Original Research

Journal of General Internal Medicine

, Volume 27, Issue 12, pp 1587-1593

Risk of Unintentional Overdose with Non-Prescription Acetaminophen Products

  • Michael S. WolfAffiliated withHealth Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern UniversityDepartment of Learning Sciences, School of Education and Social Policy, Northwestern University Email author 
  • , Jennifer KingAffiliated withHealth Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University
  • , Kara JacobsonAffiliated withDivision of General Medicine, Emory University School of Medicine
  • , Lorenzo Di FrancescoAffiliated withDivision of General Medicine, Emory University School of Medicine
  • , Stacy Cooper BaileyAffiliated withHealth Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University
  • , Rebecca MullenAffiliated withHealth Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University
  • , Danielle McCarthyAffiliated withHealth Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University
  • , Marina SerperAffiliated withHealth Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University
  • , Terry C. DavisAffiliated withDepartment of Medicine-Pediatrics, Louisiana State University Health Sciences Center at Shreveport
    • , Ruth M. ParkerAffiliated withDivision of General Medicine, Emory University School of Medicine

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Abstract

Background

There is increasing concern over the risk of consumer unintentional misuse of non-prescription (a.k.a. ‘over-the-counter’) medications containing acetaminophen, which could lead to acute liver failure.

Objective

To determine the prevalence of potential misuse and overdose of over-the-counter medications containing acetaminophen, either alone or in combination.

Design

Cross-sectional, structured interviews with literacy assessment.

Setting

One academic and one community-based general internal medicine practice in Chicago, IL, and one academic general internal medicine practice and a public hospital clinic in Atlanta, GA.

Patients

Five hundred adults seeking primary care, ages 18–80.

Measurement

Demonstration of how and when patients would take over-the-counter medications containing acetaminophen, alone or in combination with one another, over a 24-hour period.

Results

Overall, 23.8 % of participants demonstrated they would overdose on a single over-the-counter acetaminophen product by exceeding a dose of four grams in a 24-hour period; 5.2 % made serious errors by dosing out more than six grams. In addition, 45.6 % of adults demonstrated they would overdose by ‘double-dipping’ with two acetaminophen-containing products. In multivariable analyses, limited literacy (Relative Risk Ratio (RR) 1.65, 95 % Confidence Interval (CI) 1.03–2.66) and heavy acetaminophen use in the past six months (RR 1.70, 95 % CI 1.10–2.64) were independently associated with overdosing over-the-counter products.

Conclusion

Misunderstanding of the active ingredient and proper instructions for over-the-counter medications containing acetaminophen is common. The potential for errors and adverse events associated with unintentional misuse of these products is substantial, particularly among heavy users of acetaminophen and those with limited literacy.

KEY WORDS

over-the-counter drugs medication health literacy understanding knowledge medication errors acetaminophen pain