Study Underscores Risk of Acetaminophen Overdose

Patients demonstrated a high likelihood of taking an overdose of acetaminophen in a variety of scenarios presented by researchers.

Acetaminophen is the most commonly used OTC medication in the United States, with 1 in 5 adults taking it in a given week. When consumed according to established guidelines, it is generally safe, but overdose with the drug is the most common cause of acute liver failure—and poor product labeling has been identified as a contributing factor. This risk is underscored by the results of a study published online on May 26, 2012, in the Journal of General Internal Medicine, in which patients identified how much OTC pain medication they would take in a range of scenarios—and many of their choices added up to an overdose.

The study, led by Michael Wolf, PhD, MPH, of Northwestern University, included 500 adult primary care patients at 2 internal medicine practices in each of Chicago and Atlanta. (The participants’ mean age was 49.3; 62.6% were female; 56.8% were African American; and 38.7% read at less than a 9th-grade level.) Each participant completed a structured, in-person interview in which they were asked to indicate how much of each of 5 OTC medications they would consume over a 24-hour period in order to take the maximum recommended dose. Then they were asked whether it would be safe to take a second OTC medication assuming they were already taking the maximum recommended dose of another, specified OTC medication.

The results of the first part of the study showed that 23.8% of the participants would have taken more than the recommended maximum 4-gram dose of acetaminophen over 24 hours with at least one medication, and 5.2% of participants would have taken a dangerously high dose of more than 6 grams. Limited literacy was associated with a 65% increased risk of overdose, heavy acetaminophen use over the previous 6 months was associated with a 70% increased risk, and receiving care at a community clinic was associated with an 81% increased risk. African Americans, however, were 54% less likely to overdose than white patients.

In the second part of the study, 45.6% of participants would have exceeded the maximum daily recommended dose of acetaminophen by taking 2 products containing it. Patients with lower household income were 96% more likely to do so, and heavy acetaminophen users were 42% more likely to do so, but women were 36% less likely than men to do so. Rates of “double-dipping” were highest when combining differently labeled medications, such as a sinus medication and a PM pain reliever, suggesting that since the medications are advertised to treat different symptoms, patients assume they contain different ingredients and that combining them will be safe.

“Our findings suggest that many consumers do not recognize or differentiate the active ingredient in OTC pain medicines, nor do they necessarily closely adhere to package or label instructions,” the researchers write. “Given the prevalence of the problem, risk of significant adverse effects, and lack of a learned intermediary to guide decision making and counsel consumers on proper use, we believe this to be a serious public health threat requiring urgent attention.”

Pharmacists can help improve awareness of these issues by reminding patients of the the maximum daily recommended dose of acetaminophen and by emphasizing the fact that many different OTC medications contain the same ingredients.


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9 Bad Work Habits and How to Break Them

You constantly check your email or post updates on Facebook or Twitter.

There's a reason (beyond procrastinating) why you can't stay away from your personal email account and social networking sites. "Social interaction is addictive because it activates the rewards center of our brains," says David Rock DProf, director of the NeuroLeadership Institute and author of Your Brain at Work. Connecting to people is similar to eating chocolate, he explains. "The more you do it, the more you want it that's when it becomes distracting." To keep yourself focused on work, Dr. Rock recommends designating times of day when you'll check these sites. That way, you'll get your fix without being sucked into the trap of constantly wanting more. Or, as Michelle Goodman, author of The Anti9-to-5 Guide advises, treat visiting these sites as a reward. Work for, say, an hour, and then allow yourself to check in quickly as a treat. A word of warning: Think twice before you post about work matters on social networking sites. As Goodman points out, "these sites are frequently changing their privacy settings, so your page may be publicly broadcasted without you knowing it, which could land you in hot water." 

You write-and send-work emails too hastily.

"Misread emails create unnecessary anxiety," says Dr. Rock. A slap dash message may come across as confusing, or worse, offensive, to the person on the receiving end-and it may cast you in a bad light. There's a huge benefit to pausing after you write an email but before you press send. "If you feel uncertain about your message, save it as a draft and come back to it later," suggests Dr. Rock. Not only will this give you time to work off anger that may have provoked you to write things you didn't mean, but it may also allow you to add helpful information to the email, which can make you come across as capable and thoughtful. And if you struggle with an email about a sensitive topic, keep Dr. Rock's rule in mind: "Anything that's likely to generate strong emotion should be a phone or face-to-face conversation."

You're set in your ways.

If it isn’t broke, don't fix it-right? Not always. If you're sticking without dated procedures because "that's the way it's always been done," re-think your attitude. Though knowing the ins and outs of office processes may seem like proof of your expertise, it may actually make you seem obsolete. Especially in a shaky economy, it's integral to be open to new ideas, says Goodman. "Holding on to old systems isn't the way to be irreplaceable," she explains. "Getting along well with everyone, contributing great ideas and doing innovative work is." She adds that resisting change often stems from a fear of being left behind in the workforce. Instead of standing your ground, be flexible about learning from others. "Get comfortable with the fact that there's always going to be someone smarter or younger than you," says Goodman.

