Severity of overdose after restriction of paracetamol availability: retrospective study
Limiting the number of paracetamol tablets in a single packet has reduced the amount taken in single overdoses, but not the level of severe liver failure, according to a study in this week's BMJ.
Researchers in Belfast identified patients admitted to hospital with paracetamol poisoning during the months January to June in 1998 and 1999 - before and after the change to smaller packets in September 1998. For each case, they estimated the amount of paracetamol ingested, recorded the numbers of patients transferred to a specialist liver unit and deaths related to paracetamol overdose.
Although the amount of paracetamol ingested was significantly lower during the second study period (8 grams in 1999, compared to 10 grams in 1998), the authors found no reduction in the number of severe paracetamol overdoses. Two patients were transferred to a specialist liver unit in 1998 and three in 1999. In 1998 neither patient required liver transplantation and both made a full recovery. However, in 1999 only one patient recovered completely; one died and one received a liver transplant.
Restricting the availability of paracetamol has changed overdose behaviour, say the authors, but paracetamol overdose remains the most common cause of severe liver failure, they conclude.
Contact:
Professor G Dennis Johnston, Department of Therapeutics and Pharmacology, Queen's University of Belfast, Northern Ireland
Email: g.d.johnston@qub.ac.uk