When does paracetamol overuse spike?

paracetamol challenge: blister pack with one tablet separate

Americans are more likely to take too much paracetamol during cold and flu season, new research has found

Researchers from Massachusetts and New Jersey set out to estimate the prevalence of excess intake of paracetamol (acetaminophen) and investigate the seasonal variations involved.

They sampled 14,481 US adults who had used acetaminophen in the preceding 30 days from national online panels.

Detailed online daily diaries of acetaminophen medication use were completed for seven days, though the respondents were not told that the study actually concerned acetaminophen.

The researchers identified cold/flu season (CFS) using Google Trends data, and contrasted symptoms, use of acetaminophen, and consumption exceeding 4g – the recommended daily maximum – during cold/flu season with off-season.

They found a correlation with cold/flu season and overuse of acetaminophen, linked to higher use of OTC medicines containing the drug.

“Overall, 6.3% [95% CI: 6.0%‐6.6%] of users exceeded 4 grams on at least one day; 3.7% [3.5%‐3.9%] of usage days exceeded 4 grams,” the researchers write.

“Cold/flu symptoms were more likely to be experienced and treated with acetaminophen in CFS than off‐season.

“Acetaminophen users were more likely to exceed 4 grams during CFS (6.5% vs 5.3%; OR= 1.24, 1.04‐1.48); days exceeding 4 grams also increased (3.9% vs 2.8%; OR= 1.37, 1.11‐1.69).

“This was not due to differences in characteristics of individuals using acetaminophen in CFS, but primarily to increased use of over‐the‐counter (OTC) combination medications designed to treat upper respiratory cold/flu symptoms (33.2% of usage days in CFS vs 24.8% in off‐season; OR=1.6, 1.5‐1.7).

“When such medications were omitted, there was no statistically significant seasonal variation in exceeding 4 grams.”

The authors suggest that pharmacists should warn acetaminophen users to follow labelled dosing directions, particularly during the cold and flu season.

The study was published in the British Journal of Clinical Pharmacology.

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