Unexpected paracetamol (acetaminophen) hepatotoxicity at standard dosage in two older patients: time to rethink 1 g four times daily?
We present two cases of acute hepatotoxicity associated with elevated paracetamol (acetaminophen) levels in older patients. Both patients were receiving a standard European dose of oral paracetamol (2 × 500 mg QDS) with no risk factors for slowed metabolism (weight <50 kg, interacting medications, hepatic enzyme inducers, history of liver disease). Significantly, both patients had recently had a dose escalation from 'as needed' dosing to 4 g daily, and the medication was being administered by nursing staff. Our experience shows that even when prescribed appropriately at the usual therapeutic dosage, paracetamol can be hepatotoxic.
Department of Pharmacy, Mater Misericordiae University Hospital, Dublin, Ireland.
Patricia
P
Ging
Department of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
Olga
O
Mikulich
Department of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, Ireland School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland School of Medicine, University of Southampton, Southampton, UK.
Katherine M A
KM
O'Reilly
D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects*; D000284:Administration, Oral; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004334:Drug Administration Schedule; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D012307:Risk Factors; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen
older people; paracetamol, hepatotoxicity, metabolism, glutathione