Prescriber's Letter: July 2009; Vol: 16, No. 7

INTRODUCTION This is an actual Issue article. Click "Detail-Document" to read more on this subject. See "Table of Contents" for all the articles in this issue. SUBSCRIBE TODAY!      You'll see big changes regarding acetaminophen...to reduce overdosing that leads to liver toxicity.      People don't realize that acetaminophen has a narrow therapeutic index. The toxic dose is not much higher than the therapeutic dose.      Just 6 g/day for 2 days can cause liver toxicity in some patients.      It's easy for a patient to get too much due to multiple prescribers or multiple ailments...Vicodin for pain, Excedrin for headache, Theraflu for cold or flu, Sinutab for allergies, etc. Hospital patients also get acetaminophen from many, sometimes overlapping, standing orders.      In fact, half of acute liver failures due to acetaminophen are due to UNintentional overdoses.      You'll hear talk about lowering the maximum recommended dose to 650 mg/dose and 3250 mg/day...down from 1000 mg/dose and 4000 mg/day.      3250 mg/day works out to be 650 mg 5 times a day. Explain that 650 mg works almost as well as 1000 mg for pain...and it's safer.      Experts will debate an even lower dose for people who have three or more alcoholic drinks per day or have liver disease.      Regulators will consider big changes...limiting acetaminophen products to 325 mg/tab...allowing just ONE strength of pedi liquids...eliminating OTC combo products...and requiring patient leaflets for Rxs.      Try to avoid Rxs with high doses of acetaminophen...Vicodin ES, Vicodin HP, hydrocodone/acetaminophen 7.5/650, Darvocet-N 100, etc. These contain 650 to 750 mg acetaminophen per TABLET.      When appropriate, use a formulation with just 325 mg/tab, such as Norco (hydrocodone/acetaminophen).      Help patients recognize and limit the total acetaminophen they get from ALL their Rxs and OTCs.      Advise heavy drinkers to keep acetaminophen well below 3250 mg/day.      Symptoms of acetaminophen toxicity can resemble flu-like symptoms. So people take more acetaminophen...until it's too late.      Consider potential toxicity in people who take over 10 g or 200 mg/kg in one day...or 6 g/day or 150 mg/kg for 2 or more days.      Send appropriate people to the ED to get their acetaminophen level checked right away to see if treatment is necessary. View Detail-Document #250701 Copyright © 2009 Prescriber's Letter. Illegal to reproduce and/or forward. PrescribersLetter.com

Prescriber's Letter: July 2009; Vol: 16, No. 7

Download This Issue's Handheld File Start reading this issue of the Letter or skip to any topic below. INTRODUCTION big changes regarding acetaminophen read this article WOMEN'S HEALTH new warnings not to combine tamoxifen with certain SSRIs NEUROLOGY / PSYCHIATRY increased risk of bradycardia and fainting in patients taking cholinesterase inhibitors OPHTHALMOLOGY new ophthalmic quinolone called Besivance GASTROENTEROLOGY overuse of proton pump inhibitors (PPIs) and H2-blockers in hospitalized patients STROKE More patients will be eligible to get tPA (alteplase, etc) for acute ischemic stroke CARDIOLOGY how genetic variations and drug interactions may decrease the efficacy of clopidogrel (Plavix) SUPPLEMENTS Does flaxseed have the same benefits as fish oil MEN'S HEALTH when to use 5-alpha-reductase inhibitors (Proscar, Avodart) or PSA screening to prevent prostate cancer PAIN new opioid analgesic called Nucynta (new-SINN-tah, tapentadol) FOLLOW-ON DRUG MARKETING Nuvigil launch brings up more questions about whether new isomers or metabolites of existing drugs are better than the original P.S. stop using Zicam NASAL products due to loss of smell SUPPLEMENTS supplements to help prevent or slow age-related macular degeneration (AMD) CARDIOLOGY how to prevent or treat orthostatic hypotension CME QUESTIONS July 2009 CME Questions Start reading this issue of the Letter or skip to any topic above.

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