Impact of regulations on paracetamol overdoses between 2018 and 2021: Retrospective monocentric study in a French university hospital

Abstract

Objective

In early 2020 in France, two regulatory measures have been applied in order to limit access to paracetamol and occurrence of overdose: withdrawal of open access in pharmacy and warning message on medicine boxes about the hepatic risk in case of paracetamol overdose. So far, the impact of these measures has not been evaluated.

Method

Therefore, we analyzed every paracetamol overdose, confirmed by a plasma dosage > 50 mg/L at the 12th hour (toxicity line in the Prescott chart), performed at the Grenoble University Hospital, two years before (2018–2019) and after (2020–2021) the regulatory measures.

Results

In total, 324 paracetamol overdoses were included. 176 occurred before the regulatory measures and 148 after. Sex ratio was largely female, 3.8 before and 2.8 after the regulatory measures. The mean age is young and similar over the 2 period: 29.5 years-old. Pediatric overdoses (under 18 years of age) represented 29% of all overdoses, stable over the 2 periods. The median value of plasma paracetamol dosage was similar during the 2 periods: 100 mg/L, but more severe overdoses (paracetamol plasma dosage up to 946 mg/L) occurred after the regulatory measures.

Discussion

This before/after analysis of paracetamol overdoses between 2018 and 2021 in a French university hospital showed a reduction of 8%. However, the confinement in 2020 due to the COVID-19 pandemic could affect this result. The significant proportion of poisonings in pediatrics could be explained by an increase in voluntary poisonings among adolescents and administration errors by parents to children. The reason for the poisoning, voluntary or not, and the clinical consequences were not known. It would be interesting to carry out the same study in other university hospitals, over a longer period and with clinical data.

Conclusion

Other preventive measures could target patient education on the maximum dose, or on medical prescription of paracetamol compulsory.