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Ryan MJ, Graudins A, O'Shea N, Noghrehchi F, Wong A. Has the rescheduling of modified-release paracetamol in Australia affected the frequency of overdoses? Emerg Med Australas 2024; 36:589-595. [PMID: 38529697 DOI: 10.1111/1742-6723.14403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 02/24/2024] [Accepted: 02/29/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVES In June 2020, modified-release paracetamol (paracetamol-MR) preparations were up-scheduled from schedule-2 (available in pharmacy) to schedule-3 (available by request to a pharmacist only). The present study aims to ascertain whether up-scheduling affected the frequency of paracetamol-MR overdoses. METHODS This is a retrospective cohort study of two data sets from 1 June 2017 to 31 May 2022. Monash Health data were extracted using the diagnosis of paracetamol overdose coding and electronic medical records data. Calls regarding paracetamol-MR overdoses to Victorian Poisons Information Centre (VPIC) were extracted from the Poisons centre call database. We used a quasi-experimental research design with interrupted time series analysis to evaluate the immediate impact and change in trend of poisoning-related calls and ED presentations before and after June 2020. The change in proportion of paracetamol-MR cases in both databases was analysed using the Χ2 test. RESULTS The proportion of paracetamol-MR cases in both data sets did not change. From Monash Health, there was no level change in monthly paracetamol-MR overdose-related presentations following re-scheduling (rate ratio [RR] = 1.08, 95% confidence interval [CI] = 0.57-2.01). There was no change in monthly paracetamol-MR overdose-related calls to VPIC following re-scheduling (RR = 1.05, 95% CI = 0.96-1.14). CONCLUSION The proportion of paracetamol-MR overdoses did not decrease after the up-scheduling to S3. Similarly, the frequency of overdoses by month remained similar. Further limitations on access to paracetamol products may need to be considered.
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Affiliation(s)
- Michaela J Ryan
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Andis Graudins
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Monash Toxicology Unit and Emergency Department, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Nicole O'Shea
- Victorian Poisons Information Centre, Austin Health, Melbourne, Victoria, Australia
| | - Firouzeh Noghrehchi
- Translational Australian Clinical Toxicology, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anselm Wong
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
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Alqahtani SS, Banji D, Banji OJF. Assessment of Paracetamol Usage Practices and Perceptions among Caregivers for Children Post-COVID-19 in Saudi Arabia: A Cross-Sectional Analysis. Healthcare (Basel) 2024; 12:1047. [PMID: 38786457 PMCID: PMC11121457 DOI: 10.3390/healthcare12101047] [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: 03/05/2024] [Revised: 05/07/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
Caregivers often use paracetamol in the management of pediatric illnesses without a clear rationale. This study evaluated the perception and practices of caregivers regarding the use of paracetamol in children in Southwestern Saudi Arabia. This study involved a cross-sectional design involving 373 caregivers of children under twelve. The questionnaire elucidated the reasons, usage frequency, and safe usage practices. Data were analyzed using SPSS, applying Chi-square tests and logistic regression. Most caregivers were in the age range of 31-40 years, and with intermediate education. Paracetamol was mainly used for fever, generalized pain and, diarrhea, with fewer opting for other self-care measures. Caregivers with primary or less education were more likely to perceive paracetamol as safe (AOR = 2.98 (1.3-6.73), p = 0.009) and less inclined to check warning labels (AOR: 0.11 (0.05-0.25), p < 0.001) and expiry dates (AOR: 0.063 (0.027-0.14), p < 0.001). The caregiver's education level significantly influenced the determination of treatment duration (χ2 = 21.58 (4), p < 0.001), dosage (χ2 = 30.70 (4), p < 0.001), and frequency of administration (χ2 = 17.77 (4), p = 0.001). In conclusion, inadequate health literacy can result in a lack of attention towards crucial safety information about pediatric paracetamol use. Hence, counselling initiatives should be undertaken to ensure the safe and effective use of paracetamol in children.
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Affiliation(s)
- Saad S. Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia;
| | - David Banji
- Department of Pharmacology & Toxicology, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia
| | - Otilia J. F. Banji
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia
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Wang C, Wong A. The presence of abdominal pain associated with acetaminophen overdose does not predict severity of liver injury. Am J Emerg Med 2024; 79:52-57. [PMID: 38364689 DOI: 10.1016/j.ajem.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024] Open
Abstract
AIM Whilst it is known that abdominal pain is a common symptom in patients with acetaminophen overdose, its association with severity of liver injury has not been clearly defined. This study investigates the association between the symptom of abdominal pain on presentation to hospital and the degree of liver injury post-acetaminophen overdose. METHODS Admissions with acetaminophen poisoning, requiring treatment with acetylcysteine were identified and reviewed from a search of a large Australian tertiary hospital network from February 20th, 2014, to August 30th, 2018. Parameters such as presence of abdominal pain, time post-ingestion and peak ALT were collected. Single acute ingestions, staggered and repeated supratherapeutic ingestions were analysed. RESULTS 539 cases were identified in the study period, 79% female, with mean age 25 (17-43) years. Patients presenting to the emergency department with abdominal pain post-acetaminophen overdose had a similar risk of developing hepatotoxicity or acute liver injury compared to patients without abdominal pain regardless of time to presentation. Patients presenting <8-h post-overdose with abdominal pain were as likely to develop hepatotoxicity (1/46, 2.2%) compared to those without abdominal pain (1/54 [1.9%]; OR = 1.18 [0.07 to 19.4]). Those presenting >8-h post-overdose with abdominal pain were as likely to develop hepatotoxicity (13/92, 14.1%) compared to those without abdominal pain (4/35 [11.4%]; OR = 1.28 [0.39 to 4.21]). CONCLUSIONS The presence of abdominal pain after acetaminophen overdose was not predictive of the development of liver injury in patients receiving acetylcysteine treatment. Further prospective studies are required to confirm this finding. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
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Affiliation(s)
- Chen Wang
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | - Anselm Wong
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Victoria, Australia.
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4
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Perananthan V, Shihana F, Chiew AL, George J, Dawson A, Buckley NA. Intestinal injury in paracetamol overdose (ATOM-8). J Gastroenterol Hepatol 2024; 39:920-926. [PMID: 38149309 DOI: 10.1111/jgh.16450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND AIM Paracetamol, a widely used medication, is known for its delayed hepatotoxicity in cases of overdose. However, the potential for intestinal toxicity resulting from very high paracetamol concentrations during absorption is not well explored. This study aims to investigate the presence of intestinal toxicity and its correlation with observations in early and late paracetamol toxicity. METHODS Serial samples of 30 patients with acute paracetamol overdose (> 10 g or 200 mg/kg) were prospectively tested. Markers of enterocyte damage, including plasma intestinal fatty acid binding protein (IFABP) and selected gut-related microRNAs (miR-21, miR-122, miR-194, and miR-215), were analyzed. Sub-analysis was performed on patients presenting with hyperlactatemia defined as a lactate greater than 2 mmol/L within 12 h post ingestion. RESULTS In paracetamol overdose patients, median plasma IFABP was significantly elevated compared with healthy controls (720 μg/L [interquartile range, IQR, 533-1644] vs 270 μg/L [IQR 153-558], P < 0.001). Four patients had early hyperlactatemia and had significantly higher median plasma IFABP compared with those without early hyperlactatemia (3028 μg/L [IQR 1399-3556] vs 574 μg/L [IQR 526-943], P = 0.007). Furthermore, two microRNAs (miR-122 and miR-215) were downregulated in early hyperlactatemia (P = 0.019 and P = 0.006, respectively). Plasma IFABP concentrations correlated with paracetamol concentration (Spearman's r = 0.55) and lactate (r = 0.60). CONCLUSIONS Paracetamol overdose causes concentration-related intestinal toxicity, and this is a possible explanation for the early hyperlactatemia syndrome. Intestinal toxicity has potential impacts on pharmacokinetics of other agents ingested and on the evolution of hepatotoxicity. Further studies are required to explore the mechanisms and prognostic implications of intestinal toxicity.
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Affiliation(s)
- Varan Perananthan
- Edith Collins Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics and Digital Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Fathima Shihana
- Edith Collins Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics and Digital Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Angela L Chiew
- Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics and Digital Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Emergency Department and Clinical Toxicology, Prince of Wales Hospital and Community Health Services, Sydney, New South Wales, Australia
- NSW Poisons Information Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Andrew Dawson
- Edith Collins Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics and Digital Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- NSW Poisons Information Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Nicholas A Buckley
- Edith Collins Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics and Digital Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- NSW Poisons Information Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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5
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Ramachandran A, Akakpo JY, Curry SC, Rumack BH, Jaeschke H. Clinically relevant therapeutic approaches against acetaminophen hepatotoxicity and acute liver failure. Biochem Pharmacol 2024:116056. [PMID: 38346541 DOI: 10.1016/j.bcp.2024.116056] [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: 12/05/2023] [Revised: 01/15/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
Liver injury and acute liver failure caused by an acetaminophen (APAP) overdose is a significant clinical problem in western countries. With the introduction of the mouse model of APAP hepatotoxicity in the 1970 s, fundamental mechanisms of cell death were discovered. This included the recognition that part of the APAP dose is metabolized by cytochrome P450 generating a reactive metabolite that is detoxified by glutathione. After the partial depletion of glutathione, the reactive metabolite will covalently bind to sulfhydryl groups of proteins, which is the initiating event of the toxicity. This insight led to the introduction of N-acetyl-L-cysteine, a glutathione precursor, as antidote against APAP overdose in the clinic. Despite substantial progress in our understanding of the pathomechanisms over the last decades viable new antidotes only emerged recently. This review will discuss the background, mechanisms of action, and the clinical prospects of the existing FDA-approved antidote N-acetylcysteine, of several new drug candidates under clinical development [4-methylpyrazole (fomepizole), calmangafodipir] and examples of additional therapeutic targets (Nrf2 activators) and regeneration promoting agents (thrombopoietin mimetics, adenosine A2B receptor agonists, Wharton's Jelly mesenchymal stem cells). Although there are clear limitations of certain therapeutic approaches, there is reason to be optimistic. The substantial progress in the understanding of the pathophysiology of APAP hepatotoxicity led to the consideration of several drugs for development as clinical antidotes against APAP overdose in recent years. Based on the currently available information, it is likely that this will result in additional drugs that could be used as adjunct treatment for N-acetylcysteine.
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Affiliation(s)
- Anup Ramachandran
- Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jephte Y Akakpo
- Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Steven C Curry
- Department of Medical Toxicology, Banner - University Medical Center Phoenix, Phoenix, AZ, USA; Department of Medicine, and Division of Clinical Data Analytics and Decision Support, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Barry H Rumack
- Department of Emergency Medicine and Pediatrics, University of Colorado School of Medicine, Denver, CO, USA
| | - Hartmut Jaeschke
- Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA.
