Overdose with modified‐release paracetamol (Panadol Osteo®) presenting to a metropolitan emergency medicine network: A case series

@article{Graudins2014OverdoseWM,
  title={Overdose with modified‐release paracetamol (Panadol Osteo{\textregistered}) presenting to a metropolitan emergency medicine network: A case series},
  author={Andis Graudins},
  journal={Emergency Medicine Australasia},
  year={2014},
  volume={26}
}
  • A. Graudins
  • Published 1 August 2014
  • Medicine
  • Emergency Medicine Australasia
BACKGROUND There are currently no large cases series documenting poisoning with paracetamol modified-release (Panadol Osteo®, GlaxoSmithKline, Sydney, NSW, Australia. [] Key MethodMETHOD Descriptive retrospective case series presenting to a metropolitan hospital network with paracetamol poisoning from October 2009 to September 2013. RESULTS There were 42 cases of Panadol Osteo® poisoning identified.
The standard treatment protocol for paracetamol poisoning may be inadequate following overdose with modified release formulation: a pharmacokinetic and clinical analysis of 53 cases
TLDR
The pharmacokinetic and clinical analysis showed that the standard treatment protocol used for IR paracetamol poisoning not appear suitable for MR formulation, and individual and tailored treatment may be valuable but further studies are warranted to determine optimal regimen of overdoses with MR formulation.
Liver injury induced by paracetamol and challenges associated with intentional and unintentional use
TLDR
The clinical and pathophysiologic features of hepatotoxicity secondary to paracetamol are described and an update on current available knowledge and treatment options is provided.
Extended Release Acetaminophen Overdose With Delayed Peak Concentrations.
TLDR
This study presents 3 patients who overdosed on extended-release acetaminophen, and some similarities exist between cases abroad and in the US, there is a potential difference because of the amount of immediate and delayed release.
Accuracy of the paracetamol-aminotransferase multiplication product to predict hepatotoxicity in modified-release paracetamol overdose
TLDR
Above a cut-point of 10,000 mg/L × IU/L, it was very strongly associated with the development of acute liver injury and hepatotoxicity, especially when calculated more than eight hours post-ingestion.
Accuracy of the paracetamol-aminotransferase product to predict hepatotoxicity in paracetamol overdose treated with a 2-bag acetylcysteine regimen
TLDR
The multiplication product accurately predicts hepatotoxicity when using a two-bag acetylcysteine regimen, especially in patients treated more than eight hours post-overdose, as well as for acute liver injury.
Changing nomogram risk zone classification with serial testing after acute acetaminophen overdose: a retrospective database analysis
TLDR
Being older, male, and co-ingesting opioids, antimuscarinics, or NSAIDs were independently associated with line-crossing, which supports recommendations for serial APAP testing until the individual risk of hepatic injury is clearly established.
Modified release paracetamol overdose: a prospective observational study (ATOM-3)
TLDR
Following an acute MR paracetamol overdose, this study found that many patients had a persistently elevated par acetamol concentrations, many required prolonged treatment and some developed liver injury despite early acetylcysteine treatment.
Nomogram line crossing after acetaminophen combination product overdose
TLDR
After acute overdose of acetaminophen combination products, patients with detectable but non-toxic 4-hour acetaminphen concentrations should have repeat concentrations obtained in a time frame that would allow providers to initiate acetylcysteine treatment, if needed, without undue delay.

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Early presentation following overdose of modified-release paracetamol (Panadol Osteo) with biphasic and prolonged paracetamol absorption.
TLDR
Current intravenous dosing regimens may not provide enough N-acetylcysteine to effectively metabolise paracetamol to non-toxic adducts, leading to massive ingestion of modified-release par acetamol (Panadol Osteo).
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