Document Detail


The therapeutic applications of and risks associated with acetaminophen use: a review and update.
MedLine Citation:
PMID:  21193765     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In response to the April 2010 U.S. Food and Drug Administration's (FDA's) revision of warning labeling for over-the-counter (OTC) acetaminophen, or N-acetyl-p-aminophenol (APAP), products, the authors reviewed APAP's potential for liver toxicity.
TYPES OF STUDIES REVIEWED: The authors reviewed the literature in which investigators examined data related to the epidemiology of APAP-related liver toxicity, studies in which the investigators evaluated the risk factors for its occurrence and case reports. They included articles that were used by the FDA as the basis for establishing the new labeling requirements.
RESULTS: Findings from the literature in which investigators have examined the relationship between APAP and liver toxicity indicate several key risk factors. Foremost are the extensive use of one or more APAP-containing compounds (particularly combinations with opioid agents) and the small margin of safety between the therapeutic and toxic doses. Both of these factors lead to unintentional or intentional drug overdose. Concurrent use of alcohol may contribute to hepatotoxicity, but it may be related to behavior rather than biochemical mechanisms involved in liver damage.
CONCLUSIONS: The widespread use of APAP has contributed to a substantial increase in the number of cases of acute liver toxicity in the United States. Since APAP is a component of many prescription and OTC medications, unintentional overdose can occur.
CLINICAL IMPLICATIONS: APAP has numerous applications in dentistry, but if it is used conjointly for other conditions, the risk of the patient's experiencing an overdose increases. In the context of recent FDA concerns about the increased incidence of APAP-related liver toxicity, the authors provide recommendations for safe prescribing practices for APAP. Practitioners should caution patients to follow recommended dosage instructions and avoid taking multiple APAP-containing products.
Authors:
James Guggenheimer; Paul A Moore
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of the American Dental Association (1939)     Volume:  142     ISSN:  1943-4723     ISO Abbreviation:  J Am Dent Assoc     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-03     Completed Date:  2011-06-02     Revised Date:  2011-07-21    
Medline Journal Info:
Nlm Unique ID:  7503060     Medline TA:  J Am Dent Assoc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  38-44     Citation Subset:  D; IM    
Affiliation:
Department of Diagnostic Services, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA. guggen@dental.pitt.edu
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MeSH Terms
Descriptor/Qualifier:
Acetaminophen / therapeutic use*,  toxicity
Alcohol Drinking / adverse effects
Analgesics, Non-Narcotic / therapeutic use*,  toxicity
Drug Combinations
Humans
Liver / drug effects*
Overdose / etiology
Risk Factors
Safety
Chemical
Reg. No./Substance:
0/Analgesics, Non-Narcotic; 0/Drug Combinations; 103-90-2/Acetaminophen
Comments/Corrections
Comment In:
J Am Dent Assoc. 2011 Jun;142(6):596   [PMID:  21628680 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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