Abstract
BackgroundHospitals in sub-Saharan Africa (SSA) continue to receive high numbers of severely ill (HIV-infected) patients with physical pain that may suffer from hepatic and renal dysfunction. Paracetamol is widely used for pain relief in this setting but it is unknown whether therapeutic drug concentrations are attained. The aim of this study was to assess the occurrence of therapeutic, sub-therapeutic and toxic paracetamol concentrations in SSA adult hospital population.MethodsIn a cross-sectional study, plasma paracetamol concentrations were measured in patients with an oral prescription in a referral hospital in Mozambique. From August to November 2015, a maximum of four blood samples were drawn on different time points for paracetamol concentration measurement and biochemical analysis. Study endpoints were the percentage of participants with therapeutic (≥ 10 and ≤ 20 mg/L), sub-therapeutic (< 10 mg/L) and toxic (> 75 mg/L) concentrations.ResultsSeventy-six patients with a median age of 37 years, a body mass index of 18.2, a haemoglobin concentration of 10.3 g/dL and an albumin of 29 g/L yielded 225 samples. 13.4% of participants had one or more therapeutic paracetamol concentrations. 86.6% had a sub-therapeutic concentration at all time points and 70.2% had two or more concentrations below the lower limit of quantification. No potentially toxic concentrations were found.ConclusionsRoutine oral dosing practices in a SSA hospital resulted in substantial underexposure to paracetamol. Palliation is likely to be sub-standard and oral palliative drug pharmacokinetics and dispensing procedures in this setting need further investigation.
Highlights
Health care institutions in sub-Sahara Africa (SSA) continue to receive large numbers of severely ill HIV-infected patients with opportunistic infections and cancer, conditions known to be important causes of physical pain irrespective of treatment with antiretroviral drugs or chemotherapy [1, 2]
In the so-called WHO Pain Ladder, an analgesic treatment tool for physicians, the use of paracetamol is recommended as a first step [3, 4]
Study population Participants for the current study were selected from the 143 population pharmacokinetic (PPK) study participants enrolled during the last 4 months of the inclusion period
Summary
Health care institutions in sub-Sahara Africa (SSA) continue to receive large numbers of severely ill HIV-infected patients with opportunistic infections and cancer, conditions known to be important causes of physical pain irrespective of treatment with antiretroviral drugs or chemotherapy [1, 2]. Since kidney and liver disease are common in the general population as a result of the high prevalence of hypertension and hepatitis B, and over-thecounter drug and prescription medicine misuse is high, such information could shed light on the occurrence of potentially toxic drug concentrations [5,6,7,8]. Hospitals in sub-Saharan Africa (SSA) continue to receive high numbers of severely ill (HIV-infected) patients with physical pain that may suffer from hepatic and renal dysfunction. Paracetamol is widely used for pain relief in this setting but it is unknown whether therapeutic drug concentrations are attained. The aim of this study was to assess the occurrence of therapeutic, sub-therapeutic and toxic paracetamol concentrations in SSA adult hospital population
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