You're too involved in office politics.

Happen to find yourself gathered around the water cooler frequently? While joining in on office gossip is inevitable, spending too much time dissecting workplace dynamics can harm your reputation. "If you're seen as always schmoozing or stirring the pot, you may also be seen as a troublemaker or unproductive," says Goodman. Instead of worrying about who said what to whom when, devote that energy to work. "Like logging on to Facebook, office gossip is a distraction. If you must indulge, treat it as a reward that you'll give yourself after doing a set amount of work." And as she notes, the more you concentrate on work, the less time you'll have for petty gossip.

You start each day with the wrong plan of attack-or none at all.

 After a long day at work, the last thing you want to do is prepare for the next one. But by making a beeline for the door at quitting time, you're setting yourself up for trouble the next morning. "Without a plan, it's easy to become distracted by small tasks and coworkers' questions," says Goodman. And that can prevent you from accomplishing the bigger stuff. "If you spend most of your dayhandling minor assignments, you won't have the mental resources left to give your most important duties the attention they need," says Dr. Rock. Goodman suggests taking a few minutes the night before-or first thing the next morning as a last resort-to write down the two or three meatiest tasks you need to get done that day. "You're not likely to finish more than four, so prioritize your to-do list."

You're always running late.

"People are most often behind schedule because they're not thinking about how long it takes to get from point A to point B, or because they leave things until the last minute," says Dr. Rock. "And these people usually haven't noticed the impact that running late has on their performance and that of others." By repeatedly missing deadlines or arriving after meetings start, you seem less reliable and you hinder those who depend on you. If your hour-long meetings frequently run over, Dr. Rock recommends scheduling them for 50 minutes instead of 60. Those ten extra minutes serve as padding if the conversation goes long. And if you're chronically tardy with deadlines or other appointments, Goodman advises setting computer alerts to chime a half hour before you need to be ready to keep you on the ball. If nothing else, set your clocks forward a few minutes to help you be on time.

You can't manage your personal and professional lives.

The balance between your work and your personal life varies depending on the office environment you're in. But one thing is constant: Failing to meet coworkers' or friends' and family's expectations will upset them, according to Dr. Rock. If your office culture prides itself on working around the clock, you'll raise eyebrows for taking personal calls all day long. "Set parameters," recommends Dr. Rock. "If personal issues distract you at work, tell friends and family you'll respond to their calls and emails at, say, the beginning or end of each day." However, if you're the only one constantly working late, consider meeting with your boss to discuss your workload, says Goodman. And if everyone is on call 24/7, think about whether or not you're in the right job. On the other hand, if your coworkers regularly get together after work, you'll stand out for turning down invitations or sending stiff emails at all hours. So consider tagging along once in a while. As Goodman puts it, "You'll get the inside scoop and bond with people, which will only help your projects as well as people's image of you. If you're not sure what to share, follow other people's lead." If they seem happy chatting about their family drama, feel free to chime in with your own anecdotes.

You don't take a lunch break.

Powering straight through lunch may seem like a noble endeavor, not to mention a great way to get ahead on your to-do list. But by refusing to take a break, you're actually doing yourself more harm than good. Not only is sitting all day linked to a host of health issues, like a greater risk of dying from heart disease, according to a 2010 study published in Medicine & Science in Sports & Exercise, but stepping away from the screen will also revive you, allowing you to view your work with a fresh perspective, says Goodman. Daunting tasks you dreaded earlier can seem more doable after taking a break. Even a short walk around the block will give you a much-needed boost. "Doing so is extremely rewarding to the brain and resets our ability to think straight," says Dr. Rock. Besides, you can't deliver the best results with a sandwich in one hand and your computer mouse in the other. You'll be more productive once you fully devote your attention to work.

You have a negative attitude.

Maintaining a chipper outlook day in and day out isn't realistic, of course. But if you find yourself griping about your job more often than not, you're setting yourself up for an endless cycle of negativity. "A negative bias can reduce the quality of your ideas and the work you produce-and can cause you to see everything as negative, even when it's not," says Dr. Rock. In other words, a doom-and-gloom attitude will make all around you seem worse, causing your creativity to suffer. Instead of griping about work things you can't change, focus on what you can improve, and try to see everything in a positive light. That may mean keeping away from coworkers who goad you into talking smack. It may also mean seeking out positive cues, like happy people, uplifting images (try hanging a few vacation snapshots in your cubicle) or taking a break to watch a funny YouTube video, says Dr. Rock. The more cheerful your attitude, the less you'll find to complain about. And remember: The more you grumble, the more likely it is that people, like your superiors and your loudmouth cube- mate, will take notice-and if your boss knows you're unhappy, you could be the first one on the chopping block, says Goodman.

 
Article originally appeared on WomansDay.com