Paracetamol poisoning – impact of pack size restrictions

@article{Hughes2003ParacetamolP,
  title={Paracetamol poisoning – impact of pack size restrictions},
  author={Bethany Hughes and Anna Durran and Nigel J Langford and David Mutimer},
  journal={Journal of Clinical Pharmacy and Therapeutics},
  year={2003},
  volume={28}
}
Background:  Pack sizes of paracetamol available to the public were reduced by legislation in 1998. 

Does Restricting Pack Size of Paracetamol (Acetaminophen) Reduce Suicides?

TLDR
A new study that examined the change in deaths attributed to paracetamol poisoning in England and Wales in the six years before and after a legislated reduction in the maximum pack size finds that the number of deaths has increased.

Pack-size legislation reduces severity of paracetamol overdoses in Ireland

TLDR
Legislation controlling sale and packaging of par acetamol preparations appears to be associated with a significant fall in the number of tablets taken in acute deliberate paracetamol overdoses in Ireland.

Limiting paracetamol pack size: has it worked in the UK?

TLDR
Limitation of pack size limitation as applied in the United Kingdom has not reduced paracetamol-related death, and reasons postulated include patient avoidance of the legislation's intentions, patient confusion, and ineffectiveness of the regulations as conceived and implemented.

Impact of Restricting Paracetamol Pack Sizes on Paracetamol Poisoning in the United Kingdom

TLDR
The UK government introduced legislation that reduced the maximum pack size of all non-effervescent tablets and capsules containing aspirin or paracetamol that can be sold or supplied from outlets other than registered pharmacies from 25 to 16 tablets or capsules in 1998, to determine the effectiveness of the legislation.

Acetaminophen overdose in the Military Health System

TLDR
The annual trend, distribution, and determinants of acetaminophen overdose using data from the Military Health System are reported and the proportion of individuals with an acetamine overdose who received a prescription for any acetamine‐containing medication prior to their event is assessed.

Restriction of non-opioid analgesics sold over-the-counter in Denmark: A national study of impact on poisonings.

Restricting paracetamol in the United Kingdom to reduce poisoning: a systematic review.

TLDR
It is suggested that the 1998 regulations may have been associated with reduced admissions to liver units and liver transplants, reduced hospital attendance due to paracetamol poisoning and reduced sales of paracetAMol.

Acetaminophen Availability Increases in Canada with No Increase in the Incidence of Reports of Inpatient Hospitalizations with Acetaminophen Overdose and Acute Liver Toxicity

TLDR
The decision to lift Canadian place-of-sale restrictions increased acetaminophen availability and did not increase the rate of reported hospitalizations related to acetaminphen overdose toxicity.

Outcomes of liver transplantation for paracetamol (acetaminophen)‐induced hepatic failure

  • S. CooperRoland C. Aldridge J. Neuberger
  • Medicine, Psychology
    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
  • 2009
TLDR
This study suggests that, notwithstanding the shortage of donor liver grafts, transplantation is an appropriate therapy in selected patients, although close follow‐up is indicated.

References

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Change in occurrence of paracetamol overdose in UK after introduction of blister packs

Paracetamol (acetaminophen) poisoning. No need to change current guidelines to accident departments.

TLDR
Paracetamol is an effective, simple analgesic that is well tolerated by adults and children at therapeutic doses, but therapeutic misadventures do occur rarely, in both adults andChildren.

Limitation of over the counter sales of paracetamol

TLDR
These packaging regulations aspire to reduce the incidence of deliberate and accidental overdose, but it is believed that their effect will be limited and they are unlikely to succeed and will only inconvenience the vast majority of people, who use these drugs appropriately and responsibly, and add to the workload of general practitioners and pharmacists.

Paracetamol Self-Poisoning Characteristics, Prevention and Harm Reduction

TLDR
Establishing a maximum number of tablets (e.g. 25) that can be available in individual preparations is likely to reduce the dangers of paracetamol self-poisoning.

Reducing paracetamol overdoses

TLDR
Britain's Medicines Control Agency launched a programme of consultation on the availability of solid dose analgesics, including paracetamol, last month, with the aim of reinforcing the country's remarkable safety record.

Deaths from low dose paracetamol poisoning

TLDR
The key point is that a treatment strategy must allow a margin of safety that allows for some degree of inaccuracy in the history or an individual patient’s susceptibility to paracetamol.

Paracetamol (acetaminophen) poisoning.

Use of paracetamol for suicide and non-fatal poisoning in the UK and France: are restrictions on availability justified?

TLDR
Trends towards greater availability of paracetamol are paralleled by increases in its use for both non-fatal overdose and suicide, which suggests that restrictions in the quantity of par acetamol available as a single purchase in the UK may reduce suicide and liver failure related to paracetmol.

Improvements in the packaging of drugs and chemicals may reduce the likelihood of severe intentional poisonings in adults

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TLDR
Reducing the maximum number of tablets that can be available in individual preparations or prescriptions may also reduce the likelihood of severe poisonings, and the methyl salicylate content and the size of the bottle and its opening should be restricted.

Serious paracetamol poisoning and the results of liver transplantation.

TLDR
A role for liver transplantation is suggested in the management of selected patients with paracetamol poisoning, as it seemed to predict the outcome of patients who did not have a transplant managed on the Birmingham liver unit.