Abstract
Acetaminophen is one of the most commonly consumed analgesics world wide. Generally perceived as a safe medication, it is the most common cause of acute liver failure in the United States with inadvertent hepatotoxicity in half of all cases. We therefore conducted a survey on the public perceptions of acetaminophen in patients attending the outpatient clinic in Vancouver, Canada. Among 928 patients who were asked, 765 completed the survey questionnaire. The majority of respondents were female (59%), Caucasian (61%), and educated beyond the secondary school level (81%). 23% reported using acetaminophen at least once a week. A significant minority were unaware of the potential liver toxicity of acetaminophen (24%), and knowledge of hepatotoxicity did not vary with education status. In terms of the medicinal composition of acetaminophen products, over half of the respondents (58%) did not know that extra strength preparations of acetaminophen contained the same drug but in a different dose. This knowledge was more prevalent among those with higher level of education (49% in graduate school educated respondents), but was still low overall. The knowledge that alcohol use with acetaminophen was more harmful was low (43%), but improved with level of education (P for trend 0.03). Among respondents who consumed alcohol regularly, 21% were consuming over 1.5 grams of acetaminophen at a time. These patients had similar harm perception to liver as patients who consumed lower doses of acetaminophen. Overall, in a large, well-educated cohort of patients, knowledge about the adverse effects of acetaminophen, the additional risks with alcohol and composition of various retailed products was suboptimal. We speculate that consumer ignorance is a significant reason why acetaminophen is a leading cause of acute liver failure.
Highlights
Acetaminophen (APAP) is an over-the-counter analgesic/antipyretic widely used across the world
APAP is available over the counter (OTC) in several dosage formulations including 325 mg, 500 mg and 650 mg tablets/capsules and it is an ingredient of other combination products including prescription analgesics as well as other OTC “cold” products such as cough syrups
Most patients were aware of liver toxicity of APAP, almost a quarter of those surveyed, were unaware
Summary
Acetaminophen (APAP) is an over-the-counter analgesic/antipyretic widely used across the world. APAP has grown increasingly popular in North America since the early 1980s is the most commonly used over-the-counter analgesic/antipyretic in the United States with over 28 billion doses distributed annually [1]. The most common and feared adverse event of APAP overdose is hepatotoxicity and acute liver failure. In the 1990s APAP toxicity was thought to account for roughly 20% of all acute liver failure diagnoses[5]. This has concerningly increased over the past two decades, with recent data from a US longitudinal registry cohort study of acute liver failure (ALF) (defined as liver failure with the presence of hepatic encephalopathy, coagulopathy and no previous liver disease) reporting that APAP hepatotoxicity is the single most common cause of ALF in the United States occurring in 46% of reported cases with over half the cases of APAP being inadvertent[6]. ALF from APAP continues to carry a significant risk of mortality with transplant free survival between 2006 to 2013 reported as 75.6% in the United States[6]
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