In December I attended the American Society of Health-System Pharmacists clinical meeting in Anaheim. The Mid-year, as it’s called, is the largest pharmacy meeting in the country with almost 20,000 registrants this year crowding the convention center and streets of Downtown Disney and the parks.

A meeting relevant to CHAMP practice focused on acetaminophen poisoning and discussed FDA actions and current thinking about acetaminophen (APAP). There is considerable debate regarding existing evidence about the significance of adverse effects and the extent of the problem in the US. Equally controversial were the FDA Advisory Committee’s recommendations which we voted on using polling devices. Our responses were compared to that of the Advisory Committee amid much head-shaking and murmurs of “they’ve got to be kidding,” with many publically voicing concerns about the seemingly Draconian measures FDA is considering that would limit availability of acetaminophen and significantly impact pain management.

In an August 2009 post,  I wrote that the FDA’s advisory panel was considering removing prescription drugs that combine acetaminophen and opiates such as Vicodin and Percocet®. However, instead, last week the FDA announced that it is asking manufacturers of prescription APAP combination products to limit the maximum amount of APAP in these products to 325mg per dosage. FDA is hoping this action will reduce the risk of severe liver injury from acetaminophen overdosing. What this means is that some hydrocodone/500mg APAP products may disappear from the market. Already practitioners have been recommending Norco brand as it contains only 325 mg of APAP.

What these recommendations mean for our elderly home care patients remains to be seen. But for now you can help prevent potential overuse of APAP by keeping in mind the current recommended limits of 4000 mg per day, carefully assessing total mgs of APAP your clients are using in prescription and OTC products, and educating your clients on some of the points below. And feel free to post comments about this issue.

The FDA site has some helpful resource materials for using acetaminophen and OTC pain relievers safely. Here’s a quick summary:

1. Check if a medication contains acetaminophen, and if so, how much.
2. Avoid taking more than one medication at a time that contains acetaminophen.
3. Having 3 or more drinks a day or a history of liver disease can increase risk of liver damage.