David Baxter PhD
Late Founder
Doctors urge much stronger warnings for over-the-counter acetaminophen products
By Sharon Kirkey, Ottawa Citizen
August 23, 2011
Drugs containing acetaminophen can be so lethally toxic to the liver in high doses that stronger warnings are needed to warn consumers of the risks, Canada's leading doctors' group says.
The Canadian Medical Association is calling for front-of-package warnings, in large, bold prominent print, on over-the-counter products containing acetaminophen, one of the most widely used pain and fever relievers.
Acetaminophen poisoning is one of the most common forms of acute liver failure in North America.
"In Canada, acetaminophen can be purchased in huge quantities over the counter," B.C. physician Dr. William Cunningham told delegates to the doctors' annual general council meeting in St. John's. A recent Calgary study of 1,500 patients found that the worst risk factor for liver toxicity was unintentional overdoses of acetaminophen.
Health Canada recently strengthened warnings on products containing the drug. But Cunningham said those warnings are in such tiny print that they're illegible to most people. "I believe that this constitutes a health hazard to the general population," he said.
Cunningham's hospital in Duncan, B.C., recently saw a rash of teens who had overdosed and become comatose on dextromethorphan, one of the active ingredients in cough and cold medicines. The products also contain acetaminophen.
"In doing our toxicology work-up we found that they had incredibly high acetaminophen levels to the degree there was permanent liver damage. And this is a very scary thing," Cunningham told Postmedia News. "These children were going to the stores and either buying or shoplifting these products. They didn't know they were inadvertently using this other poison, which was causing the harm," he said. "This is not isolated. This is in every province in Canada in nearly every jurisdiction. Every single emergency physician has seen this, and seen it regularly," said Cunningham, who would like to see the products moved behind pharmacy counters.
Acetaminophen-containing products are safe and effective when used as directed. But high doses can be seriously toxic to the liver, causing acute liver failure requiring a liver transplant, or even death, said Dr. Atul Kupur, an emergency physician at The Ottawa Hospital. The danger occurs when people combine products, Kupur said they take a decongestant for a cough or cold, then another product for a headache, essentially double-dosing on acetaminophen.
One addiction medicine doctor from Edmonton said he often sees patients who are taking excess amounts of over-the-counters, "often in hundreds of tablets a day," and often unaware of the risks.
After Britain enacted legislation limiting the amount of pills in a package to 24-tablets and blister-packed with strong labelling, there was a 60 per cent drop in liver failure cases, Cunningham said.
By Sharon Kirkey, Ottawa Citizen
August 23, 2011
Drugs containing acetaminophen can be so lethally toxic to the liver in high doses that stronger warnings are needed to warn consumers of the risks, Canada's leading doctors' group says.
The Canadian Medical Association is calling for front-of-package warnings, in large, bold prominent print, on over-the-counter products containing acetaminophen, one of the most widely used pain and fever relievers.
Acetaminophen poisoning is one of the most common forms of acute liver failure in North America.
"In Canada, acetaminophen can be purchased in huge quantities over the counter," B.C. physician Dr. William Cunningham told delegates to the doctors' annual general council meeting in St. John's. A recent Calgary study of 1,500 patients found that the worst risk factor for liver toxicity was unintentional overdoses of acetaminophen.
Health Canada recently strengthened warnings on products containing the drug. But Cunningham said those warnings are in such tiny print that they're illegible to most people. "I believe that this constitutes a health hazard to the general population," he said.
Cunningham's hospital in Duncan, B.C., recently saw a rash of teens who had overdosed and become comatose on dextromethorphan, one of the active ingredients in cough and cold medicines. The products also contain acetaminophen.
"In doing our toxicology work-up we found that they had incredibly high acetaminophen levels to the degree there was permanent liver damage. And this is a very scary thing," Cunningham told Postmedia News. "These children were going to the stores and either buying or shoplifting these products. They didn't know they were inadvertently using this other poison, which was causing the harm," he said. "This is not isolated. This is in every province in Canada in nearly every jurisdiction. Every single emergency physician has seen this, and seen it regularly," said Cunningham, who would like to see the products moved behind pharmacy counters.
Acetaminophen-containing products are safe and effective when used as directed. But high doses can be seriously toxic to the liver, causing acute liver failure requiring a liver transplant, or even death, said Dr. Atul Kupur, an emergency physician at The Ottawa Hospital. The danger occurs when people combine products, Kupur said they take a decongestant for a cough or cold, then another product for a headache, essentially double-dosing on acetaminophen.
One addiction medicine doctor from Edmonton said he often sees patients who are taking excess amounts of over-the-counters, "often in hundreds of tablets a day," and often unaware of the risks.
After Britain enacted legislation limiting the amount of pills in a package to 24-tablets and blister-packed with strong labelling, there was a 60 per cent drop in liver failure cases, Cunningham said.
