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When Acetaminophen goes supratherapeutic...



Background: We investigated acetaminophen use and identify factors contributing to supratherapeutic dosing of acetaminophen in hospitalized patients.

Methods: We retrospectively reviewed the electronic health records of adult patients who were admitted to 2 academic tertiary care hospitals (hospital A and hospital B) from June 1, 2010, to August 31, 2010, and who received acetaminophen during their hospitalization. Patients’ acetaminophen administration records (includ- ing drug name, dose, administration time, hospital units, etc), demographic data, diagnoses, and results from liver function tests were obtained. The main outcome measures included acetaminophen exposure rate and supra- therapeutic dosing rate among hospitalized patients, hazard ratios (HRs) and 95% confidence intervals (CIs) for risk factors for supratherapeutic dosing, and changes in liver function test before and after supratherapeutic dosing.

Results: A total of 14 411 patients
 (60.7%) were ex- posed to acetaminophen, of whom 955 (6.6%) ex- ceeded the 4 g per day maximum recommended dose. In addition, 22.3% of patients who were 65 years or older and 17.6% of patients with chronic liver diseases exceeded the recommended limit of 3 g per day. 

 Patients receiving excessive doses of acetaminophen tended to have significant alkaline phosphatase elevations, although causal relationship cannot be concluded. 

 A significantly higher risk of supratherapeutic dosing was observed in hospital A (HR, 1.6 [95% CI, 1.4-1.8]), white patients (HR, 1.5 [95% CI, 1.3-1.7]), patients diagnosed as having osteoarthritis (HR, 1.4 [95% CI, 1.3-1.6]), and those who received scheduled administrations (HR, 16.6 [95% CI, 13.5-20.6]), multiple product formulations (HR, 2.4 [95% CI 2.0-2.9]), or the 500-mg strength formulation (HR, 1.9 [95% CI, 1.5-2.3]). 

 A lower risk was found for pro re nata (as needed) administrations (HR, 0.7 [95% CI, 0.6-0.9]) and in nonsurgical and non–intensive care units (HR, 0.6 [95% CI, 0.5-0.7]).

 Conclusions: Supratherapeutic dosing of acetamino- phen was significantly associated with multiple factors. Interventions to reduce the incidence of some risk fac- tors may prevent supratherapeutic acetaminophen dosing in hospitalized patients.

Arch Intern Med. 2012;172(22):1721-1728. Published online November 12, 2012. doi:10.1001/2013.jamainternmed.438 

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