Ott P, Dalhoff K, Hansen P B, Loft S, Poulsen H E
Department of Medicine A, Rigshospitalet, Copenhagen, Denmark.
J Intern Med. 1990 Jun;227(6):423-8. doi: 10.1111/j.1365-2796.1990.tb00181.x.
During the period 1978-1986, annual sales of paracetamol in Denmark increased from 1 million defined daily doses (DDD) (3 g) to 47 million DDD, while the number of admissions and deaths from overdose increased from 26 to 202 and from 1 to 3-4, respectively. The corresponding figures for salicylates are a decrease in sales from 113 to 94 million DDD, an increase in admissions from 282 to 595, and an increase in deaths from 5 to 22. From 1 January 1984 paracetamol became available on an over-the-counter basis. The figures for 1983 and 1984 were an increase in sales from 14 to 28 million DDD, an increase in admissions from 114 to 198, and an increase in deaths from 0 to 4. The number of deaths from opioid overdose remained constant at a value of about fifty during this period, the mortality per dose being about 20-fold higher than for paracetamol and salicylates. Dextropropoxyphene-related deaths increased twofold to 121 in 1986, with unchanged sales figures. A campaign launched by the National Board of Health resulted in a reduction in the number of deaths from dextropropoxyphene to 66 in 1987. The main effect of over-the-counter release of paracetamol was a dramatic increase in sales, without the epidemic of deaths observed a decade ago in the UK. It is suggested that the higher mortality of paracetamol poisonings in the UK compared to Denmark is related to the dextropropoxyphene content of the combination product, which is not available in Denmark. From an epidemiological toxicological viewpoint such combinations are not justified.
在1978年至1986年期间，丹麦对乙酰氨基酚的年销售量从100万限定日剂量（DDD）（3克）增至4700万DDD，而过量用药导致的住院人数和死亡人数分别从26例增至202例以及从1例增至3至4例。水杨酸盐类药物的相应数据为：销售量从1.13亿DDD降至9400万DDD，住院人数从282例增至595例，死亡人数从5例增至22例。自1984年1月1日起，对乙酰氨基酚开始非处方销售。1983年和1984年的数据显示：销售量从1400万DDD增至2800万DDD，住院人数从114例增至198例，死亡人数从0例增至4例。在此期间，阿片类药物过量致死人数保持在约50例的恒定水平，每剂量的死亡率比对乙酰氨基酚和水杨酸盐类药物高出约20倍。右丙氧芬相关的死亡人数在1986年增至两倍，达到121例，而销售量未变。国家卫生局发起的一项运动使右丙氧芬导致的死亡人数在1987年降至66例。对乙酰氨基酚非处方销售的主要影响是销售量急剧增加，并未出现英国十年前观察到的死亡流行情况。有人认为，与丹麦相比，英国对乙酰氨基酚中毒的死亡率较高与复方制剂中的右丙氧芬含量有关，丹麦没有这种复方制剂。从流行病学毒理学观点来看，这种复方制剂是不合理的。
