Paracetamol prescribing in primary care

too little and too much?

Ammar Kazouini, Baba S. Mohammed, Colin R. Simpson, Peter J. Helms, James S. McLay

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

AIMS

To assess the level of paracetamol off label prescribing in the community and the potential for paracetamol under or overdosing.

METHODS

The Scottish Practice Team Information (PTI) database containing prescribing data for approximately 35 839 children aged (0-12 years) was analysed for paracetamol prescriptions for the year 2006. Off label prescribing was defined as prescribing outside the BNFc age and dose recommendations.

RESULTS

Two thousand seven hundred and sixty-one children aged 0-12 years were issued with 4423 prescriptions for paracetamol. (1446 males). Children 1-5 years (1329, 42.2%) accounted for 48.9% (2164) of all paracetamol prescriptions. Eighteen per cent (793) of individual prescriptions were off label and after accounting for repeat prescriptions 625 (22.75%) individuals were exposed to off label prescriptions. A further 15% (668) of prescriptions contained insufficient dosage data to determine their status, 13.3% (368) being underdosed and 4.4% (121) overdosed at least once during the study year. In total 11.3% (502) of all prescriptions were classified as underdose, 2.9% (127) as overdose and 15% (667) had no dosage instructions. Age was significantly related to non recommended dosage (chi(2) test, P < 0.001). Children 1-3 months old were at highest risk of being overdosed; 27% of prescriptions recommended actual or potential overdosage and 25% (354) of children aged 6-12 years were prescribed an actual or potential underdose. Overall 57.2% of all prescriptions failed to comply with current BNFc recommendations.

CONCLUSION

Paracetamol off label prescribing is common in primary care, with relatively high levels of potential overdosing in the youngest children and potential underdosing in the oldest children.

Original languageEnglish
Pages (from-to)500-504
Number of pages5
JournalBritish Journal of Clinical Pharmacology
Volume72
Issue number3
Early online date8 Aug 2011
DOIs
Publication statusPublished - Sep 2011

Keywords

  • children
  • off label
  • overdose
  • paracetamol
  • underdose
  • acetaminophen overdose
  • drug-use
  • hepatotoxicity
  • infants

Cite this

Paracetamol prescribing in primary care : too little and too much? / Kazouini, Ammar; Mohammed, Baba S.; Simpson, Colin R.; Helms, Peter J.; McLay, James S.

In: British Journal of Clinical Pharmacology, Vol. 72, No. 3, 09.2011, p. 500-504.

Research output: Contribution to journalArticle

Kazouini, Ammar ; Mohammed, Baba S. ; Simpson, Colin R. ; Helms, Peter J. ; McLay, James S. / Paracetamol prescribing in primary care : too little and too much?. In: British Journal of Clinical Pharmacology. 2011 ; Vol. 72, No. 3. pp. 500-504.
@article{93152ca2c7b7406587ff652ac03a339e,
title = "Paracetamol prescribing in primary care: too little and too much?",
abstract = "AIMSTo assess the level of paracetamol off label prescribing in the community and the potential for paracetamol under or overdosing.METHODSThe Scottish Practice Team Information (PTI) database containing prescribing data for approximately 35 839 children aged (0-12 years) was analysed for paracetamol prescriptions for the year 2006. Off label prescribing was defined as prescribing outside the BNFc age and dose recommendations.RESULTSTwo thousand seven hundred and sixty-one children aged 0-12 years were issued with 4423 prescriptions for paracetamol. (1446 males). Children 1-5 years (1329, 42.2{\%}) accounted for 48.9{\%} (2164) of all paracetamol prescriptions. Eighteen per cent (793) of individual prescriptions were off label and after accounting for repeat prescriptions 625 (22.75{\%}) individuals were exposed to off label prescriptions. A further 15{\%} (668) of prescriptions contained insufficient dosage data to determine their status, 13.3{\%} (368) being underdosed and 4.4{\%} (121) overdosed at least once during the study year. In total 11.3{\%} (502) of all prescriptions were classified as underdose, 2.9{\%} (127) as overdose and 15{\%} (667) had no dosage instructions. Age was significantly related to non recommended dosage (chi(2) test, P < 0.001). Children 1-3 months old were at highest risk of being overdosed; 27{\%} of prescriptions recommended actual or potential overdosage and 25{\%} (354) of children aged 6-12 years were prescribed an actual or potential underdose. Overall 57.2{\%} of all prescriptions failed to comply with current BNFc recommendations.CONCLUSIONParacetamol off label prescribing is common in primary care, with relatively high levels of potential overdosing in the youngest children and potential underdosing in the oldest children.",
keywords = "children, off label, overdose, paracetamol, underdose, acetaminophen overdose, drug-use, hepatotoxicity, infants",
author = "Ammar Kazouini and Mohammed, {Baba S.} and Simpson, {Colin R.} and Helms, {Peter J.} and McLay, {James S.}",
year = "2011",
month = "9",
doi = "10.1111/j.1365-2125.2011.03993.x",
language = "English",
volume = "72",
pages = "500--504",
journal = "British Journal of Clinical Pharmacology",
issn = "0306-5251",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Paracetamol prescribing in primary care

T2 - too little and too much?

