Moving the Needle to Reduce Acetaminophen (Paracetamol) Hepatotoxicity

Acetaminophen (paracetamol) is the most widely used pain reliever globally. It was approved in the US in 1950 as a prescription drug and then for over-the-counter (OTC) use in 1955. Currently, more than 52 million persons in the US consume acetaminophen on a weekly basis, although many of them are unaware that they are consuming medications that contain acetaminophen. Although acetaminophen has a remarkable safety record when taken as directed, its use has been associated with liver and kidney toxicity, which may be fatal because of a narrow safety range between therapeutic effect and toxicity. The public health burden of acetaminophen is substantial. Annually in the US, acetaminophen is responsible for 112 000 poison center calls, 59 000 emergency department visits, and 38 000 hospitalizations. Of more concern, it is the leading cause of acute liver failure in the US and other high-income countries. While the majority of cases of acute liver failure are related to deliberate self-harm, close to half are related to unintentional overdose or “therapeutic misadventure.”