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Naser AY, Alshehri H. Paediatric hospitalisation related to medications administration errors of non-opioid analgesics, antipyretics and antirheumatics in England and Wales: a longitudinal ecological study. BMJ Open 2023; 13:e080503. [PMID: 38000821 PMCID: PMC10680006 DOI: 10.1136/bmjopen-2023-080503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE This study aimed to explore paediatric hospitalisation related to medication administration errors (MAEs) of non-opioid analgesics, antipyretics and antirheumatics in England and Wales. DESIGN An ecological study. SETTING A population-based study on hospitalised patients in England and Wales. Hospital admission data were extracted from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales for the period between April 1999 and April 2020. Admissions cause was confirmed using the diagnostic codes T39.0-T39.9. PARTICIPANTS Paediatric patients aged 15 years and below who were hospitalised at all National Health Service (NHS) trusts and any independent sector funded by NHS trusts. PRIMARY OUTCOME MEASURE Hospitalisation rates related to MAEs of non-opioid analgesics, antipyretics and antirheumatics. RESULTS The yearly number of admissions for MAEs associated with non-opioid analgesics, antipyretics and antirheumatics experienced a notable growth of 21.7% over the span of two decades, rising from 4574 cases in 1999 to 5568 cases in 2020. The observed increase demonstrates a significant upward trend in hospital admissions rate, with a 12.3% growth from 46.16 per 100 000 individuals in 1999 to 51.83 per 100 000 individuals in 2020 (95% CIs 44.83 to 47.50 and 50.47 to53.19, respectively, trend test, p<0.05). The therapeutic categories that exhibited the highest frequency of MAEs were '4-aminophenol derivatives' and 'other non-steroidal anti-inflammatory drugs', accounting for 79.3% and 16.0% of cases, respectively. It is worth noting that there was a significant increase of 28.9% in hospitalisations linked to MAEs specifically associated with '4-aminophenol derivatives.' CONCLUSION The research revealed a notable rise in the overall yearly number of hospital admissions associated with MAEs within the paediatric population. This study emphasises the necessity for additional research aimed at mitigating the potential hazards associated with the ingestion of these medications, particularly within susceptible demographics, such as young children.
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Affiliation(s)
- Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Isra University, Amman, Jordan
| | - Hassan Alshehri
- Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, UK
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Patterson T, Beckenkamp PR, Turner J, Gnjidic D, Mintzes B, Bennett C, Bywaters L, Clavisi O, Baysari M, Ferreira M, Ferreira P. Barriers and facilitators to reducing paracetamol use in low back pain: A qualitative study. Musculoskelet Sci Pract 2023; 67:102856. [PMID: 37696066 DOI: 10.1016/j.msksp.2023.102856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Paracetamol is widely used for low back pain (LBP), but research questions its efficacy and safety. Patient education booklets have been explored for promoting deprescribing, but barriers and facilitators specific to LBP deprescribing remain unexamined. OBJECTIVE To identify contextual factors facilitating and obstructing successful deprescribing of paracetamol for LBP after receiving an educational booklet. STUDY DESIGN This study is part of an uncontrolled cohort feasibility study (CEASE NOW) in the community, recruiting from Musculoskeletal Australia and painaustralia. PATIENT SAMPLE Twenty-four participants with acute, sub-acute, or chronic LBP, self-reporting paracetamol consumption, were included. METHODS Thematic content analysis was used to analyze qualitative data on barriers and facilitators. Data were categorized by deprescribing outcomes: i) successful deprescribing, ii) attempted but failed, or iii) no attempt. Semi-structured telephone interviews were conducted within one week after each participant completed the one-month follow-up. RESULTS Successful deprescribing was facilitated by supportive healthcare professionals, willingness, high self-efficacy, fear of future illness, and diverse strategies for deprescribing plans. Barriers included unsupportive healthcare professionals and fear of flare-ups. Participants not attempting deprescribing believed it unnecessary, perceived it as effortful, unquestioningly trusted healthcare professionals, and lacked risk awareness. CONCLUSIONS Support from healthcare professionals, patient willingness, perceived necessity, risk awareness, effort, and varied strategies influence deprescribing outcomes for LBP patients using paracetamol. Addressing these factors is crucial when designing interventions to promote safe and effective deprescribing in LBP management.
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Affiliation(s)
- Thomas Patterson
- The University of Sydney, Sydney Musculoskeletal Health, Faculty of Medicine and Health, Charles Perkins Centre, Susan Wakil Health Building D18, Camperdown, NSW, 2006, Australia.
| | - Paula R Beckenkamp
- The University of Sydney, Sydney Musculoskeletal Health, Faculty of Medicine and Health, Charles Perkins Centre, Susan Wakil Health Building D18, Camperdown, NSW, 2006, Australia
| | - Justin Turner
- University of Montreal, Faculty of Pharmacy, Edouard Montpetit Blvd, Montreal, Quebec, H3T 1J4, Canada
| | - Danijela Gnjidic
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, A15, Science Rd, Camperdown, NSW, 2006, Australia
| | - Barbara Mintzes
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, A15, Science Rd, Camperdown, NSW, 2006, Australia
| | - Carol Bennett
- Painaustralia, Unit 6/42 Geils Ct, Deakin ACT, 2600, Australia
| | - Lisa Bywaters
- Consumer Services for Musculoskeletal Australia, 263-265 Kooyong Rd, Elsternwick, VIC, 3185, Australia
| | - Ornella Clavisi
- Consumer Services for Musculoskeletal Australia, 263-265 Kooyong Rd, Elsternwick, VIC, 3185, Australia
| | - Melissa Baysari
- The University of Sydney, Biomedical Informatics and Digital Health, Faculty of Medicine and Health, Charles Perkins Centre, John Hopkins Drive, Camperdown, NSW, 2006, Australia
| | - Manuela Ferreira
- The University of Sydney, Sydney Musculoskeletal Health and the Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, St Leonards, NSW 2064, Australia
| | - Paulo Ferreira
- The University of Sydney, Sydney Musculoskeletal Health, Faculty of Medicine and Health, Charles Perkins Centre, Susan Wakil Health Building D18, Camperdown, NSW, 2006, Australia
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Gatenby J, Low GK, Rahman MA, Salter M, Bhurawala H. Intentional paediatric poisoning presentations to emergency departments during the COVID-19 pandemic. Emerg Med Australas 2023; 35:642-651. [PMID: 36802109 DOI: 10.1111/1742-6723.14194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To characterise paediatric poisoning presentations to EDs and determine if the advent of the COVID-19 pandemic was associated with increased intentional paediatric poisoning presentations. METHODS We performed a retrospective analysis of paediatric poisoning presentations to three EDs (two regional and one metropolitan). Simple and multiple logistic regression analysis were performed to determine the association between COVID-19 and intentional poisoning events. In addition, we calculated the frequency with which patients reported various psychosocial risk factors as being an implicating factor in engaging in an intentional poisoning event. RESULTS A total of 860 poisoning events met inclusion criteria during the study period (January 2018-October 2021), with 501 being intentional, and 359 unintentional. There was an increased proportion of intentional poisoning presentations during the COVID-19 pandemic (261 intentional and 218 unintentional in the pre-COVID-19 period vs 241 intentional and 140 unintentional during the COVID-19 period). In addition, we found a statistically significant association between intentional poisoning presentations and an initial COVID-19 lockdown (adjusted odds ratio 26.32, P < 0.05). 'The COVID-19 lockdown' or 'COVID-19' was reported to be implicating factor for psychological stress in patients who presented with intentional poisonings during the COVID-19 pandemic. CONCLUSIONS Intentional paediatric poisoning presentations increased during the COVID-19 pandemic in our study population. These results may support an emerging body of evidence that the psychological strain of COVID-19 disproportionately impacts adolescent females.
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Affiliation(s)
- Jennifer Gatenby
- Department of Paediatrics, Blue Mountains Hospital, Nepean Blue Mountains Local Health District, Sydney, New South Wales, Australia
- Paediatrics and Child Health, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Gary Kk Low
- Research Operations, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Professional Unit, The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Muhammad A Rahman
- Institute of Health and Wellbeing, Federation University Australia, Melbourne, Victoria, Australia
- Department of Noncommunicable Diseases, Bangladesh University of Health Sciences, Dhaka, Bangladesh
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Mark Salter
- Department of Emergency Medicine, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, New South Wales, Australia
- New South Wales Poisons Information Centre, Sydney, New South Wales, Australia
| | - Habib Bhurawala
- Department of Paediatrics, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, New South Wales, Australia
- Discipline of Paediatrics, The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
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9
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Chiew AL, Isbister GK, Stathakis P, Isoardi KZ, Page C, Ress K, Chan BS, Buckley NA. Acetaminophen Metabolites on Presentation Following an Acute Acetaminophen Overdose (ATOM-7). Clin Pharmacol Ther 2023; 113:1304-1314. [PMID: 36919638 PMCID: PMC10952325 DOI: 10.1002/cpt.2888] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/09/2023] [Indexed: 03/16/2023]
Abstract
Acetaminophen (APAP) is commonly taken in overdose and can cause acute liver injury via the toxic metabolite NAPQI formed by cytochrome (CYP) P450 pathway. We aimed to evaluate the concentrations of APAP metabolites on presentation following an acute APAP poisoning and whether these predicted the subsequent onset of hepatotoxicity (peak alanine aminotransferase > 1,000 U/L). The Australian Toxicology Monitoring (ATOM) study is a prospective observational study, recruiting via two poison information centers and four toxicology units. Patients following an acute APAP ingestion presenting < 24 hours post-ingestion were recruited. Initial samples were analyzed for APAP metabolites, those measured were the nontoxic glucuronide (APAP-Glu) and sulfate (APAP-Sul) conjugates and NAPQI (toxic metabolite) conjugates APAP-cysteine (APAP-Cys) and APAP-mercapturate (APAP-Mer). The primary outcome was hepatotoxicity. In this study, 200 patients were included, with a median ingested dose of 20 g, 191 received acetylcysteine at median time of 5.8 hours post-ingestion. Twenty-six patients developed hepatotoxicity, one had hepatotoxicity on arrival (excluded from analysis). Those who developed hepatotoxicity had significantly higher total CYP metabolite concentrations: (36.8 μmol/L interquartile range (IQR): 27.8-51.7 vs. 10.8 μmol/L IQR: 6.9-19.5) and these were a greater proportion of total metabolites (5.4%, IQR: 3.8-7.7) vs. 1.7%, IQR: 1.3-2.6, P < 0.001)]. Furthermore, those who developed hepatotoxicity had lower APAP-Sul concentrations (49.1 μmol/L, IQR: 24.7-72.2 vs. 78.7 μmol/L, IQR: 53.6-116.4) and lower percentage of APAP-Sul (6.3%, IQR: 4.6-10.9 vs. 13.1%, IQR, 9.1-20.8, P < 0.001)]. This study found that those who developed hepatotoxicity had higher APAP metabolites derived from CYP pathway and lower sulfation metabolite on presentation. APAP metabolites may be utilized in the future to identify patients who could benefit from increased acetylcysteine or newer adjunct or research therapies.
