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Br J Clin Pharmacol. 2018 Jun;84(6):1250-1257. doi: 10.1111/bcp.13551. Epub 2018 Mar 25.

Prevalence of exceeding maximum daily dose of paracetamol, and seasonal variations in cold-flu season.

Author information

1
Pinney Associates, Pittsburgh, PA, USA.
2
Departments of Psychology, Psychiatry, Pharmaceutical Sciences, and Clinical Translational Research, University of Pittsburgh, Pittsburgh, PA, USA.
3
Slone Epidemiology Center at Boston University, Boston, MA, USA.
4
Appleseed Consumer Insight, Arlington, MA, USA.
5
Janssen Research & Development, LLC, Titusville, NJ, USA.

Abstract

AIMS:

To estimate prevalence of excess intake of paracetamol and investigate seasonal variations therein.

METHODS:

Between 2011 and 2016, 14 481 US adults who used paracetamol in the preceding 30 days were sampled from national online panels and completed a detailed online daily diary of paracetamol medication use for 7 days. Respondents were not told that the study concerned paracetamol. Cold/flu season (CFS), identified using Google Trends data, was contrasted to off-season in symptoms, use of paracetamol medications, and consumption exceeding 4 g (the recommended daily maximum).

RESULTS:

Overall, 6.3% [95% confidence interval: 5.9-6.7%] of users exceeded 4 g on at least one day; 3.7% [3.5-3.8%] of usage days exceeded 4 g. Cold/flu symptoms were more likely to be experienced and treated with paracetamol in CFS than off-season. Paracetamol users were more likely to exceed 4 g during CFS (6.5% vs. 5.3%; odds ratio = 1.24, 1.04-1.48); days exceeding 4 g also increased (3.9% vs. 2.8%; odds ratio = 1.37, 1.11-1.69). This was not due to differences in characteristics of individuals using paracetamol in CFS, but primarily to increased use of over-the-counter combination medications designed to treat upper respiratory cold/flu symptoms (33.2% of usage days in CFS vs. 24.8% in off-season; odds ratio = 1.58, 1.46-1.72). When such medications were omitted, there was no statistically significant seasonal variation in exceeding 4 g.

CONCLUSIONS:

Paracetamol use and over-dosing increases in CFS, primarily due to increased use of over-the-counter combinations treating upper respiratory cold/flu symptoms. Pharmacists should warn users to follow labelled dosing directions, especially during CFS.

KEYWORDS:

cold; combination products; flu; nonprescription; paracetamol; seasonality

PMID:
29516533
PMCID:
PMC5980528
DOI:
10.1111/bcp.13551

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