Acetaminophen: old drug, new issues.
BACKGROUND
The purpose of this review was to discuss new issues related to safety, labeling, dosing, and a better understanding of the analgesic effect of acetaminophen.


METHODS
The MEDLINE, Embase, Cochrane, and PubMed databases were searched. Additionally, the bibliography of all relevant articles and textbooks were manually searched. Two reviewers independently selected the relevant articles.


RESULTS
Concerns about acetaminophen overdose and related liver failure have led the US Food and Drug Administration to mandate new labeling on acetaminophen packaging. In addition, large-scale epidemiologic studies increasingly report evidence for second-generation adverse effects of acetaminophen. Prenatal exposure to acetaminophen is associated with neurodevelopmental and behavioral disorders. Recent studies also suggest that acetaminophen is a hormone disrupter (ie, it interferes with sex and thyroid hormone function essential for normal brain development) and thus may not be considered a safe drug during pregnancy. Finally, emerging evidence suggests that although the predominant mechanism by which acetaminophen exerts its therapeutic effect is by inhibition of cyclooxygenase, multiple other mechanisms also contribute to its analgesic effect.


CONCLUSIONS
Available evidence suggests that indiscriminate usage of this drug is not warranted. and its administration to a pregnant patient should be considered with great caution.
Department of Endodontics, Case School of Dental Medicine, Cleveland, Ohio. Electronic address: Axa53@case.edu.
Anita
A
Aminoshariae
Department of Endodontics, University of North Carolina, Chapel Hill, North Carolina.
Asma
A
Khan
D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D004348:Drug Labeling; D005260:Female; D006801:Humans; D011247:Pregnancy; D014481:United States
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen
Acetaminophen; mechanism of action; paracetamol; review; side effects