Paracetamol, a New Awareness on an Old Drug: A Survey Report on its Clinical Use in a Cancer Institute

Introduction: In spite of its large use, a conspicuous number of paracetamol adverse reaction reports have been recently collected, due to overdosage or posologic mistakes. A recent metanalysis by BMC Med Inform Decis Mak [1] has inserted paracetamol in the list of the six drugs causing severe ototoxicity and a pharmacovigilance retrospective study [2] has highlighted that it induced 1.4% of all severe drug-induced adverse reactions. Another recent review on the analgesic standard doses of paracetamol has demonstrated its grade of toxicity, at the maximum prescribed dose [3]. Objective: A knowledge assessment on paracetamol management among health professionals can rise new inputs for the risk/benefit ratio of this old molecule [4,5]. Methods: A survey of 7 questions on standard dosage, dose adjustment and antidotes to paracetamol overdose was submitted to 36 health professionals (nurses, pharmacists, oncologists, hematologists, surgeons) in the Cancer Institute of Bari. The answers were collected and charted in diagrams, in order to soon identify critical evidences. Results: The correct answers to the 7 questions were distributed as follows: up to 30-33% to 4, 70% to 2 and 89% to 1 questions, respectively. The lowest value of correct answers (11%) was reported for the question on the minimum time interval among successive administrations, while the highest (89%) was related to the volume of drug solution per administration. About 30-33% of correct responses were given to both questions on the maximum doses in patients with or without additional risks (kidney and/or liver comorbility), respectively, highlighting the lack of knowledge on the need to personalize therapy. The 70% value of correct answers regards the maximum consented daily doses and the antidote N-acetilcysteine. Conclusion: The collecting data have demonstrated the clinical need to manage accurately old and apparently well-known drugs to grant a controlled clinical risk in hospitals. The implementation of Recommendation no 7 by Italian Ministry of Health and precise indications on medical reports of doses and timing in therapy are possible solutions to avoid bad interpretation on prescription and accidental paracetamol overdoses. Pharmacovigilance is a duty for health professionals and the awareness that also old drugs can be causes of toxicity is a substantial starting point for safety of care.