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Affiliation(s)
- Angela L. Chiew
- Department of Clinical ToxicologyPrince of Wales HospitalRandwickNew South WalesAustralia
- Faculty of MedicineThe University of New South WalesSydneyNew South WalesAustralia
- New South Wales Poisons Information CentreSydney Children's HospitalSydneyNew South WalesAustralia
| | - Geoffrey K. Isbister
- New South Wales Poisons Information CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle and School of Medical PracticeUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Paul Stathakis
- NSW Health PathologyPrince of Wales HospitalRandwickNew South WalesAustralia
| | - Katherine Z. Isoardi
- Clinical Toxicology UnitPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- Queensland Poisons Information CentreQueensland Children's HospitalBrisbaneQueenslandAustralia
| | - Colin Page
- Clinical Toxicology UnitPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- Queensland Poisons Information CentreQueensland Children's HospitalBrisbaneQueenslandAustralia
| | - Kirsty Ress
- NSW Health PathologyPrince of Wales HospitalRandwickNew South WalesAustralia
| | - Betty S.H. Chan
- Department of Clinical ToxicologyPrince of Wales HospitalRandwickNew South WalesAustralia
- Faculty of MedicineThe University of New South WalesSydneyNew South WalesAustralia
- New South Wales Poisons Information CentreSydney Children's HospitalSydneyNew South WalesAustralia
| | - Nicholas A. Buckley
- New South Wales Poisons Information CentreSydney Children's HospitalSydneyNew South WalesAustralia
- Discipline of Biomedical Informatics and Digital HealthThe University of SydneySydneyNew South WalesAustralia
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Noghrehchi F, Cairns R, Buckley NA. Hospital admissions for paracetamol poisoning declined following codeine re-scheduling in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 116:104040. [PMID: 37116402 DOI: 10.1016/j.drugpo.2023.104040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Codeine was restricted to prescription only in Australia in 2018. This intervention aimed to reduce harms from codeine dependance and use, including toxicity from co-formulated paracetamol. We aimed to quantify the impact of this intervention on paracetamol poisoning hospital admissions in a national hospital admissions database. METHODS We analyzed the number of paracetamol overdoses resulting in hospital admissions from the Australian Institute of Health and Welfare National Hospital Morbidity Database, January 2011 to June 2020. We used interrupted time series analysis to quantify the effect of codeine re-scheduling on the monthly number of paracetamol poisoning-related hospital admissions in Australia. We compared paracetamol poisonings with no opioid combinations, and poisonings with probable paracetamol-codeine combinations. RESULTS There was an immediate and sustained decrease (level shift) in the number of paracetamol poisoning-related hospital admissions following codeine re-scheduling (RR=0.85; 95% CI 0.80-0.89). This reduction was due to the decrease in poisonings with likely paracetamol-codeine combinations (RR=0.62; 95% CI 0.57-0.67) while there was no change in other paracetamol poisonings (RR=0.91; 95% CI 0.96-1.01). CONCLUSION Codeine re-scheduling in Australia appears to have reduced paracetamol poisoning-related hospital admissions.
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Affiliation(s)
- Firouzeh Noghrehchi
- Translational Australian Clinical Toxicology Research Group, Discipline of Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, NSW, 2006, Australia.
| | - Rose Cairns
- NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, 2145, Australia; Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia
| | - Nicholas A Buckley
- Translational Australian Clinical Toxicology Research Group, Discipline of Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, NSW, 2006, Australia; NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, 2145, Australia
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11
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Fadil HAE, Behairy A, Ebraheim LLM, Abd-Elhakim YM, Fathy HH. The palliative effect of mulberry leaf and olive leaf ethanolic extracts on hepatic CYP2E1 and caspase-3 immunoexpression and oxidative damage induced by paracetamol in male rats. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:41682-41699. [PMID: 36637651 PMCID: PMC10067661 DOI: 10.1007/s11356-023-25152-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/02/2023] [Indexed: 06/17/2023]
Abstract
This study investigated the possible protective role of mulberry leaf (MLE) and olive leaf (OLE) ethanolic extracts against paracetamol (PTL)-induced liver injury in rats compared to silymarin as a reference drug. Initially, MLE and OLE were characterized using gas chromatography-mass spectrometry (GC/MS). Then, forty male Sprague Dawley rats were divided into five groups: the negative control group orally received distilled water for 35 days, the PTL-treated group (PTG) received 500 mg PTL/kg b. wt. for 7 days, the MLE-treated group (MLTG) received 400 mg MLE/kg b. wt., the OLE-treated group (OLTG) received 400 mg OLE/kg b. wt., and the silymarin-treated group (STG) received 100 mg silymarin/kg b. wt. The last three groups received the treatment for 28 days, then PTL for 7 days. The GC-MS characterization revealed that MLE comprised 19 constituents dominated by ethyl linoleate, phytol, hexadecanoic acid, ethyl ester, and squalene. Moreover, OLE comprised 30 components, and the major components were 11-eicosenoic acid, oleic acid, phytol, and à-tetralone. MLE and OLE significantly corrected the PTL-induced normocytic normochromic anemia, leukocytosis, hypercholesterolemia, and hypoproteinemia. Moreover, the MLE and OLE pretreatment considerably suppressed the PTL-induced increment in serum levels of hepatic enzymes, including alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase. Furthermore, the PTL-induced depletion in antioxidant enzymes, including glutathione peroxidase, superoxide dismutase, and catalase, and the rise in hepatic malondialdehyde content were significantly reversed by the MLE and OLE pretreatment. Besides, MLE and OLE pretreatment significantly protected the hepatic tissue against PTL-induced DNA damage, pathological perturbations, and increased caspase 3 and CYP2E1 immunoexpression. Of note, OLTG showed better enhancement of most indices rather than MLTG. Conclusively, these findings imply that OLE, with its antioxidant and antiapoptotic capabilities, is superior to MLE in protecting against PTL-induced liver injury.
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Affiliation(s)
- Hosny Abd El Fadil
- Department of Pharmacology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Amany Behairy
- Department of Physiology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Lamiaa L M Ebraheim
- Department of Histology and Cytology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Yasmina M Abd-Elhakim
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt.
| | - Heba Hussein Fathy
- Department of Pharmacology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
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12
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Shen XL, Guo YN, Lu MH, Ding KN, Liang SS, Mou RW, Yuan S, He YM, Tang LP. Acetaminophen-induced hepatotoxicity predominantly via inhibiting Nrf2 antioxidative pathway and activating TLR4-NF-κB-MAPK inflammatory response in mice. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 252:114590. [PMID: 36738614 DOI: 10.1016/j.ecoenv.2023.114590] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 06/18/2023]
Abstract
To explore the action time and molecular mechanism underlying the effect of acetaminophen (APAP) on liver injury. APAP was used to establish drug-induced liver injury (DILI) model in mice. Mice in the model group were intraperitoneally injected 300 mg/kg APAP for 6, 12, and 24 h respectively, and control group mice were given the same volume of normal saline. The mice were anesthetized through intravenous injection of sodium pentobarbital at 6, 12, and 24 h after APAP poisoning. Analysis of ALT, AST and ALP in serum, liver histopathological observation, oxidative damage and western blot were performed. The livers in APAP exposed mice were pale, smaller, with a rough texture, and poorly arranged cells. Lesions, large areas of hyperemia, inflammation, swelling, poorly cell arrangement, necrosis, and apoptosis of liver cells were obvious in the liver tissue sections. Serum ALT, AST and ALP levels were significantly enhanced at 12 h of APAP adminstration mice than that of in control group mice (P<0.05). The histopathological alterations and proinflammatory cytokines (IL-1β, TNF-α and IL-6) levels were most severe at 12 h of APAP-induced hepatotoxicity. APAP treatment induced oxidative stress by decreasing hepatic activities of superoxide dismutase (SOD) and glutathione (GSH) (P<0.05), and enhancing malondialdehyde (MDA) content (P<0.05). Moreover, APAP inhibited erythroid 2-related factor 2 (Nrf2) antioxidative pathway with decreased of Nrf2 and HO-1 proteins levels. Furthermore, APAP aggravated the activation of NLRP3 inflammasome by increasing of NLRP3, caspase-1, ASC, IL-1β and IL-18 proteins levels. Finally, APAP further significantly activated the toll-like receptor 4 (TLR4), nuclear factor-kappa B (NF-κB) and mitogen-activated protein kinases (MAPKs) signaling pathways. This study demonstrated that APAP-induced hepatotoxicity by inhibiting of Nrf2 antioxidative pathway and promoting TLR4-NF-κB-MAPK inflammatory response and NLRP3 inflammasome activation.
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Affiliation(s)
- Xing-Ling Shen
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Yan-Na Guo
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Meng-Han Lu
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Kang-Ning Ding
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Shao-Shan Liang
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Rui-Wei Mou
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Sheng Yuan
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Yong-Ming He
- School of Life Science and Engineering, Foshan University, Foshan 528225, China.
| | - Lu-Ping Tang
- School of Life Science and Engineering, Foshan University, Foshan 528225, China.
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Chidiac AS, Buckley NA, Noghrehchi F, Cairns R. Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease. Expert Opin Drug Metab Toxicol 2023; 19:297-317. [PMID: 37436926 DOI: 10.1080/17425255.2023.2223959] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/05/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Paracetamol is one of the most used medicines worldwide and is the most common important poisoning in high-income countries. In overdose, paracetamol causes dose-dependent hepatotoxicity. Acetylcysteine is an effective antidote, however despite its use hepatotoxicity and many deaths still occur. AREAS COVERED This review summarizes paracetamol overdose and toxicity (including mechanisms, risk factors, risk assessment, and treatment). In addition, we summarize the epidemiology of paracetamol overdose worldwide. A literature search on PubMed for poisoning epidemiology and mortality from 1 January 2017 to 26 October 2022 was performed to estimate rates of paracetamol overdose, liver injury, and deaths worldwide. EXPERT OPINION Paracetamol is widely available and yet is substantially more toxic than other analgesics available without prescription. Where data were available, we estimate that paracetamol is involved in 6% of poisonings, 56% of severe acute liver injury and acute liver failure, and 7% of drug-induced liver injury. These estimates are limited by lack of available data from many countries, particularly in Asia, South America, and Africa. Harm reduction from paracetamol is possible through better identification of high-risk overdoses, and better treatment regimens. Large overdoses and those involving modified-release paracetamol are high-risk and can be targeted through legislative change.
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Affiliation(s)
- Annabelle S Chidiac
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
| | - Nicholas A Buckley
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
- Faculty of Medicine and Health, School of Medical Sciences, Discipline of Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
| | - Firouzeh Noghrehchi
- Faculty of Medicine and Health, School of Medical Sciences, Discipline of Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
| | - Rose Cairns
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
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14
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He YM, Shen XL, Guo YN, Liang SS, Ding KN, Lu MH, Tang LP. Yinhuang oral liquid protects acetaminophen-induced acute liver injury by regulating the activation of autophagy and Nrf2 signaling. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 244:114073. [PMID: 36115150 DOI: 10.1016/j.ecoenv.2022.114073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 06/15/2023]
Abstract
This study aimed to investigate the protective effect and potential mechanism of Yinhuang oral liquid (YOL) against acetaminophen (APAP) induced liver injury in mice. C57BL/6 mice were randomly divided into control group, model group (300 mg/kg APAP), NAC group and YOL group. Mice were treated intragastrical with YOL (8 g/kg) and N-Acetylcysteine (NAC, 300 mg/kg) 6 h before and 6 h after the APAP (300 mg/kg) intraperitoneal injection. 12 h after APAP exposure, blood and liver samples were collected for subsequent testing. The results showed that APAP decreased liver index, induced liver pathological injury with hepatocytes swelling, necrosis and apoptosis and inflammatory cell infiltration. APAP exposure significantly increased serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels to 35 and 6 multiples than their original levels. YOL alleviated liver pathological damage, decreased the serum levels of ALT and AST in APAP exposure mice, and it worked better than NAC. Moreover, APAP promoted oxidative stress by increasing lipid peroxidation (MDA) and decreasing anti-oxidant enzyme activities of SOD and GSH, inhibited the mRNA levels of Nrf2, HO-1, Gclc and Gclm, and decreased the protein levels of Nrf2, HO-1 and Keap1, compared to control group. Furthermore, APAP exposure significantly down-regulated the mRNA and protein levels of autophagy related genes (Beclin-1, LC3-II, LC3-I, Atg4B, Atg5, Atg16L1 and Atg7). However, the gene levels of mTOR and p-mTOR increased, and p-ULK1 protein level decreased in liver of APAP treated mice. Additionally, YOL alleviated the oxidative injury by up-regulating Nrf2 pathway. The gene and protein levels of autophagy-related genes Beclin-1, LC3-II, LC3-I, Atg4B, Atg5, Atg16L1 and Atg7 reached the basal levels after YOL treatment. In conclusion, YOL had a protective and therapeutic role in APAP-induced liver injury in mice by activating Nrf2 signaling pathway and autophagy.
