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From pain killer to poison - Acetaminophen
- Sohil Ahmed Khan, Gabriel Rodrigues, Dept of Surgery, Kasturba Medical College, Manipal, INDIA (20 March 2006)
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"Safe" paracetamol
- John P Heptonstall (21 March 2006)
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Paracetamol overdoses are rarely unintentional
- Geoffrey Brandon (4 April 2006)
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Re: Paracetamol overdoses are rarely unintentional
- John P Heptonstall (12 April 2006)
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Sohil Ahmed Khan, Faculty and Research Scholar Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, INDIA, Gabriel Rodrigues, Dept of Surgery, Kasturba Medical College, Manipal, INDIA
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We read with interest the article on acetaminophen poisoning. Acetaminophen is an effective alternative to aspirin as an analgesic- antipyretic agent, however, unlike aspirin, its anti-inflammatory activity is relatively weak. Because acetaminophen is well tolerated, lacks many of the side effects of aspirin, and is available without prescription, it has earned a prominent place as a common household analgesic. Incidentally it is one of the drugs most commonly involved in suicide attempts and accidental poisonings, both as the sole agent and in combination with other drugs. Acute overdosage causes fatal hepatic damage, and the number of self-poisonings and suicides with acetaminophen has grown alarmingly in recent years. Early diagnosis is vital in the treatment of overdosage with acetaminophen, however therapy should not be delayed while awaiting laboratory results if the history suggests a significant overdosage. Vigorous supportive therapy is essential when intoxication is severe. The main message in paracetamol poisoning is ‘if in doubt, treat with N-acetylcysteine’ [1] which is the principal antidotal treatment. We need to gear up research related to specific biomarkers and target molecules for rapid diagnosis. Hepatic sinusoidal endothelial cells (SEC) are a sensitive direct target for early toxicity to acetaminophen [2]. The identification of specific target proteins like measurement of acetaminophen-protein adducts [3] might improve diagnostic accuracy in acute liver failure (ALF) patients and to clarify the mechanism of acetaminophen hepatotoxicity in a better way. REFERENCES: 1.Alison L Jones, Glyn Volans. Management of self-poisoning. BMJ 1999;319:1414-1417 . 2.Mc Cuskey RS. Sinusoidal endothelial cells as an early target for hepatic toxicants. Clin Hemorheol Microcirc 2006;34:5-10. 3.Davern TJ 2nd, James LP, Hinson JA, Polson J, Larson AM, Fontana RJ et al. Measurement of serum acetaminophen-protein adducts in patients with acute liver failure. Gastroenterology 2006;130:687-694 Competing interests: None declared |
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John P Heptonstall, Director of the Morley Acupuncture Clinic Leeds LS27 8EG
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Sir What happened to the provsion of "Safe" paracetamol that had been campaigned for - that containing a judicious amount of methionine which significantly reduced the potential for overdose? It was released for public purchase some years ago being designed to save lives, such as those mentioned in Tanne's article, but seems to have disappeared from the few pharamacists shelves that, it appeared, reluctantly stocked it. I say reluctantly as I and several others made an effort to check its availability for public purchase and were astounded that most pharmacists when asked for it either kept it "under the counter" or "had to chase it up and would take a couple of days to obtain it"...and in almost every case the purchaser was asked why they would wish to purchase it when there was some perfectly safe paracetamol without methionine for sale already! If "safe" paracetomol is available, and so many people are dying of paracetamol poisoning that could be saved through the widespread sale of "safe" paracetamol, why does the Government Health Department fail to ensure its widespread availability? Regards John H. Competing interests: None declared |
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Geoffrey Brandon, Director of Paracetamol Information Centre Paracetamol Information Centre, Norfolk IP20 9PJ UK
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Editor We must take issue with the BMJ News Extra report by Janice Tanne, “Paracetamol causes most liver failure in UK and US”(1). Dr Tanne cites a US study(2) to help support her statement that “unintentional overdosage with the painkiller paracetamol is the most common cause of acute liver failure in the United Kingdom”. We can find no part of this paper that states this point concerning unintentional overdosage, and in fact it is not the case; UK studies including those by Professor Hawton’s group at Oxford(3) show that the vast majority of paracetamol overdoses are intentional, and indeed the US authors Dr Tanne quotes have previously acknowledged that unintentional overdoses in “the United Kingdom and Europe” are rare(4). This point is important in that it affects both treatment protocols and any measures that might be considered for prevention of self harm. Indeed, it is the answer to the question posed by John Heptonstall in the BMJ(5) as to why paracetamol combined with methionine is not widely available. Paracetamol combined with methionine is inappropriate for the more than 99.99% of users of paracetamol products who have no intention of overdosing and is likely to be avoided by those who are intent on taking an overdose. Yours sincerely Dr Geoffrey Brandon,
Refs: 1. J Tanne; BMJ 2006;332:628 (18 March)
Competing interests: The Paracetamol Information Centre is funded by the pharmaceutical industry |
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John P Heptonstall, Director of the Morley Acupuncture Clinic Leeds LS27 8EG
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Sir Does Geoffrey Brandon miss the point, if only 'safe' paracetamol was available OTC and on prescription both intentional and unintentional deaths from paracetamol poisoning would cease; is that not an honourable aim? I take issue with Geoffrey Brandon's statement that "Paracetamol combined with methionine is inappropriate for the more than 99.99% of users of paracetamol products who have no intention of overdosing" as I suspect a good percentage of 99.9% prefer a 'safe' version, therefore it would be quite appropriate for them. Are any deaths from OTC and prescription paracetamol poisoning acceptable when a 'safe' alternative exists? Regards John H. Competing interests: None declared |
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