Clark Roderick, Fisher Judith E, Sketris Ingrid S, Johnston Grace M
Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada.
BMC Clin Pharmacol. 2012 Jun 18;12:11. doi: 10.1186/1472-6904-12-11.
Paracetamol (acetaminophen) is generally considered a safe medication, but is associated with hepatotoxicity at doses above doses of 4.0 g/day, and even below this daily dose in certain populations.
The Nova Scotia Prescription Monitoring Program (NSPMP) in the Canadian province of Nova Scotia is a legislated organization that collects dispensing information on all out-of-hospital prescription controlled drugs dispensed for all Nova Scotia residents. The NSPMP provided data to track all paracetamol/opioids redeemed by adults in Nova Scotia, from July 1, 2005 to June 30, 2010. Trends in the number of adults dispensed these prescriptions and the numbers of prescriptions and tablets dispensed over this period were determined. The numbers and proportions of adults who filled prescriptions exceeding 4.0 g/day and 3.25 g/day were determined for the one-year period July 1, 2009 to June 30, 2010. Data were stratified by sex and age (<65 versus 65+).
Both the number of prescriptions filled and the number of tablets dispensed increased over the study period, although the proportion of the adult population who filled at least one paracetamol/opioid prescription was lower in each successive one-year period. From July 2009 to June 2010, one in 12 adults (n = 59,197) filled prescriptions for over 13 million paracetamol/opioid tablets. Six percent (n = 3,786) filled prescriptions that exceeded 4.0 g/day and 18.6% (n = 11,008) exceeded 3.25 g/day of paracetamol at least once. These findings exclude non-prescription paracetamol and paracetamol-only prescribed medications.
A substantial number of individuals who redeem prescriptions for paracetamol/opioid combinations may be at risk of paracetamol-related hepatotoxicity. Healthcare professionals must be vigilant when prescribing and dispensing these medications in order to reduce the associated risks.
对乙酰氨基酚通常被认为是一种安全的药物，但在每日剂量超过4.0克时会导致肝毒性，在某些人群中，即使低于此每日剂量也会出现这种情况。
加拿大新斯科舍省的新斯科舍省处方监测项目（NSPMP）是一个法定组织，收集该省所有居民在院外配给的所有受管制处方药物的配给信息。NSPMP提供数据以追踪2005年7月1日至2010年6月30日期间新斯科舍省成年人赎回的所有对乙酰氨基酚/阿片类药物。确定了在此期间配发这些处方的成年人数量趋势以及配发的处方数量和药片数量。确定了在2009年7月1日至2010年6月30日这一年期间，开具超过4.0克/天和3.25克/天处方的成年人数量及比例。数据按性别和年龄（<65岁与65岁及以上）分层。
在研究期间，所配处方数量和配发药片数量均有所增加，尽管在每个连续的一年期间，开具至少一张对乙酰氨基酚/阿片类药物处方的成年人口比例有所下降。从2009年7月至2010年6月，每12名成年人中有1人（n = 59,197）开具了超过1300万片对乙酰氨基酚/阿片类药物的处方。6%（n = 3,786）的人开具的处方至少有一次超过4.0克/天，18.6%（n = 11,008）的人超过3.25克/天的对乙酰氨基酚剂量。这些发现不包括非处方对乙酰氨基酚和仅开具对乙酰氨基酚的药物。
大量赎回对乙酰氨基酚/阿片类药物组合处方的个体可能面临与对乙酰氨基酚相关的肝毒性风险。医疗保健专业人员在开具和配发这些药物时必须保持警惕，以降低相关风险。