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Affiliation(s)
- Yong-Ming He
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Xing-Ling Shen
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Yan-Na Guo
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Shao-Shan Liang
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Kang-Ning Ding
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Meng-Han Lu
- School of Life Science and Engineering, Foshan University, Foshan 528225, China
| | - Lu-Ping Tang
- School of Life Science and Engineering, Foshan University, Foshan 528225, China.
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Dewanjee S, Dua TK, Paul P, Dey A, Vallamkondu J, Samanta S, Kandimalla R, De Feo V. Probiotics: Evolving as a Potential Therapeutic Option against Acetaminophen-Induced Hepatotoxicity. Biomedicines 2022; 10:biomedicines10071498. [PMID: 35884803 PMCID: PMC9312935 DOI: 10.3390/biomedicines10071498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 12/03/2022] Open
Abstract
Acetaminophen (APAP) is the most common prescription medicine around the world for the treatment of pain and fever and is considered to be a safe drug at its therapeutic dose. However, a single overdose or frequent use of APAP can cause severe acute liver injury. APAP hepatotoxicity is a prevalent cause of acute liver disease around the world and the lack of suitable treatment makes it a serious problem. In recent years, there has been a surge in interest in using probiotics and probiotic-derived products, known as postbiotics, as health and disease negotiators. A growing body of evidence revealed that they can be equally effective against APAP hepatotoxicity. Different probiotic bacteria were found to be pre-clinically effective against APAP hepatotoxicity. Different postbiotics have also shown exciting results in preclinical models of APAP hepatotoxicity. This review summarized the protective roles and mechanisms of the different probiotic bacteria and postbiotics against APAP hepatotoxicity, with critical discussion. A brief discussion on potential novel probiotics and postbiotics for oxidative liver injury was also included. This review was written in an attempt to pique the interest of researchers in developing a safe therapeutic option against oxidative liver damage using probiotics and/or postbiotics as dietary supplements.
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Affiliation(s)
- Saikat Dewanjee
- Advanced Pharmacognosy Research Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata 700032, India
- Correspondence: (S.D.); (V.D.F.); Tel.: +91-33-2457-2043 (S.D.); +39-089-969-751 (V.D.F.)
| | - Tarun K. Dua
- Department of Pharmaceutical Technology, University of North Bengal, Raja Rammohunpur 734013, India; (T.K.D.); (P.P.)
| | - Paramita Paul
- Department of Pharmaceutical Technology, University of North Bengal, Raja Rammohunpur 734013, India; (T.K.D.); (P.P.)
| | - Abhijit Dey
- Department of Life Sciences, Presidency University, Kolkata 700073, India;
| | | | - Sonalinandini Samanta
- Department of Dermatology (Skin & Venereology), Employee’s State Insurance Corporation Medical College & Hospital, Patna 801103, India;
| | - Ramesh Kandimalla
- Department of Biochemistry, Kakatiya Medical College, Warangal 506007, India;
- Applied Biology, Council of Scientific and Industrial Research-Indian Institute of Chemical Technology, Tarnaka 500007, India
| | - Vincenzo De Feo
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy
- Correspondence: (S.D.); (V.D.F.); Tel.: +91-33-2457-2043 (S.D.); +39-089-969-751 (V.D.F.)
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16
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Vong SK, Kang L, Carter SR. Consumers' self-reported adherence to directions for non-prescription medicines and the role of risk perception. Res Social Adm Pharm 2022; 18:3929-3938. [PMID: 35729055 DOI: 10.1016/j.sapharm.2022.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 04/14/2022] [Accepted: 06/09/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Non-prescription medicines (NPMs), while relatively safe, are responsible for a small but significant proportion of medication misadventure and inappropriate use may lead to avoidable healthcare cost. Some consumers vary their use of NPMs from the directions provided on packaging or advice from healthcare professionals. Consumers may use NPMs at lower doses or less frequently than directed because of the risk of side effects. PURPOSE This study aimed to develop and validate a self-report measure for the extent to which consumers' follow directions (FDs) for NPMs. Secondly, it aimed to explore the relationship between risk perception towards NPMs and following directions. METHODS A cross-sectional study was administered online to participants who belong to an Australian agency which conducts consumer research. Participants were Australian adults who had used NPMs within the last month. Items for the FD-NPM scale were developed and validated. Exploratory factor analysis and confirmatory factor analysis were used to validate the FD-NPM scale. Structural equation modelling (SEM) was employed to explore the relationships between risk perception, covariates, and FDs. RESULTS There were 403 participants recruited. Less than 20% "always" or "often" self-reported following directions for dose, frequency, or duration of use. Factor analyses confirmed that there are two moderately positively correlated dimensions of FD-NPM (r = 0.46), which were named underuse and overuse. That is, consumers who self-reported underuse of non-prescription medicines were also more likely to self-report overuse. Consumers with high-risk perception towards NPMs, those who were younger and those who were more educated had a greater tendency to not follow directions. CONCLUSION A new self-report measure, the FD-NPM scale was developed and validated. That people who perceives NPMs to be harmful, tend to underuse and more concerningly, overuse them, is of great interest to clinicians and policymakers who are required to manage risk communications.
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Affiliation(s)
- Si Kei Vong
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Lifeng Kang
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Stephen R Carter
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
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Patterson T, Beckenkamp P, Ferreira M, Bauman A, Carvalho-E-Silva AP, Ferreira LC, Ferreira P. The impact of different intensities and domains of physical activity on analgesic use and activity limitation in people with low back pain: a prospective cohort study with a one-year follow-up. Eur J Pain 2022; 26:1636-1649. [PMID: 35642334 PMCID: PMC9544541 DOI: 10.1002/ejp.1987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/16/2022] [Accepted: 05/21/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Analgesics are the most common form of managing low back pain (LBP). No previous study has examined which domains and intensities of physical activity are most beneficial in reducing the frequency of analgesic use for LBP, and its related activity limitation. METHODS This cohort study forms part of the AUstralian Twin low BACK pain study, investigating the impact of physical activity on LBP. Information on demographics, LBP and health-related factors, including physical activity were collected at baseline. Data on the total counts of analgesic use and activity limitation for LBP were collected weekly for one-year. Negative binomial regression models were conducted separately for each type of physical activity. Results were presented as Incidence Rate Ratios (IRR) and 95% Confidence Intervals (CI). RESULTS From an initial sample of 366 participants, 86 participants reported counts of analgesic use and 140 recorded counts of activity limitation across the follow up period. The negative binomial regression models for analgesic use counts indicated moderate-vigorous physical activity (IRR 0·97, 95% C.I 0·96-0·99) and physical workload (IRR 1·02, 95% C.I 1·01-1·05) to be significant. For activity limitation counts, significant associations were shown for sedentary time (IRR 1·04, 95% C.I 1·01-1·09) and leisure activity (IRR 0·94, 95% C.I 0·81-0·99). CONCLUSIONS Our findings highlight the potential importance of supporting engagement in moderate-vigorous and leisure physical activity, as well as minimising sedentary time and physical workload to reduce the risk of activity limitation and the need for analgesic use in people with LBP.
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Affiliation(s)
- Thomas Patterson
- The University of Sydney, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Susan Walking Building D18 Western Avenue, Camperdown, NSW, Australia
| | - Paula Beckenkamp
- The University of Sydney, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Susan Walking Building D18 Western Avenue, Camperdown, NSW, Australia
| | - Manuela Ferreira
- The University of Sydney, Sydney Musculoskeletal Health, School of Health Sciences, The Kolling Institute of Medical Research, Faculty of Medicine and Health, Kolling Building, St Leonards, NSW, Australia
| | - Adrian Bauman
- The University of Sydney, Public Health, Sydney School of Public Health, Faculty of Medicine and Health, Edward Ford Building A27 Fisher Rd, Camperdown, NSW, Australia
| | - Ana Paula Carvalho-E-Silva
- The University of Sydney, Public Health, Sydney School of Public Health, Faculty of Medicine and Health, Edward Ford Building A27 Fisher Rd, Camperdown, NSW, Australia
| | - Lucas Calais Ferreira
- The University of Melbourne, Twins Research Australia Unit, School of Population and Global Health, 207 Bouverie St, Carlton, VIC, Australia
| | - Paulo Ferreira
- The University of Sydney, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Susan Walking Building D18 Western Avenue, Camperdown, NSW, Australia
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Mills BW, Hill MG, Miles AK, Smith EC, Afrifa-Yamoah E, Reid DN, Rogers SL, Sim MGB. Ability of the Australian general public to identify common emergency medical situations: Results of an online survey of a nationally representative sample. Australas Emerg Care 2022; 25:327-333. [PMID: 35525724 DOI: 10.1016/j.auec.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the Australian general public's ability to identify common medical emergencies as requiring an emergency response. METHODS An online survey asked participants to identify likely medical treatment pathways they would take for 17 hypothetical medical scenarios (eight emergency and nine non-emergency). The number and type of emergency scenarios participants correctly suggested warranted an emergency medical response was examined. Participants included Australian residents (aged >18 years; n = 5264) who had never worked as an Australian registered medical doctor, nurse or paramedic. RESULTS Most emergencies were predominately correctly classified as requiring emergency responses (e.g. Severe chest pain, 95% correct). However, non-emergency medical responses were often chosen for some emergency scenarios, such as a child suffering from a scalp haematoma (67%), potential meningococcal disease (57%), a box jellyfish sting (40%), a paracetamol overdose (37%), and mild chest pain (26%). Participants identifying as Aboriginal or Torres Strait Islander suggested a non-emergency response to emergency scenarios 40% more often compared with non-indigenous participants. CONCLUSIONS Educational interventions targeting specific medical symptoms may work to alleviate delayed emergency medical intervention. This research highlights a particular need for improving symptom identification and healthcare system confidence amongst Aboriginal and Torres Strait Islander populations.
