Hepatotoxicity risk factors and acetaminophen dose adjustment, do prescribers give this issue adequate consideration? A French university hospital study View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2019-04-10

AUTHORS

Astrid Bacle, Charlotte Pronier, Helene Gilardi, Elisabeth Polard, Sophie Potin, Lucie-Marie Scailteux

ABSTRACT

BackgroundThe hepatotoxicity of acetaminophen is recognised worldwide. Unfavourable prognoses relating to overdose include liver transplantation and/or death. Several hepatotoxicity risk factors (HRFs) should motivate the adjustment of acetaminophen daily intake (to < 4 g/day): advanced age, weight < 50 kg, malnutrition, chronic alcoholism, chronic hepatitis B and C and HIV infection, severe chronic renal failure and hepatocellular insufficiency.MethodOver a 7-day period in Rennes University Hospital in December 2017, using DxCare® software, with an odds ratio estimation, we analysed all acetaminophen prescriptions, to assess to what extent the presence of HRFs altered the prescribers’ choice of acetaminophen dose (< 4 g/day versus 4 g/day).ResultsAmong 1842 patients, considering only the first acetaminophen prescription, 73.7% were on 4 g/day. Almost half this population had at least 1 HRF. Whereas around 80% of the prescriptions in the < 4 g/day group were for patients with at least 1 HFR, only 53% of the prescriptions in the 4 g/day group concerned patients without HFRs (p < 0.001). Age > 75 and low weight were associated with the prescriber’s choice of dose. Neither chronic alcoholism nor hepatocellular insufficiency influenced the acetaminophen doses prescribed.ConclusionConsidering the widespread use of acetaminophen and its favourable safety profile compared with other analgesic drugs, it appears urgent to remind prescribers of the maximum daily dose recommendations for acetaminophen for patients with HRFs, especially those with chronic alcoholism and hepatocellular insufficiency. More... »

PAGES

1143-1151

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00228-019-02674-5

DOI

http://dx.doi.org/10.1007/s00228-019-02674-5

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1113356158

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30972451


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