title: Serum acetaminophen concentrations after acute overdose are not altered by opioid co-ingestion.
abstract: Serum acetaminophen concentrations are of critical importance in determining the need for acetylcysteine therapy after acute acetaminophen overdose. Limited data suggest opioid co-ingestion might alter acetaminophen pharmacokinetics. The present study was designed to examine serum acetaminophen concentrations after acute overdose, and to compare between patients that co-ingested an opioid and those that did not. A prospective study of consecutive patients that presented to hospital within 16 hr of acute acetaminophen overdose. Equivalent 4-hr acetaminophen concentrations were calculated using the serum acetaminophen concentration at a fixed interval 3 to 16 hr after ingestion. Groups were compared using Mann Whitney tests. There were 990 patients; 295 (29.8%) had co-ingested an opioid, and 695 had not. The median (interquartile range) stated dose was 10 g (6-16 g) vs. 10 g (7-16 g) respectively (P = 0.94), interval between ingestion and acetaminophen determination was 4.5 hr (4.0-6.0 hr) vs. 4.5 hr (4.0-5.5 hr) respectively (P = 0.41), and serum acetaminophen concentration was 56 mg/l (24-105 mg/l) va. 60 mg/l (23-129 mg/l) respectively (P = 0.25). A positive relationship was noted between stated dose and equivalent 4-hr serum acetaminophen concentration, but did not differ between groups. The acetaminophen dose-concentration relationship was similar in patients that did and did not co-ingest an opioid. Therefore, early serum acetaminophen concentrations can be used to determine the extent of drug exposure, irrespective of whether an opioid has been co-ingested.
authors.affiliation: Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, Scotland, UK. s.waring@ed.ac.uk
authors.forename: W Stephen
authors.initials: WS
authors.lastname: Waring
authors.forename: Suzanne
authors.initials: S
authors.lastname: Benhalim
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000097:blood* / Q000506:poisoning*; D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D062787:Drug Overdose; D005260:Female; D006801:Humans; D008297:Male; D011041:Poisoning / Q000097:blood / Q000188:drug therapy; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000082:Acetaminophen; D000111:Acetylcysteine