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Affiliation(s)
- Brennen W Mills
- School of Medical and Health Sciences, Edith Cowan University, Australia.
| | - Michella G Hill
- School of Medical and Health Sciences, Edith Cowan University, Australia
| | - Alecka K Miles
- School of Medical and Health Sciences, Edith Cowan University, Australia
| | - Erin C Smith
- School of Medical and Health Sciences, Edith Cowan University, Australia
| | | | - David N Reid
- School of Medical and Health Sciences, Edith Cowan University, Australia
| | - Shane L Rogers
- School of Arts and Humanities, Edith Cowan University, Australia
| | - Moira G B Sim
- School of Medical and Health Sciences, Edith Cowan University, Australia
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Over-the-Counter Medicine Attitudes and Knowledge among University and College Students in Brunei Darussalam: Findings from the First National Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052658. [PMID: 35270352 PMCID: PMC8909889 DOI: 10.3390/ijerph19052658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/09/2022] [Accepted: 01/19/2022] [Indexed: 12/04/2022]
Abstract
Over-the-counter (OTC) medicine is defined as safe and effective for the general public to use, without seeking therapy from a health professional. As primary social media and internet users, university and college students are more likely to be exposed to unverified sources of health information. This study aims to assess the knowledge, attitudes, and behaviour of students at institutions of higher learning in Brunei with regard to the safe use of OTC medicines. A cross-sectional study was performed using a self-administered online questionnaire, adapted from the literature with additional information from the United States Food and Drug Administration (FDA) on the educational resources in understanding OTC medicine for consumers. The questionnaire consisted of 4 sections: demographic information, knowledge of OTC medicines, attitudes, and practice. Descriptive and inferential statistics were used for data analysis. A total of 335 students returned a completed questionnaire. The students had a mean knowledge score of 7.1 out of 9, with more than half (53.4%) having good knowledge (knowledge score > 7), and only a small percentage (5.7%) with poor knowledge. Almost all of the students (99.7%) had a positive attitude toward OTC medicine use. Few of the students practiced improper habits in terms of OTC medicine use, such as not reading the instructions or taking more than the recommended dose. Awareness of proper OTC medicine use among students in institutions of higher learning is necessary to prevent the rise of inappropriate user practices.
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Ghabril M, Ma J, Patidar KR, Nephew L, Desai AP, Orman ES, Vuppalanchi R, Kubal S, Chalasani N. Eight-Fold Increase in Dietary Supplement-Related Liver Failure Leading to Transplant Waitlisting Over the Last Quarter Century in the United States. Liver Transpl 2022; 28:169-179. [PMID: 34331346 DOI: 10.1002/lt.26246] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/01/2021] [Accepted: 07/20/2021] [Indexed: 01/13/2023]
Abstract
We investigated the trends in listing and outcomes of drug-induced acute liver failure (DIALF) over the last quarter century in the United States using the United Network for Organ Sharing (UNOS) database. We examined waitlisted patients in the UNOS database between 1995 and 2020 with a diagnosis of DIALF and assessed trends in etiologies, demographic and clinical characteristics, and outcomes over 3 periods: 1995-2003, 2004-2012, and 2013-2020. Patients with DIALF and cirrhosis were classified as drug-induced acute-on-chronic liver failure. Implicated agents including acetaminophen (APAP) and herbal or dietary supplements (HDSs) were ascertained. There were 2146 individuals with DIALF during the study period. The observed demographic trends between the earliest and latest period included fewer pediatric patients (18.8% to 13.5%) but with an increasing number of males in non-APAP DIALF (31.8% to 41.4%) and increased racial diversity in APAP DIALF. Antimicrobials remained the most common non-APAP agents across all periods, but antiepileptics, propylthiouracil, and mushroom poisoning decreased, while HDSs markedly increased from 2.9% to 24.1% of all non-APAP DIALF patients. The overall 5-year post-liver transplantation (LT) patient survival improved significantly over the 3 periods (69.9% to 77.4% to 83.3%) and was evident for both APAP and non-APAP DIALF. Over the last quarter century, there has been an 8-fold increase in HDS-related liver failure necessitating waitlisting for liver transplantation in the United States. There are other important temporal trends during the study period, including improved survival following LT among both APAP and non-APAP DIALF patients.
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Affiliation(s)
- Marwan Ghabril
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
| | - Jiayi Ma
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
| | - Kavish R Patidar
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
| | - Lauren Nephew
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
| | - Archita P Desai
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
| | - Eric S Orman
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
| | - Raj Vuppalanchi
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
| | - Shekhar Kubal
- Department of Transplant Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Naga Chalasani
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
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21
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Loc TT, Dat ND, Tran HN. Nano-sized hematite-assembled carbon spheres for effectively adsorbing paracetamol in water: Important role of iron. KOREAN J CHEM ENG 2022; 40:1-10. [PMID: 35095157 PMCID: PMC8786625 DOI: 10.1007/s11814-021-1013-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/07/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022]
Abstract
This study developed a new α-Fe2O3 (hematite) nanoparticles-loaded spherical biochar (H-SB) through the direct pyrolysis of glucose-derived spherical hydrochar and FeCl3. The optimal impregnation ratio (hydrochar and FeCl3) was 1/1.25 (wt/wt). H-SB was applied to remove paracetamol (PRC) from water. Results indicated that H-SB exhibited a relatively low surface area (127 m2/g) and total pore volume (0.089 cm3/g). The presence of iron particles in its surface was confirmed by scanning electron microscopy with energy dispersive spectroscopy. The dominant form of iron nanoparticles (α-Fe2O3) in its surface was confirmed by X-ray powder diffraction and Raman spectrum. The crystallite size of α-Fe2O3 in H-SB was 27.4 nm. The saturation magnetization of H-SB was 6.729 cmu/g. The analysis of Fourier-transform infrared spectroscopy demonstrated that the C-O and O-H groups were mainly responsible for loading α-Fe2O3 nanoparticles in its surface. The adsorption study indicated the amount of PRC adsorbed by H-SB slightly decreased within solution pH from 2 to 11. The adsorption reached a fast saturation after 120 min. The Langmuir maximum adsorption capacity of H-SB was 49.9 mg/g at 25 °C and pH 7.0. Ion-dipole interaction and π-π interaction played an important role in adsorption mechanisms, while hydrogen bonding and pore filling were minor. Therefore, H-SB can serve as a promising material for treating PRC-contaminated water streams. ELECTRONIC SUPPLEMENTARY MATERIAL Supplementary material is available in the online version of this article at 10.1007/s11814-021-1013-z.
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Affiliation(s)
- Ton That Loc
- Institute of Fundamental and Applied Sciences, Duy Tan University, Ho Chi Minh City, 700000 Vietnam
- Faculty of Environmental and Chemical Engineering, Duy Tan University, Da Nang, 550000 Vietnam
| | - Nguyen Duy Dat
- Faculty of Chemical & Food Technology, Ho Chi Minh City University of Technology and Education, Thu Duc, Ho Chi Minh City, 700000 Vietnam
| | - Hai Nguyen Tran
- Institute of Fundamental and Applied Sciences, Duy Tan University, Ho Chi Minh City, 700000 Vietnam
- Faculty of Environmental and Chemical Engineering, Duy Tan University, Da Nang, 550000 Vietnam
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22
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P. Abhilash K, Sanjay M, Rabbi A, Jain A. Profile of patients presenting with deliberate drug overdose and outcome. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_715_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Prabhakar Abhilash K, Murugan S, S. Rabbi NA, Pradeeptha S, Kumar S, Selvaraj B, Gunasekaran K. Deliberate self-poisoning and harm: A meticulous quest of methods in vogue. J Family Med Prim Care 2022; 11:233-239. [PMID: 35309643 PMCID: PMC8930158 DOI: 10.4103/jfmpc.jfmpc_1184_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/20/2021] [Accepted: 10/06/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Deliberate self-poisoning and harm (DSPH) is an unabating problem with a wide variation in the methods used across the world. Hence, this study was conducted to understand the current spectrum of methods used for DSPH by patients in our geographic locality and catchment area with special emphasis on newer compounds and drugs used. Methods: This retrospective study included patients presenting with DSPH to the emergency department (ED) between January 2017 and December 2018. Results: This study included 1802 patients, with a mean age of 32 ± 12.7 years. Of the patients, 85% were in the young to middle age group (16–45 years). Agrochemicals (n = 604, 33.5%), drugs (n = 498, 27.6%), plant toxins (n = 150, 8.3%) and rodenticides (n = 145, 8%) were the predominantly used compounds. The major emergency resuscitation procedures required in the ED were intubation (n = 321, 18%), vasopressor support (n = 73, 4%) and cardiopulmonary resuscitation (n = 27, 1.4%). A quarter (23.2%) was discharged stable from the ED, whereas a further 56.5% were discharged stable after hospital admission. The in-hospital mortality rate was 3% (n = 47). Multivariate logistic regression analysis showed rodenticides (odds ratio (OR): 22.32; 95% confidence interval (CI): 8.05–61.88; P = 0.005) and plant poisons (OR: 23.92; 95% CI: 8.95–63.94; P = 0.005) to be the independent predictors of mortality. Conclusion: DSPH is prevalent in the highly productive young age group. Agrochemical ingestion and drug overdose are the most common methods used, whereas rodenticide and plant poisoning are associated with significant mortality.
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Jasat H, Thompson J, Sonneborn O, Dayment J, Miller C. Prolonged use of paracetamol and the prescribing patterns on rehabilitation facilities. J Clin Nurs 2021; 31:3605-3616. [PMID: 34957612 DOI: 10.1111/jocn.16188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The study investigated: (a) the usage patterns of paracetamol, and (b) the association between paracetamol use and patient outcomes such as liver and kidney functions among older people. BACKGROUND Paracetamol is a well-known analgesic and antipyretic drug, with an excellent safety profile when used within its recommended dose. It is a commonly used drug by people aged over 65 years to treat chronic pain. Prolonged use of paracetamol in the elderly is poorly understood. As such, there is a genuine risk among older people of unintentional overdose. METHODS A retrospective analysis of medical records in rehabilitation wards was undertaken from 1 July 2016 to 30 June 2017. Patients' paracetamol use, prescribing patterns and biochemical results were analysed to assess for differences in admission and discharge biochemistry results. The TREND Statement was utilised to guide study reporting (Enhancing the QUAlity and Transparency Of health Research, 2021). RESULTS A total of 1119 patients were admitted for seven or more days in a metropolitan tertiary hospital in Melbourne. Almost three-quarters (74%) of patients were administered paracetamol; 76.1% received Immediate-Release Paracetamol (IRP), and 23.9% were given Sustained-release paracetamol (SRP). A proportion (4.5%) of patients in both the IRP and SRP groups received more than the daily recommended dose. There were limited statistically significant differences between patients' admission and discharge biochemistry results; group or time differences were observed, which were indicative of improvements within the paracetamol group. CONCLUSION Paracetamol was a commonly used medication among long-stay elderly patients. Precaution to ensure paracetamol use does not exceed recommended daily doses is required. This study suggests that paracetamol used at a therapeutic level in older patients had limited, negative associations with liver and kidney function. RELEVANCE TO CLINICAL PRACTICE The clinical practice regarding prolonged use of paracetamol is ambitious. The increased risk of paracetamol toxicity among the frail elderly is a concern. Optimising the dose adjustment in the elderly is important to avoid adverse outcomes.
