) Findings of two pilot randomised controlled trials suggested that, although it would be feasible to scale up these interventions to full trials, these interventions might have low generalisability and be of limited benefit to patients.ConclusionWithin the context of the strengths and limitations of the individual studies, this research programme has made significant additions to the evidence base related to suicide and self-harm prevention in the UK.Study registrationA pilot study of a contact and information based intervention to reduce repeat self-harm; ISRCTN65171515.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
Collapse
Affiliation(s)
- D Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - K Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - O Bennewith
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Cooper
- Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - S Simkin
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - J Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Evans
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Avon and Wiltshire Mental Health Partnership NHS Trust, Chippenham, UK
| | - D Longson
- Manchester Mental Health and Social Care Trust, Manchester, UK
| | - S O'Connor
- Avon and Wiltshire Mental Health Partnership NHS Trust, Chippenham, UK
| | - N Kapur
- Centre for Suicide Prevention, University of Manchester, Manchester, UK
- Manchester Mental Health and Social Care Trust, Manchester, UK
| |
Collapse
|
29
|
Corcoran P, Heavey B, Griffin E, Perry IJ, Arensman E. Psychotropic medication involved in intentional drug overdose: implications for treatment. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/npy.13.23] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
30
|
Abstract
AIM Paracetamol (acetaminophen) is a common cause of liver failure due to overdose. Legislation introduced in the UK in 1998 to limit pack sizes of paracetamol has had limited impact on the overall number and severity of paracetamol overdoses. This may be because people have large amounts of paracetamol stored at home, but no previous studies have explored this question. METHODS Individuals who regularly take part in market research surveys were invited to take part in an Internet survey. They were asked to supply demographic details, the frequency with which they use paracetamol and ibuprofen, and details of the amount and location of these drugs that they possessed. RESULTS The mean age of respondents was 43.3 years (standard deviation 14.5 years), and 49.9% were female. People with both ibuprofen and paracetamol tended to have more packs and tablets of paracetamol (P < 0.001) and over a third had 32 or more paracetamol tablets. The most common pack size was 16 tablet packs (44.8% of all packs), which accounted for 39.4% of tablets. The most common site of paracetamol storage in the home was the kitchen (63.8% of people, 95% confidence interval 60.7, 66.7). CONCLUSION This study suggests that pack size legislation in the UK has had limited effect on the amount of paracetamol that individuals have access to in the home. This may explain, at least in part, the limited impact of the pack size legislation on paracetamol overdoses in the UK.
Collapse
Affiliation(s)
- A D Shah
- Medical Toxicology Office, 2nd Floor, Bermondsey Wing, Guy's Hospital, Great Maze Pond, London, UK
| | | | | |
Collapse
|
31
|
Barr B, Taylor-Robinson D, Scott-Samuel A, McKee M, Stuckler D. Suicides associated with the 2008-10 economic recession in England: time trend analysis. BMJ 2012; 345:e5142. [PMID: 22893569 PMCID: PMC3419273 DOI: 10.1136/bmj.e5142] [Citation(s) in RCA: 291] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2012] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine whether English regions worst affected by the economic recession in the United Kingdom in 2008-10 have had the greatest increases in suicides. DESIGN Time trend analysis comparing the actual number of suicides with those that would be expected if pre-recession trends had continued. Multivariate regression models quantified the association between changes in unemployment (based on claimant data) and suicides (based on data from the National Clinical Health Outcomes Database). SETTING 93 English regions, based on the Nomenclature of Territorial Units Statistics level 3 groupings of local authorities at county level and groups of unitary local authorities. PARTICIPANTS Men and women with a record of death from suicide or injury of undetermined cause in 2000-10. MAIN OUTCOME MEASURE Number of excess suicides during the economic recession (2008-10). RESULTS Between 2008 and 2010, we found 846 (95% confidence interval 818 to 877) more suicides among men than would have been expected based on historical trends, and 155 (121 to 189) more suicides among women. Historically, short term yearly fluctuations in unemployment have been associated with annual changes in suicides among men but not among women. We estimated that each 10% increase in the number of unemployed men was significantly associated with a 1.4% (0.5% to 2.3%) increase in male suicides. These findings suggest that about two fifths of the recent increase in suicides among men (increase of 329 suicides, 126 to 532) during the 2008-10 recession can be attributed to rising unemployment. CONCLUSION The study provides evidence linking the recent increase in suicides in England with the financial crisis that began in 2008. English regions with the largest rises in unemployment have had the largest increases in suicides, particularly among men.
Collapse
Affiliation(s)
- Ben Barr
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GB UK.
| | | | | | | | | |
Collapse
|