Over-the-Counter Analgesics: A Toxicologic Perspective

Jones, A

Analgesics such as paracetamol, aspirin, and other nonsteroidal anti-inflammatory drugs (NSAIDs) are available over the counter in many parts of the world. As usage and availability increase, benefits and risks must both be weighed. This article explores the features, treatment, incidence, and causes of analgesic overdoses. In the US, information on the incidence and origins of analgesic overdoses is gathered by counting telephone calls from both the public and medical professionals. Results may be overestimated, due to unnecessary calls from an uninformed public. In the UK, only calls from medical professionals are counted, resulting in a potential underestimation of incidence (because the public at large has no traceable way to report an analgesic overdose). Australia and Denmark also use telephone-based poison control centers to gather quantitative information on analgesic overdoses. Paracetamol poisoning's main feature is hepatotoxicity. Treatment for paracetamol overdose is required for: 0.01 percent of the US population, Australia 0.02 percent, and UK 0.08 percent. Comparisons between countries could be irrelevant, as access to medical care may affect results. Used therapeutically, paracetamol carries little risk. In the UK, less than 0.1 percent of 30 million users experience an overdose. Approximately 200 of these users die annually, most of whom did not receive timely treatment. In the UK, the number of aspirin overdoses continues to decline. In the US, aspirin was believed to have caused 27 deaths in 2000 (most of which were believed to be suicides). Dangers of aspirin overdose include metabolic acidosis, renal failure, and central nervous system effects. Aspirin exhibits some adverse effects even in therapeutic doses. Of all analgesics, it offers the least favorable risk-benefit profile. NSAID overdoses are common, according to Toxic Exposure Surveillance System (TESS) data. However, this author suggests that most NSAID overdoses result in no more than mild gastrointestinal upset. NSAIDs have more adverse effects than paracetamol when used therapeutically but carry less risk of severe incident or death in the case of overdose. In terms of accidental versus deliberate analgesic overdose, the approximate breakdown by country is 65 percent accidental and 35 percent deliberate in the US; 26.9 percent accidental and 66.5 percent deliberate in Australia; 6.8 percent accidental and 93 percent deliberate in the UK; 15 percent accidental and 85 percent deliberate in Denmark. The disparity between the US and other countries could be a result of insurance and healthcare regulations. The author suggests that a reduction of analgesic poisonings can be achieved through various means, including quantity restrictions, more informative packaging, ingredient modification, more limited availability, and increased monitoring of over-the-counter analgesics. It should be noted that while most analgesics are used to great benefit with little to no negative effect, management and treatment of analgesic poisoning is still a concern within the medical community. Am J Ther 2002;9:245-57 Return to Top