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Affiliation(s)
- Homairah Jasat
- La Trobe University, Bundoora, Victoria, Australia.,Austin Health, Heidelberg, Victoria, Australia
| | - John Thompson
- Department of Nursing, The University of Melbourne, Carlton, Victoria, Australia.,Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Olivia Sonneborn
- La Trobe University, Bundoora, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
| | | | - Charne Miller
- La Trobe University, Bundoora, Victoria, Australia.,Department of Nursing, The University of Melbourne, Carlton, Victoria, Australia
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Syafira N, Graudins A, Yarema M, Wong A. Comparing development of liver injury using the two versus three bag acetylcysteine regimen despite early treatment in paracetamol overdose. Clin Toxicol (Phila) 2021; 60:478-485. [PMID: 34758680 DOI: 10.1080/15563650.2021.1998518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Some studies have reported that early administration of acetylcysteine using a 3-bag regimen may not fully prevent development of liver injury in some patients. We compared the incidence of acute liver injury (ALI) in patients receiving acetylcysteine within eight hours of ingestion between the two-bag acetylcysteine regimen (200 mg/kg over four hours, 100 mg/kg over 16 h) and the three-bag regimen (150 mg/kg over 1 h, 50 mg/kg over 4 h, 100 mg/kg over 16 h). METHOD This was a retrospective cohort study of the two-bag and three-bag acetylcysteine regimens from Monash Health, Victoria, Australia (2009-2020), compared to the three-bag acetylcysteine regimen data from the Canadian Acetaminophen Overdose Study (CAOS) database (1980-2005). The inclusion criteria included patients with an acute single ingestion of paracetamol; normal aminotransferases on presentation and acetylcysteine administered within eight hours post-overdose. The primary outcome was development of ALI (defined as: peak aminotransferase >150 IU/L). RESULTS At Monash Health, 191 patients were treated with the two-bag acetylcysteine regimen, and 180 patients with the three-bag regimen. The CAOS cohort provided 515 patients treated with the three-bag regimen. ALI developed in 1.6% (3/191) of the two-bag Monash Health group, 2.2% (4/180) of the three-bag Monash Health group (difference -0.6%, p 0.7), and 2.9% (15/515) of the three-bag CAOS group (difference compared to two-bag -1.3%, p 0.4). Hepatotoxicity (ALT >1000) developed in 0.5% (1/191) of patients treated with the two-bag regimen, 1.7% (3/180) in the Monash Health three-bag regimen and 1% (5/515) of the three-bag CAOS group. There were no statistically significant differences between groups. CONCLUSIONS ALI and hepatotoxicity were observed in a small, comparable percentage of patients despite early acetylcysteine administration using the two-bag and three-bag regimens. Repeating blood tests at the end of acetylcysteine treatment will identify these patients and indicate those requiring continuation of acetylcysteine.
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Affiliation(s)
- Naura Syafira
- Department of Medicine, School of Clinical Science at Monash Health, Monash University, Victoria, Australia.,Faculty of Medicine, Universitas Indonesia, Special Capital Region of Jakarta, Indonesia
| | - Andis Graudins
- Department of Medicine, School of Clinical Science at Monash Health, Monash University, Victoria, Australia.,Monash Toxicology Unit, Dandenong Hospital, Monash Health, Victoria, Australia
| | - Mark Yarema
- Poison and Drug Information Service, Alberta Health Services, Calgary, Canada.,Department of Emergency Medicine, University of Calgary, Calgary, Canada
| | - Anselm Wong
- Department of Medicine, School of Clinical Science at Monash Health, Monash University, Victoria, Australia.,Austin Toxicology Unit, Austin Health, Victoria, Australia.,Department of Critical Care, University of Melbourne, Victoria, Australia
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26
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Nash E, Sabih AH, Chetwood J, Wood G, Pandya K, Yip T, Majumdar A, McCaughan GW, Strasser SI, Liu K. Drug-induced liver injury in Australia, 2009-2020: the increasing proportion of non-paracetamol cases linked with herbal and dietary supplements. Med J Aust 2021; 215:261-268. [PMID: 34272737 DOI: 10.5694/mja2.51173] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare the characteristics and outcomes of drug-induced liver injury (DILI) caused by paracetamol and non-paracetamol medications, particularly herbal and dietary supplements. DESIGN Retrospective electronic medical record data analysis. SETTING, PARTICIPANTS Adults admitted with DILI to the Gastroenterology and Liver Centre at the Royal Prince Alfred Hospital, Sydney (a quaternary referral liver transplantation centre), 2009-2020. MAIN OUTCOME MEASURES 90-day transplant-free survival; drugs implicated as causal agents in DILI. RESULTS A total of 115 patients with paracetamol-related DILI and 69 with non-paracetamol DILI were admitted to our centre. The most frequently implicated non-paracetamol medications were antibiotics (19, 28%), herbal and dietary supplements (15, 22%), anti-tuberculosis medications (six, 9%), and anti-cancer medications (five, 7%). The number of non-paracetamol DILI admissions was similar across the study period, but the proportion linked with herbal and dietary supplements increased from 2 of 13 (15%) during 2009-11 to 9 of 19 (47%) during 2018-20 (linear trend: P = 0.011). Despite higher median baseline model for end-stage liver disease (MELD) scores, 90-day transplant-free survival for patients with paracetamol-related DILI was higher than for patients with non-paracetamol DILI (86%; 95% CI, 79-93% v 71%; 95% CI, 60-82%) and herbal and dietary supplement-related cases (59%; 95% CI, 34-85%). MELD score was an independent predictor of poorer 90-day transplant-free survival in both paracetamol-related (per point increase: adjusted hazard ratio [aHR], 1.19; 95% CI, 1.09-3.74) and non-paracetamol DILI (aHR, 1.24; 95% CI, 1.14-1.36). CONCLUSION In our single centre study, the proportion of cases of people hospitalised with DILI linked with herbal and dietary supplements has increased since 2009. Ninety-day transplant-free survival for patients with non-paracetamol DILI, especially those with supplement-related DILI, is poorer than for those with paracetamol-related DILI.
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Affiliation(s)
- Emily Nash
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
| | - Abdul-Hamid Sabih
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
| | - John Chetwood
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
| | - Georgette Wood
- Sydney Medical School, University of Sydney, Sydney, NSW
| | - Keval Pandya
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
| | - Terry Yip
- Medical Data Analytic Centre and Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong
| | - Avik Majumdar
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW.,Sydney Medical School, University of Sydney, Sydney, NSW
| | - Geoffrey W McCaughan
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW.,Sydney Medical School, University of Sydney, Sydney, NSW
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW.,Sydney Medical School, University of Sydney, Sydney, NSW
| | - Ken Liu
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW.,Sydney Medical School, University of Sydney, Sydney, NSW
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Wojt IR, Cairns R, Gillooly I, Patanwala AE, Tan ECK. Clinical factors associated with increased length of stay and readmission in patients with medication-related hospital admissions: a retrospective study. Res Social Adm Pharm 2021; 18:3184-3190. [PMID: 34556433 DOI: 10.1016/j.sapharm.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/23/2021] [Accepted: 09/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Adverse drug events (ADEs) remain a key contributor to hospitalisations, resulting in long hospital stays and readmissions. Information pertaining to the specific medications and clinical factors associated with these outcomes is limited. Hence, a better understanding of these factors and their relationship to ADEs is required. OBJECTIVES To investigate medications involved, clinical manifestations of ADE-related hospitalisations, and their association with length of stay and readmission. METHODS A retrospective medical record review of patients admitted to a major, tertiary referral hospital in NSW, Australia, from January 2019 to August 2020 was conducted. ADEs were identified using Australian Refined Diagnosis Related Group (AR-DRG) codes: X40, X61, X62 and X64. Medications were classified per the Anatomical Therapeutic Chemical (ATC) classification system and clinical symptoms were classified per the International Classification of Disease (ICD) 9-CM. Logistic regression was performed to assess the relationship between medication and presentation classes with length of stay (≥2 days vs <2 days) and readmission. RESULTS There were 125 patients who met inclusion criteria (median age = 64 [interquartile range, 45-75] years; 53.6% male). Anti-thrombotic agents, opioids, antidepressants, antipsychotics, insulins and NSAIDs were the most implicated pharmacological classes. Neurological medications and falls were associated with a length of stay ≥2 days (adjusted odds ratio [aOR] 3.92, 95% confidence interval [CI] 1.48-10.33 and aOR 3.24, 95% CI 1.05-10.06, respectively). Neurological medications and neurological and cognitive disorders were associated with an increased likelihood of 90-day readmission (aOR 2.63, 95% CI 1.05-6.57 and aOR 3.20, 95% CI 1.17-8.75, respectively). CONCLUSION This study identified neurological medications as high-risk for increased length of stay and readmission in those hospitalised due to ADEs. This highlights the need for judicious prescribing and monitoring of these medications.
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Affiliation(s)
- Ilsa R Wojt
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia
| | - Rose Cairns
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia; NSW Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
| | - Isabelle Gillooly
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia
| | - Asad E Patanwala
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia; Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Edwin C K Tan
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia; Aging Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
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Ibrahim H, Hamdy AM, Merey HA, Saad AS. Dual-Mode Gradient HPLC and TLC Densitometry Methods for the Simultaneous Determination of Paracetamol and Methionine in the Presence of Paracetamol Impurities. J AOAC Int 2021; 104:975-982. [PMID: 33560299 PMCID: PMC7928902 DOI: 10.1093/jaoacint/qsab021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/20/2020] [Accepted: 01/22/2021] [Indexed: 01/06/2023]
Abstract
Background Paracetamol is one of the most widely analgesic and antipyretic drugs recently integrated into the supportive therapy of COVID-19. The pharmaceuticals containing methionine with paracetamol may contribute to avoid hepatotoxicity and eventual paracetamol overdose-dependent death. Objective The current work purposes to develop and validate two chromatographic methods for the simultaneous determination of methionine and paracetamol in presence of two paracetamol impurities (4-nitrophenol and 4-aminophenol). Methods Two chromatographic methods were established and validated according to the International Conference on Harmonization guidelines. The first one was a RP-HPLC/UV method based on applying a “dual-mode” gradient elution. The separation was realized via varying both the composition of the ternary mobile phase (acetonitrile–methanol–water) and its flow rate. This strategy enabled a relatively rapid analysis with a satisfactory resolution, although the investigated compounds exhibit a significant difference in lipophilicity. The second one relied on TLC- densitometry, where the optimum separation was realized using a quaternary mobile phase system composed of butanol–dioxane–toluene–methanol (8: 2.5: 3.5: 0.3, by volume). Both methods were monitored at 220 nm. Results The developed methods were proven to be robust, accurate, specific, and appropriate for the routine analysis of paracetamol in its pure form or in pharmaceutical formulations with methionine in quality control laboratories. Conclusions The corresponding methods are suitable to determine methionine and paracetamol in the presence of paracetamol impurities. Highlights The study achieves the analysis of methionine and paracetamol in the presence of paracetamol impurities via the application of HPLC and TLC- densitometry methods.
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Affiliation(s)
- Hany Ibrahim
- Egyptian Russian University, Faculty of Pharmacy, Analytical Chemistry Department, Badr City, Cairo, Egypt
| | - Abdallah M Hamdy
- Egyptian Russian University, Faculty of Pharmacy, Analytical Chemistry Department, Badr City, Cairo, Egypt
| | - Hanan A Merey
- Cairo University, Faculty of Pharmacy, Analytical Chemistry Department, Kasr El-Aini St, Cairo, Egypt.,October 6 University, Faculty of Pharmacy, Analytical Chemistry Department, Giza, Egypt
| | - Ahmed S Saad
- Cairo University, Faculty of Pharmacy, Analytical Chemistry Department, Kasr El-Aini St, Cairo, Egypt.,Badr University in Cairo (BUC), School of Pharmacy and Pharmaceutical Industries, Pharmaceutical Chemistry Department, Cairo, Egypt
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Abstract
Acetaminophen is a common medication taken in deliberate self-poisoning and unintentional overdose. It is the commonest cause of severe acute liver injury in Western countries. The optimal management of most acetaminophen poisonings is usually straightforward. Patients who present early should be offered activated charcoal and those at risk of acute liver injury should receive acetylcysteine. This approach ensures survival in most. The acetaminophen nomogram is used to assess the need for treatment in acute immediate-release overdoses with a known time of ingestion. However, scenarios that require different management pathways include modified-release, large/massive, and repeated supratherapeutic ingestions.
