Abstract
<h3>To the Editor.</h3> —There were 102 619 cases of ingestion of acetaminophen-containing products, including 100 deaths, reported in the United States in 1994.<sup>1</sup>Management of acute acetaminophen overdose is guided by the Rumack-Matthew nomogram, which assumes acetaminophen absorption in acute overdose is complete by 4 hours after ingestion.<sup>2</sup>In August 1994, McNeil Pharmaceuticals (Fort Washington, Pa) introduced Tylenol Extended Relief, the first extended-release formulation of acetaminophen available in the United States. Patients presenting after overdose with extended release (ER) acetaminophen (Tylenol ER) which contains 325 mg of immediate-release acetaminophen and 325 mg of extended-release acetaminophen per tablet, pose a dilemma because the kinetics of acetaminophen ER in overdose are unknown, and it is not known whether physicians can rely on the nomogram to facilitate treatment. Douglas et al<sup>3</sup>found no difference in time to peak concentration between acetaminophen ER and immediate-release acetaminophen in volunteers who ingested 75
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