AU - Kazouini, Ammar

AU - Mohammed, Baba S.

AU - Simpson, Colin R.

AU - Helms, Peter J.

AU - McLay, James S.

PY - 2011/9

Y1 - 2011/9

N2 - AIMSTo assess the level of paracetamol off label prescribing in the community and the potential for paracetamol under or overdosing.METHODSThe Scottish Practice Team Information (PTI) database containing prescribing data for approximately 35 839 children aged (0-12 years) was analysed for paracetamol prescriptions for the year 2006. Off label prescribing was defined as prescribing outside the BNFc age and dose recommendations.RESULTSTwo thousand seven hundred and sixty-one children aged 0-12 years were issued with 4423 prescriptions for paracetamol. (1446 males). Children 1-5 years (1329, 42.2%) accounted for 48.9% (2164) of all paracetamol prescriptions. Eighteen per cent (793) of individual prescriptions were off label and after accounting for repeat prescriptions 625 (22.75%) individuals were exposed to off label prescriptions. A further 15% (668) of prescriptions contained insufficient dosage data to determine their status, 13.3% (368) being underdosed and 4.4% (121) overdosed at least once during the study year. In total 11.3% (502) of all prescriptions were classified as underdose, 2.9% (127) as overdose and 15% (667) had no dosage instructions. Age was significantly related to non recommended dosage (chi(2) test, P < 0.001). Children 1-3 months old were at highest risk of being overdosed; 27% of prescriptions recommended actual or potential overdosage and 25% (354) of children aged 6-12 years were prescribed an actual or potential underdose. Overall 57.2% of all prescriptions failed to comply with current BNFc recommendations.CONCLUSIONParacetamol off label prescribing is common in primary care, with relatively high levels of potential overdosing in the youngest children and potential underdosing in the oldest children.

AB - AIMSTo assess the level of paracetamol off label prescribing in the community and the potential for paracetamol under or overdosing.METHODSThe Scottish Practice Team Information (PTI) database containing prescribing data for approximately 35 839 children aged (0-12 years) was analysed for paracetamol prescriptions for the year 2006. Off label prescribing was defined as prescribing outside the BNFc age and dose recommendations.RESULTSTwo thousand seven hundred and sixty-one children aged 0-12 years were issued with 4423 prescriptions for paracetamol. (1446 males). Children 1-5 years (1329, 42.2%) accounted for 48.9% (2164) of all paracetamol prescriptions. Eighteen per cent (793) of individual prescriptions were off label and after accounting for repeat prescriptions 625 (22.75%) individuals were exposed to off label prescriptions. A further 15% (668) of prescriptions contained insufficient dosage data to determine their status, 13.3% (368) being underdosed and 4.4% (121) overdosed at least once during the study year. In total 11.3% (502) of all prescriptions were classified as underdose, 2.9% (127) as overdose and 15% (667) had no dosage instructions. Age was significantly related to non recommended dosage (chi(2) test, P < 0.001). Children 1-3 months old were at highest risk of being overdosed; 27% of prescriptions recommended actual or potential overdosage and 25% (354) of children aged 6-12 years were prescribed an actual or potential underdose. Overall 57.2% of all prescriptions failed to comply with current BNFc recommendations.CONCLUSIONParacetamol off label prescribing is common in primary care, with relatively high levels of potential overdosing in the youngest children and potential underdosing in the oldest children.

KW - children

KW - off label

KW - overdose

KW - paracetamol

KW - underdose

KW - acetaminophen overdose

KW - drug-use

KW - hepatotoxicity

KW - infants

U2 - 10.1111/j.1365-2125.2011.03993.x

DO - 10.1111/j.1365-2125.2011.03993.x

M3 - Article

VL - 72

SP - 500

EP - 504

JO - British Journal of Clinical Pharmacology

JF - British Journal of Clinical Pharmacology

SN - 0306-5251

IS - 3

ER -