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Affiliation(s)
- Angela L Chiew
- Clinical Toxicology Unit, Prince of Wales Hospital, Barker Street, Randwick, New South Wales 2031, Australia.
| | - Nicholas A Buckley
- Pharmacology and Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales 2050, Australia
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30
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TRPM2 Non-Selective Cation Channels in Liver Injury Mediated by Reactive Oxygen Species. Antioxidants (Basel) 2021; 10:antiox10081243. [PMID: 34439491 PMCID: PMC8389341 DOI: 10.3390/antiox10081243] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022] Open
Abstract
TRPM2 channels admit Ca2+ and Na+ across the plasma membrane and release Ca2+ and Zn2+ from lysosomes. Channel activation is initiated by reactive oxygen species (ROS), leading to a subsequent increase in ADP-ribose and the binding of ADP-ribose to an allosteric site in the cytosolic NUDT9 homology domain. In many animal cell types, Ca2+ entry via TRPM2 channels mediates ROS-initiated cell injury and death. The aim of this review is to summarise the current knowledge of the roles of TRPM2 and Ca2+ in the initiation and progression of chronic liver diseases and acute liver injury. Studies to date provide evidence that TRPM2-mediated Ca2+ entry contributes to drug-induced liver toxicity, ischemia–reperfusion injury, and the progression of non-alcoholic fatty liver disease to cirrhosis, fibrosis, and hepatocellular carcinoma. Of particular current interest are the steps involved in the activation of TRPM2 in hepatocytes following an increase in ROS, the downstream pathways activated by the resultant increase in intracellular Ca2+, and the chronology of these events. An apparent contradiction exists between these roles of TRPM2 and the role identified for ROS-activated TRPM2 in heart muscle and in some other cell types in promoting Ca2+-activated mitochondrial ATP synthesis and cell survival. Inhibition of TRPM2 by curcumin and other “natural” compounds offers an attractive strategy for inhibiting ROS-induced liver cell injury. In conclusion, while it has been established that ROS-initiated activation of TRPM2 contributes to both acute and chronic liver injury, considerable further research is needed to elucidate the mechanisms involved, and the conditions under which pharmacological inhibition of TRPM2 can be an effective clinical strategy to reduce ROS-initiated liver injury.
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Li J, Chiew AL, Isbister GK, Duffull SB. Population pharmacokinetics of immediate-release and modified-release paracetamol and its major metabolites in a supratherapeutic dosing study. Clin Toxicol (Phila) 2021; 60:25-32. [PMID: 34080498 DOI: 10.1080/15563650.2021.1928163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Overdose with paracetamol modified-release (MR) formulation, a bilayer tablet containing 69% slow-release component, has been increasing since its introduction to the market. However, little evidence exists for the management of MR paracetamol overdose. We aimed to develop a population pharmacokinetic (PK) model for immediate-release (IR) and MR paracetamol and its major metabolism, and quantitatively understand the formulation difference in toxicity assessment based on the nomogram line. METHODS Data from a cross-over study design in nine healthy volunteers administered a single supratherapeutic oral dose (80 mg/kg) of either IR and MR paracetamol were available from a published study. Plasma concentrations for paracetamol and its metabolites glucuronide (APAPG) and sulfate conjugate (APAPS) for both formulations were measured and analysed with population pharmacokinetic (PK) method using NONMEM. Toxicity in both formulations was assessed by comparing the simulated paracetamol concentrations under different paracetamol dose levels with the 150 mg/L nomograms. The difference in the assessment was compared between the two formulations. RESULTS Paracetamol concentrations for the IR formulation were described with a two-compartment model with first-order input and a lag time. The delayed time-course of MR paracetamol concentrations was best captured by a parallel absorption model in which the slow-release component was a serial zero-order then the first-order process. The formation of APAPG was linear, while APAPS concentrations were best fitted by a Michaelis-Menten process. The relative bioavailability of MR paracetamol compared to IR (FMR/IR) was estimated as 0.81. The simulated probability of making different toxicity assessments based on nomogram line was increased with dose levels and was as high as 14.6% after 22 g IR or MR paracetamol ingested. CONCLUSIONS A joint parent-metabolite model to describe time-course profiles of both IR and MR paracetamol and its metabolites APAPG and APAPS concentrations was developed. Simulations from the model showed that toxicity assessment based on the 150 mg/L nomograms is not suitable in MR paracetamol overdoses.
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Affiliation(s)
- Jingyun Li
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Angela L Chiew
- Emergency Department and Clinical Toxicology, Prince of Wales Hospital and Community Health Services, Randwick, Australia.,NSW Poisons Information Centre, Children's Hospital at Westmead, Westmead, Australia
| | - Geoffrey K Isbister
- NSW Poisons Information Centre, Children's Hospital at Westmead, Westmead, Australia.,Clinical Toxicology Research Group, University of Newcastle, Newcastle, Australia
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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.
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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
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Paracetamol-related intentional drug overdose among young people: a national registry study of characteristics, incidence and trends, 2007-2018. Soc Psychiatry Psychiatr Epidemiol 2021; 56:773-781. [PMID: 33146859 DOI: 10.1007/s00127-020-01981-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 10/24/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Incidence rates of hospital-presenting self-harm are highest in people under 25 years and are reportedly increasing in some countries. Intentional drug overdose (IDO) is the most common self-harm method among young people, with paracetamol the drug most frequently used. This study aimed to describe the characteristics, incidence, and temporal trends in paracetamol-related IDO among young people. METHODS Data from the National Self-Harm Registry Ireland on hospital-presenting self-harm by individuals aged 1024 years during 2007-2018 were examined. Annual IDO rates per 100,000 were calculated by age and gender. Joinpoint regression analyses and incidence rate ratios were used to examine trends in the incidence of paracetamol-related IDO. RESULTS During the study, 10,985 paracetamol-related IDOs were recorded. The incidence of paracetamol-related IDO among young people increased by 9% between 2007 and 2018 (IRR 1.09 95% CI 1.00-1.19), with the highest annual percentage change (APC) in females aged 18-24 years (APC 1.2%). Conversely, rates of paracetamol-related IDO among males aged 18-24 years decreased significantly (APC 1.6%). Between 2013 and 2018, excesses of 386 and 151 paracetamol-related IDOs were observed in females aged 10-17 and 18-24 years, respectively, and 42 excess presentations were observed for males aged 10-17 years. There were 107 fewer presentations than expected for males aged 18-24 years. CONCLUSION The increase in paracetamol-related IDO among specific groups of young people, particularly young females is an issue of growing concern. Interventions targeting IDO among young people are needed, incorporating measures to address the availability of paracetamol and aftercare following IDO.
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Duyster T, McMillan SS, Whately E, Kelly FS. What Do Young Adults Think about the Safety of Over-the-Counter Analgesics? Findings from a Cross-Sectional Survey. PHARMACY 2021; 9:54. [PMID: 33807954 PMCID: PMC8005976 DOI: 10.3390/pharmacy9010054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/30/2022] Open
Abstract
Analgesics are commonly used over-the-counter (OTC) medicines readily available for purchase, sometimes without advice of a health professional. However, analgesics can cause harm even when taken according to dosing recommendations. Young adults may be more vulnerable to harm if they perceive low risk with OTC analgesic use, or struggle to interpret dosing instructions. This study aimed to explore factors affecting how young adults use OTC analgesics and associated perceptions of safety. An online survey was distributed to school-leavers and university students (17 to 25 years), in South-East Queensland, Australia, in the period November-December 2019. Most of the 302 respondents (school-leavers n = 147, university students n = 155) did not use analgesics frequently. School-leavers deferred to parents for analgesic information, while university students preferred the internet. The majority of respondents appeared safety conscious and did not take outside indicated use or instructions. However, a small proportion reported taking analgesics for an inappropriate indication. The difference in preferred source of analgesic information may reflect experience with analgesic use, increasing autonomy or decreased parental influence. Whilst it is encouraging that the majority of young adults appeared safety conscious, greater insight is needed into factors influencing decision making on OTC use, e.g., medicines knowledge, and changes with increasing age.
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Affiliation(s)
- Tahlia Duyster
- School of Pharmacy and Pharmacology, Gold Coast Campus, Griffith University, Southport 4215, Australia; (T.D.); (S.S.M.); (E.W.)
- Gold Coast Hospital and Health Service, Southport 4215, Australia
| | - Sara S. McMillan
- School of Pharmacy and Pharmacology, Gold Coast Campus, Griffith University, Southport 4215, Australia; (T.D.); (S.S.M.); (E.W.)
| | - Ella Whately
- School of Pharmacy and Pharmacology, Gold Coast Campus, Griffith University, Southport 4215, Australia; (T.D.); (S.S.M.); (E.W.)
- Gold Coast Hospital and Health Service, Southport 4215, Australia
| | - Fiona S. Kelly
- School of Pharmacy and Pharmacology, Gold Coast Campus, Griffith University, Southport 4215, Australia; (T.D.); (S.S.M.); (E.W.)
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Daifallah A, Jabr R, Al-Tawil F, Elkourdi M, Salman Z, Koni A, Samara A, Al-Jabi SW, Zyoud SH. An assessment of parents' knowledge and awareness regarding paracetamol use in children: a cross-sectional study from Palestine. BMC Public Health 2021; 21:380. [PMID: 33602192 PMCID: PMC7890973 DOI: 10.1186/s12889-021-10432-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Paracetamol, also known as acetaminophen, is one of the most common antipyretic and analgesic over-the-counter (OTC) medicines administered to children due to its efficacy, safety, and availability in many pharmaceutical forms, including suppositories, syrup, and drops. Parents frequently administer the wrong dose of paracetamol by mistake for their children, as reported by many previous studies. We aimed in this study to assess parents' knowledge, attitudes, and practice regarding paracetamol dosing and toxicity, as well as their awareness regarding paracetamol-containing products. METHODS This was a cross-sectional study that targeted parents of children seeking healthcare services at primary health care centers in the Nablus area in the West Bank, Palestine. We used questionnaire-based interviews with parents for data collection. RESULTS A total of 300 parents were included in the study. Most of the caregivers surveyed were (87%) females (mothers). About half the parents (50.9%) reported previously using paracetamol as an antipyretic in children under the age of six. A quarter (25.4%) preferred the syrup forms, while 33.8% preferred the suppository dosage form. Medical personnel was the primary source of information for half the caregivers (51.2%). The mean knowledge score about paracetamol was 2.1 (SD = 1.4) out of 6, and the median was 2.0 with an interquartile range of 1.0-3.0. Two hundred seventy-four (95.5%) of the participants scored less than 80% and were considered to have insufficient knowledge. Only 50.9% of parents recognized that paracetamol overdose could result in serious harm. CONCLUSIONS We found a serious lack of knowledge regarding paracetamol dosing, administration, and potential toxicity among Palestinian parents. We recommend raising awareness regarding this problem among healthcare providers and authorities and working on plans that aim to provide caregivers with accurate and adequate information on dosing, formulation, side effects, and other aspects of paracetamol use, as well as developing effective educational plans targeting healthcare providers, as well as the public.
