The pharmacists’ role in preventing acetaminophen overdoses

Consumers are more aware about acetaminophen overdosing, but there is still much more that pharmacists and other healthcare professionals can do to educate them, according to Leiana Oswald, PharmD, assistant professor in the College of Pharmacy at Roseman University of Health Sciences in Henderson, Nevada.

Oswald recently conducted a Wolters Kluwer Clinical Drug Information webinar on the topic.

“Education is one of the first lines of defense in preventing overdoses. Consumer misperception can lead to abuse,” Oswald said. Consumers could simply believe acetaminophen-containing products are safe because they are sold over-the-counter (OTC). Or, patients may use multiple acetaminophen products at a time or take the next dose too soon.

Pharmacists and other healthcare professionals need to watch for patients who have liver disease or are chronic alcoholics. “We should consider reducing the dose of acetaminophen in liver-compromised patients or alcoholic patients. It is very difficult for the body to get rid of the…toxic chemical,” Oswald said.

While there is currently no FDA-recommended dosing adjustments for alcoholics or liver-compromised patients, education would help prevent some of the 56,000 emergency room visits and 26,000 hospitalizations annually from acetaminophen overdoses. “More than 14,000 of those cases were unintentional. We want to see those numbers drop to zero,” Oswald said.

To that end, the Acetaminophen Awareness Coalition, a group of healthcare providers and consumers created in 2009 in response to an FDA advisory committee recommendation, continues to educate patients and consumers about acetaminophen safety through the “Know Your Dose” campaign.  

“They have been distributing educational messages at physicians’ offices, retail pharmacy counters, and at the point of healthcare decisions, including relevant ads on healthcare websites and Internet platforms,” Oswald said. Pharmacists can download the charts, brochures, and other information for patients at www.KnowYourDose.org. For example, Walmart distributes educational materials in its OTC pharmacy departments.

In 2015, FDA is scheduled to issue a proposed rule on adult acetaminophen dosing, product labeling, and/or product packaging, but Oswald cautions healthcare providers not to wait to educate patients on the correct dosing of acetaminophen-containing products. “It’s only a proposed rule; it won’t change immediate access to acetaminophen. The time between proposed rule and a final rule can take months to years.”

Meanwhile, more retail pharmacies can help curb unintentional overdoses by spelling out “acetaminophen” on prescription labels, instead of abbreviating it, such as APAP. “Seventy-five percent of retail chains spell out the word; we would like to see 100%.” Oswald said.

This article was updated December 29 to clarify the timing of the proposed rule on acetaminophen, the labels referred to in the last paragraph are prescription labels, and Dr. Oswald's quote in the fifth paragraph.