Misuse of over-the-counter pain medication is potential health threat

May 30, 2012

A significant number of adults are at risk of unintentionally overdosing on over-the-counter (OTC) pain medication, according to a new study in the US by Dr. Michael Wolf, from Northwestern University in Chicago, and his colleagues. Their work, looking at the prevalence and potential misuse of pain medication containing the active ingredient acetaminophen as well as the likelihood of overdosing, appears online in the Journal of General Internal Medicine.

Many adults in the US regularly use OTC containing the acetaminophen, the most commonly used OTC pain medication in the US. They take it either on its own or in combination with other drugs, which may also contain acetaminophen. The ease of access to OTC drugs presents a challenge to as many individuals may lack the necessary skills to self-administer these medicines appropriately. Indeed, individuals make independent decisions that match an OTC product to a self-diagnosed symptom or condition. Worryingly, acetaminophen overdose is the leading cause of .

Wolf and colleagues interviewed 500 receiving care at outpatient general medicine clinics in Atlanta and Chicago between September 2009 and March 2011. Over half the patients reported some acetaminophen use and 19 percent were 'heavy users' i.e. they had taken it every day, or at least a couple of times a week, during the previous six months.

The researchers tested whether these patients understood the recommended dosage and were able to self-administer OTC acetaminophen appropriately. Firstly, could they work out the proper dosing of a single OTC medication over a 24-hour period? Secondly, what was the risk of patients 'double-dipping', or simultaneously taking two acetaminophen-containing products, and thereby exceeding the recommended dose?

To assess proper dosing, the participants were given five OTC drug bottles and, for each one, were asked to imagine that they took the first dose at time X, and wanted to take the maximum dose of this medicine in one day. They were then asked to show the researcher how many pills and at which times they would need to take them for a full 24-hour day.

To assess 'double-dipping', the patients were told to imagine they were taking a maximum dose of a primary OTC drug and asked whether it would be safe to also take a second medicine with the primary medicine - both of which contained acetaminophen.

Wolf and team found that nearly a quarter of the participants were at risk of overdosing on pain medication using a single OTC acetaminophen product, by exceeding the dose of four grams in a 24-hour period; 5 percent made serious errors by dosing out more than six grams. In addition, nearly half were at risk of overdosing by 'double-dipping' with two containing products.

The authors conclude: "Our findings suggest that many consumers do not recognize or differentiate the active ingredient in OTC pain medicines, nor do they necessarily closely adhere to package or label instructions. Given the prevalence of the problem, risk of significant adverse effects, and lack of a learned intermediary i.e. a physician to guide decision making and counsel consumers on proper use, we believe this to be a serious public health threat requiring urgent attention."

Explore further: Public confused about ingredients in pain relievers

More information: Wolf MS et al (2012). Risk of unintentional overdose with non-prescription acetaminophen products. Journal of General Internal Medicine; DOI: 10.1007/s11606-012-2096-3

Related Stories

Public confused about ingredients in pain relievers

May 3, 2011
People take billions of doses of over-the-counter pain relievers like Tylenol every year, but many do not pay attention to the active ingredients they contain, such as acetaminophen, according to a new Northwestern Medicine ...

Johnson & Johnson cuts maximum Tylenol dose to prevent overdoses

July 28, 2011
(AP) -- Johnson & Johnson said Thursday that it's reducing the maximum daily dose of its Extra Strength Tylenol pain reliever to lower risk of accidental overdose from acetaminophen, its active ingredient and the top cause ...

Red flags on pain reliever safety

July 19, 2011
For many people, pain relievers are wonder drugs, allowing them to carry on with their lives despite disabling arthritis, for instance, or recurrent headaches. But all pain relievers, whether sold over-the counter (OTC) or ...

Patients may receive too much acetaminophen in hospital

May 23, 2012
(HealthDay) -- Roughly 2.5 percent of admitted hospital patients may receive more than the safe daily cumulative dose of the pain-reliever acetaminophen, best known as Tylenol, on at least one day, according to a new U.S. ...

Better labeling could help thwart acetaminophen overdose

May 3, 2011
While well known for relieving everyday aches and pains, few realize that when misused, acetaminophen can lead to acute liver failure and even death, often due to accidental overdose by an uninformed consumer. A new small ...

Recommended for you

Sensor-equipped pill raises technological, ethical questions

November 17, 2017
The first drug with a sensor embedded in a pill that alerts doctors when patients have taken their medications was approved by the Food and Drug Administration, raiding issues involving privacy, cost, and whether patients ...

New painkillers reduce overdose risk

November 16, 2017
Scientists on the Florida campus of The Scripps Research Institute (TSRI) have developed new opioid pain relievers that reduce pain on par with morphine but do not slow or stop breathing—the cause of opiate overdose.

Separating side effects could hold key for safer opioids

November 16, 2017
Opioid pain relievers can be extremely effective in relieving pain, but can carry a high risk of addiction and ultimately overdose when breathing is suppressed and stops. Scientists have discovered a way to separate these ...

US regulators approve first digital pill to track patients

November 14, 2017
U.S. regulators have approved the first drug with a sensor that alerts doctors when the medication has been taken, offering a new way of monitoring patients but also raising privacy concerns.

Introduction is different, but top medications for opioid addiction equally effective

November 14, 2017
With opioid addiction officially declared a public health emergency in the U.S., medical intervention to treat the illness is increasingly important in responding to the epidemic. Now, a new study concludes that two of the ...

Drugstore pain pills as effective as opioids in ER patients

November 7, 2017
Emergency rooms are where many patients are first introduced to powerful opioid painkillers, but what if doctors offered over-the-counter pills instead? A new study tested that approach on patients with broken bones and sprains ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.