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Affiliation(s)
- Aiman Daifallah
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Ruba Jabr
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Faraj Al-Tawil
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Moutaz Elkourdi
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Ziad Salman
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Amer Koni
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Ahmad Samara
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Samah W. Al-Jabi
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839 Palestine
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Wojt IR, Cairns R, Tan ECK. Poisoning Exposures in People with Dementia (2014‒2019): A Retrospective Study. J Am Med Dir Assoc 2020; 22:1553-1557.e1. [PMID: 33345812 DOI: 10.1016/j.jamda.2020.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/09/2020] [Accepted: 11/14/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To describe the most common types of poisoning exposures, implicated substances and underlying sources of medication error in people with dementia. DESIGN Retrospective analysis of call records from the New South Wales (NSW) Poisons Information Center (PIC). SETTING AND PARTICIPANTS People with dementia who had a poisoning exposure reported to the NSW PIC (Australia's largest PIC). METHODS A retrospective study was conducted using data from the NSW PIC from July 2014 to July 2019. All calls pertaining to individuals with a reported diagnosis of dementia (Alzheimer's disease or other) or who were taking an antidementia drug were included. Descriptive analysis was performed to characterize poisoning exposures, substances involved, and sources of error. RESULTS A total of 2726 cases involving individuals with dementia [mean age = 79.5 (standard deviation 11.0) years; 56.2% female] were reported to the NSW PIC after intentional or unintentional poisoning. Therapeutic errors comprised 1692 (62.1%) of all reported cases followed by accidental exposures which contributed 711 (26.1%). The most common therapeutic substances responsible for therapeutic errors were donepezil (137 cases, 8.1%) and paracetamol (87 cases, 5.1%). The greatest proportion of all accidental exposures was attributed to hand sanitizer (46 cases, 6.5%). Over one-half of therapeutic errors (n = 1021, 60.3%) were linked to double dosing or mistiming of medications, and nursing home or carer errors were implicated in 385 cases (22.8%). Calls were most commonly made by family (n = 1187, 43.5%) and handled at home (n =1444, 53.0%). CONCLUSIONS AND IMPLICATIONS Therapeutic errors and accidental poisonings are of concern in people with dementia. Strategies to reduce these potentially preventable adverse events should be further explored.
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Affiliation(s)
- Ilsa R Wojt
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Rose Cairns
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia; NSW Poisons Information Center, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Edwin C K Tan
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia.
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Isbister GK, Chiew A. The changing face of paracetamol toxicity and new regimens for an old antidote acetylcysteine. Br J Clin Pharmacol 2020; 87:715-716. [PMID: 32748454 DOI: 10.1111/bcp.14495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Geoffrey K Isbister
- Clinical Toxicology Research Group, University of Newcastle, Waratah, New South Wales, Australia
| | - Angela Chiew
- NSW Poisons Information Centre, Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Department of Pharmacology, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
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Schaffer AL, Cairns R, Brown JA, Gisev N, Buckley NA, Pearson S. Changes in sales of analgesics to pharmacies after codeine was rescheduled as a prescription only medicine. Med J Aust 2020; 212:321-327. [DOI: 10.5694/mja2.50552] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/18/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Andrea L Schaffer
- Centre for Big Data Research in HealthUniversity of New South Wales Sydney NSW
| | - Rose Cairns
- University of Sydney Sydney NSW
- NSW Poisons Information CentreChildren's Hospital at Westmead Sydney NSW
| | - Jared A Brown
- Centre for Big Data Research in HealthUniversity of New South Wales Sydney NSW
- NSW Poisons Information CentreChildren's Hospital at Westmead Sydney NSW
| | - Natasa Gisev
- National Drug and Alcohol Research CentreUniversity of New South Wales Sydney NSW
| | | | - Sallie‐Anne Pearson
- Centre for Big Data Research in HealthUniversity of New South Wales Sydney NSW
- Menzies Centre for Health PolicyUniversity of Sydney Sydney NSW
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Wong A, Isbister G, McNulty R, Isoardi K, Harris K, Chiew A, Greene S, Gunja N, Buckley N, Page C, Graudins A. Efficacy of a two bag acetylcysteine regimen to treat paracetamol overdose (2NAC study). EClinicalMedicine 2020; 20:100288. [PMID: 32211597 PMCID: PMC7082646 DOI: 10.1016/j.eclinm.2020.100288] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Previous studies of paracetamol overdose treatment show that a 2-bag, 20-h intravenous (IV) acetylcysteine regimen decreased the incidence of non-allergic anaphylactic reactions compared to the 3-bag, 21 h IV regimen, but have not examined efficacy of the 20-h 2 bag regimen. METHODS This was a multi-centre observational study of paracetamol overdose presentations treated with a 2-bag IV acetylcysteine regimen (200 mg/kg over 4 h, 100 mg/kg over 16 h) compared to a 3-bag regimen, performed from 2009 to 2019. Patients were referred from the emergency department to the inpatient toxicology units for continued management. For the primary non-inferiority analysis: subjects had single, acute ingestions, a serum paracetamol-concentration performed 4 to 8-h post-ingestion. The primary outcome was development of acute liver injury (ALI), defined as peak ALT>150 U/L; and > double admission baseline ALT (for presentations within 24 h post-overdose). Secondary outcomes included adverse reactions to acetylcysteine (cutaneous and systemic). FINDING Out of 6419 paracetamol overdoses, 2763 received acetylcysteine. For the primary analysis, 1003 received the 2-bag and 783 the 3-bag acetylcysteine regimen. When presentation bloods were performed 4 to 8-h post-overdose, 21 (3.1%) developed ALI with the 2-bag regimen vs 16 (2.9%) with the 3-bag regimen (Difference: 0.2%, 95%CI:-1.6 to 2.2). The incidence of hepatotoxicity was: 1.2% (n = 8) with the two-bag regimen and 1.6% (n = 9) with the three-bag regimen (Difference -0.4%, 95%CI -1.75, 0.91). When presentation bloods were performed 8 to 24-h post-overdose, 70 (21%) developed ALI with the 2-bag regimen vs 46 (23%) with the 3-bag regimen (Difference: -2%, 95%CI -9.12 to 5.36). There were significantly less cutaneous and systemic non-allergic anaphylactic reactions recorded after treatment with the two-bag than the three-bag regimen (1.3% [n = 17] and 7.1% [n = 65], Difference: -5.8%, 95%CI -7.6 to -4.0, p < 0.0001), respectively. INTERPRETATION A two-bag intravenous acetylcysteine regimen was found to be non-inferior to the three-bag regimen with regards to efficacy in preventing acute liver injury for early presentations of paracetamol overdose. No important differences were seen for any other presentations. The two-bag regimen also decreased the incidence of both non-allergic anaphylactic reactions and gastrointestinal adverse events from acetylcysteine treatment. FUNDING AW is funded by a National Health and Medical Research Council (NHMRC) Early Career Fellowship ID 1159907. GI is funded by a NHMRC Senior Research Fellowship ID 1061041. The NHMRC had no role in the design, writing of this manuscript. The corresponding author (AW) had full access to all the data in the study and final responsibility for the decision to submit the manuscript for publication.
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Affiliation(s)
- Anselm Wong
- Victorian Poisons Information Centre and Austin Toxicology Unit, Victoria, Australia
- Centre for Integrated Critical Care, Department of Medicine and Radiology, University of Melbourne, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Geoff Isbister
- Clinical Toxicology Research Group, University of Newcastle, NSW, Australia
- Department of Clinical Toxicology, Calvary Mater Newcastle, NSW, Australia
| | - Richard McNulty
- Department of Emergency Medicine, Blacktown Mount Druitt hospitals, Sydney, Australia
- Western Sydney Toxicology Service, Western Sydney LHD, Sydney, Australia
| | - Katherine Isoardi
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Keith Harris
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Angela Chiew
- Clinical Toxicology Unit, Princes of Wales Hospital, Randwick, NSW, Australia
- Pharmacology, Faculty of Medicine and Health, University of Sydney, Australia
| | - Shaun Greene
- Victorian Poisons Information Centre and Austin Toxicology Unit, Victoria, Australia
- Centre for Integrated Critical Care, Department of Medicine and Radiology, University of Melbourne, Victoria, Australia
- Department of Forensic Medicine, Monash University, Victoria, Australia
- Guy's and St Thomas’ NHS Foundation Trust, United Kingdom
| | - Naren Gunja
- Western Sydney Toxicology Service, Western Sydney LHD, Sydney, Australia
- Department of Emergency Medicine, Westmead Hospital, Sydney, Australia
- Emergency Medicine, Westmead Clinical School, University of Sydney, Australia
| | - Nicholas Buckley
- Department of Pharmacology, Faculty of Medicine and Health, University of Sydney, Australia
- NSW Poisons Information Centre, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Colin Page
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Andis Graudins
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
- Monash Toxicology Unit, Dandenong Hospital, Monash Health, Victoria, Australia
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Affiliation(s)
- Bruno T Saragiotto
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- Institute for Musculoskeletal Health, University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, School of Public Health, University of Sydney, New South Wales, Australia
| | - Christina Abdel Shaheed
- Institute for Musculoskeletal Health, University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, School of Public Health, University of Sydney, New South Wales, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, School of Public Health, University of Sydney, New South Wales, Australia
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Talley Ac NJ. The MJA in 2019: going from very good to great! Med J Aust 2019; 211:484-489. [PMID: 31813174 DOI: 10.5694/mja2.50413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chiew AL, Reith D, Pomerleau A, Wong A, Isoardi KZ, Soderstrom J, Buckley NA. Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand. Med J Aust 2019; 212:175-183. [DOI: 10.5694/mja2.50428] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Angela L Chiew
- Prince of Wales Hospital and Community Health Services Sydney NSW
- NSW Poisons Information CentreChildren's Hospital at Westmead Sydney NSW
| | | | | | - Anselm Wong
- Victorian Poisons Information CentreAustin Hospital Melbourne VIC
- Monash HealthMonash University Melbourne VIC
| | - Katherine Z Isoardi
- Princess Alexandra Hospital Brisbane QLD
- Queensland Poisons Information CentreQueensland Children's Hospital Brisbane QLD
| | - Jessamine Soderstrom
- Royal Perth Hospital Perth WA
- Western Australia Poisons Information CentreSir Charles Gairdner Hospital Perth WA
| | - Nicholas A Buckley
- NSW Poisons Information CentreChildren's Hospital at Westmead Sydney NSW
- University of Sydney Sydney NSW
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Jackson A, Little M. Electronic intravenous N-acetyl cysteine ordering tool: A retrospective review. Emerg Med Australas 2019; 32:267-270. [PMID: 31668008 DOI: 10.1111/1742-6723.13404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/18/2019] [Accepted: 09/18/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine if the electronic N-acetyl cysteine (NAC) order reduced prescribing errors. METHODS This was a retrospective chart review of all patients presenting over 2 years to Cairns Hospital ED with a discharge diagnosis of 'paracetamol overdose'. Data were collected for any patient who received i.v. NAC. Any error, and a description of the error such as dose, volume of fluid, time of infusion and incorrect patient weight was recorded. RESULTS There were 172 presentations with paracetamol poisoning with 86 receiving i.v. NAC. In the 75 (87%) where the electronic NAC order was used, there were no errors in dose of NAC, volume of i.v. fluid and length of time of infusion. In the 11 presentations where the manual NAC order was used, there were multiple errors identified. CONCLUSION The use of this electronic NAC order removed errors in NAC prescription and should be considered for prescribing and administering i.v. NAC.
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Affiliation(s)
- Angela Jackson
- Department of Emergency Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Mark Little
- Department of Emergency Medicine, Cairns Hospital, Cairns, Queensland, Australia
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45
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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
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