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ABSTRACT
The use of acetaminophen is currently under increased scrutiny by the US Food and Drug Administration (FDA) due to the risk of intentional and more concerning, unintentional overdose-related hepatotoxicity. Acetaminophen is responsible for an estimated 48% of all acute liver failure diagnoses. The purpose of this study is to evaluate patient perception and knowledge of the safe use and potential toxicity of acetaminophen-containing products. The authors conducted a descriptive, 2-week study using a convenience sample from a large family medicine clinic waiting room. Survey questions assessed ability to identify acetaminophen, knowledge of the current recommended maximum daily dose, respondent acetaminophen use patterns, common adverse effects associated with acetaminophen, and respondent self-reported alcohol consumption. Acetaminophen safety information was provided to all persons regardless of participation in the study. Of the 102 patients who chose to participate, 79% recognized acetaminophen as a synonym of Tylenol, whereas only 9% identified APAP as a frequently used abbreviation. One third of respondents thought acetaminophen was synonymous with ibuprofen and naproxen. Approximately one fourth of patients correctly identified the then maximum recommended daily acetaminophen dose of 4 g. Seventy-eight percent of patients correctly identified hepatotoxicity as the most common serious adverse effect. We conclude that patient deficiencies in knowledge of acetaminophen recognition, dosing, and toxicity warrant public education by health professionals at all levels of interaction. Current initiatives are promising; however, further efforts are required.
APPENDIX A
Patient Perception and Knowledge of Acetaminophen in a Large Family Medicine Service
***The following questionnaire is for research purposes only and participation is optional. Any information obtained from this questionnaire is strictly confidential and answers you provide cannot be traced back to you. Completion of this survey serves as your consent to participate. You may elect to discontinue completion of this survey at anytime.***
***You must be at least 18 years of age to complete this survey. If you are not at least 18 years old, please stop now.***
Please indicate the following:
Age: 18–25 years 26–38 years 39–51 years 52–64 years 65 years and over
Gender: Male Female
Ethnicity: Caucasian African-American Hispanic Other
Highest level of education completed:
Middle School (7th or 8th grade)
High School (9th–12th grade)
2-year college
4-year college
Masters/Doctoral program
Insurance type:
Private (eg, Medco) Public (eg, Medicaid, Medicare) Military (eg, Tricare) No insurance
Are any of the following another name for the active ingredient known as acetaminophen?
Which of the following do you think is the approved maximum daily dose of acetaminophen?
A. 2000 mg/day, or 4 extra strength tablets per day
B. 3000 mg/day, or 6 extra strength tablets per day
C. 4000 mg/day, or 8 extra strength tablets per day
D. 5000 mg/day, or 10 extra strength tablets per day
E. 6000 mg/day, or 12 extra strength tablets per day
Which of the following side effects has most commonly been associated with long-term acetaminophen use?
A. Heart failure
B. Liver damage
C. Breathing difficulties
D. Joint pain
When purchasing over-the-counter medications, do you check for acetaminophen as one of the active ingredients?
Yes No
When prescribed prescription medications, do you check for acetaminophen as one of the active ingredients?
Yes No
Which of the following types of medications do you think might contain acetaminophen as an ingredient (please circle all that apply)?
A. Pain relievers
B. Fever reducers
C. Cold/allergy products
D. Sleep aids
Which of the following best describes your alcohol intake?
A. I do not drink alcohol
B. 1 drink per day
C. 2 drinks per day
D. 3 or more drinks per day
8a. Have you ever received education on acetaminophen from a health care professional or other source?
Yes No
8b. If yes, who provided the education (please circle all that apply):
A. Nurse
B. Doctor
C. Pharmacist
D. Other (please specify): _____________
9. Which best describes where you get prescription medications?
a. Chain pharmacy (eg, Walgreens)
b. Grocery store pharmacy (eg, Schnucks)
c. Independent pharmacy (eg, locally-owned family pharmacy)
d. Mail-order pharmacy
10. How much acetaminophen do you consume on a daily basis*? Please include all medications that contain acetaminophen as an ingredient.
_____________ mg/day (or _____________ extra strength tablets per day)
Common Prescription Drugs That Contain Acetaminophen*
(amount of acetaminophen per tablet/capsule)
Darvocet® (650 mg)
Endocet® (between 325 mg–650 mg)
Fioricet® (325 mg)
Hydrocet® (325 mg)
Lorcet® (650 mg)
Lortab® (500 mg)
Norco® (325 mg)
Percocet® (between 325 mg–650 mg)
Sedapap® (650 mg)
Tylenol® with Codeine (300 mg)
Ultracet® (325 mg)
Vicodin® (between 500 mg and 750 mg)
Zydone® (400 mg)
Common Over-the-Counter Drugs That Contain Acetaminophen*
(amount of acetaminophen per tablet/capsule)
Alka-Seltzer® Plus Day Cold; Sinus Formula (250 mg–325 mg)
Anacin® Aspirin-Free; Advanced Headache Formula (250 mg–500 mg)
Benadryl® Allergy and Cold; Allergy and Sinus (325 mg)
Contac® Cold and Flu; Cold and Sore Throat (500 mg)
Coricidin® HBP Cold and Flu (325 mg)
Dayquil® (325 mg)
Dristan® ND (325 mg–500 mg)
Excedrin® PM; Extra Strength; Migraine; Sinus; Tension (250–500 mg)
Feverall® (80 mg)
Goody's® Powders (130 mg–500 mg)
Midol® Teen Formula (500 mg)
Nyquil® (325 mg)
Sinutab® (325 mg–500 mg)
Sudafed® Nighttime Cold; Severe Cold; Sinus Headache (325–500 mg)
Theraflu® Severe Cold and Cough; Flu and Sore Throat (325–650 mg)
Triaminic® Children's Fever Reducer Pain Reliever (160 mg/5 mL)
TYLENOL® Brand Products (various)
Vanquish® (194 mg)
Zicam® Cold and Flu (325 mg)