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Risk of Unintentional Overdose with Non-Prescription Acetaminophen Products

Journal of General Internal Medicine volume 27, pages 1587–1593 (2012)Cite this article

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.

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Acknowledgements

This project was supported by an unrestricted grant from McNeil Consumer Healthcare (PI: Wolf). The funding for this study was under an Investigator-Initiated Research (IIR) mechanism through McNeil Consumer Healthcare, and the funder had no role in the study design, data collection, analysis, or interpretation of findings

Conflict of Interest

Drs. Wolf and Davis have previously provided research consultation services (health literacy, study design for comprehension testing for OTC product use) for McNeil Consumer Healthcare. Dr. Wolf and Stacy Bailey are Consultants to Abbott Labs. All other authors declare they do not have a conflict of interest.

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Authors and Affiliations

  1. Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA

    Michael S. Wolf PhD MPH, Jennifer King MPH, Stacy Cooper Bailey MPH, Rebecca Mullen BA, Danielle McCarthy MD & Marina Serper MD

  2. Department of Learning Sciences, School of Education and Social Policy, Northwestern University, Evanston, IL, USA

    Michael S. Wolf PhD MPH

  3. Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA

    Kara Jacobson MPH, Lorenzo Di Francesco MD & Ruth M. Parker MD

  4. Department of Medicine-Pediatrics, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA

    Terry C. Davis PhD

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  1. Michael S. Wolf PhD MPH
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  2. Jennifer King MPH
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  4. Lorenzo Di Francesco MD
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  5. Stacy Cooper Bailey MPH
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  6. Rebecca Mullen BA
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Correspondence to Michael S. Wolf PhD MPH.

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Wolf, M.S., King, J., Jacobson, K. et al. Risk of Unintentional Overdose with Non-Prescription Acetaminophen Products. J GEN INTERN MED 27, 1587–1593 (2012). https://doi.org/10.1007/s11606-012-2096-3

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  • DOI: https://doi.org/10.1007/s11606-012-2096-3

KEY WORDS

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