Gewone
pijnstiller nu de belangrijkste oorzaak acuut leverfalen.*
In
de Verenigde Staten is paracetamol nu de belangrijkste oorzaak geworden van
acuut leverfalen en in de helft van die gevallen is een overdosis de reden.
Tussen 1998 en 2003 zijn het aantal gevallen van acuut leverfalen ten gevolge
van paracetamol verdubbeld. In de studie kregen 275 mensen een
paracetamolvergiftiging, waarvan 8% een levertransplantatie kreeg en 27%
doodging. Of een overdosis nu langer of slechts enige dagen ingenomen
wordt maakt voor de gevolgen niet zoveel uit, al na 3 dagen een overdosering van
20 pillen van 500 mg per dag (normale dosering is max. 8) kan voldoende zijn.
Sommigen hadden het zelf niet in de gaten omdat ze twee verschillende producten
namen met dezelfde werkzame stof paracetamol. Het probleem in Amerika kan de
verpakking zijn, je kunt er zelfs een doos met 500 pillen kopen.
A
POPULAR over-the-counter painkiller is now the leading cause of acute liver
failure in the US - and almost half of those cases are accidental overdoses.
Paracetamol
(or acetaminophen as it is known in the US) is used by millions of Americans
each year, and is commonly thought to be safe. Until 1980, paracetamol was not
even listed as a cause of acute liver failure. But between 1998 and 2003, the
proportion of cases of liver failure caused by the drug nearly doubled.
William
Lee at the University of Texas Southwestern Medical Center in Dallas and his
colleagues followed patients with acute liver failure who were in a coma. Of the
275 people with paracetamol poisoning, 8 per cent received a liver transplant,
65 per cent survived without one and 27 per cent died.
Initially
the researchers had suspected a direct relationship between how much of the drug
is in the liver and for how long, and the extent of the damage. But people who
intentionally overdosed, who tend to be identified and treated more quickly, had
similar damage to those who overdosed accidentally. That suggests a clear
threshold for what constitutes a safe dose of the drug.
Many
of the people who had accidentally poisoned themselves did so by taking just 10
grams of the medication each day for about three days - the equivalent of about
20 pills per day instead of the recommended eight, an overdose that might be
less serious with other drugs. Other people had unwittingly taken two products
that both contained the drug (Hepatology, vol 42, p 1364).
Lee thinks American drug enforcers should follow the lead of the UK, which requires products that contain acetaminophen to be packaged in blister packets and sold in small quantities. "I think we should talk about limiting package size," says Lee. "You can buy 500 at a time. They're like M&Ms." (December 2005)
