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Acetaminophen is a commonly used analgesic; excessive doses can lead to liver damage. We sought to determine the proportion of acetaminophen users exceeding the recommended maximum daily dose of 4 g and identify correlates of such behavior.U.S. adults were recruited from an internet panel in summer 2010, oversampling past 30-day acetaminophen users. Among 47 738 starting the study, 5649 completed all phases; individuals with low education were underrepresented. Subjects completed a 7-day daily diary online, reporting intake of acetaminophen products selected from a comprehensive list; total daily dose was computed from product names. An exit survey elicited: attitudes/knowledge related to product ingredients, label reading, dosing behavior; demographics, medical history, general physical, and mental health status. Unconditional logistic regression identified variables independently associated with use exceeding 4 g.Among 3618 acetaminophen users, 163 took4 g on ≥1 day (4.5%); the median dose was 5.5 g; 26 took8 g (0.7%).4-g users were characterized by chronic pain, poor physical status, and heavy use of medical care. Knowledge of ingredients and recommended OTC doses for all products taken was inversely associated with4-g use (multivariable odds ratios [ORs] = 0.5-0.6), as was the attitude to start with the lowest dose (OR = 0.6). The attitude that users could choose their own dose was positively associated (OR = 1.3).The results estimate the proportion of acetaminophen users exceeding 4 g in a group of U.S. adults, identify potentially modifiable attitudes and knowledge associated with such use, and characterize subpopulations at higher risk.

To estimate the rate of emergency department (ED) visits attributed to selected analgesic-containing medications.We used a nationally representative public health surveillance system to provide estimates of adverse events identified in EDs, and a national telephone survey to provide estimates of selected analgesic-containing medication usage in the US population, 2004-2005. Analysis was restricted to products containing acetaminophen, aspirin, ibuprofen, or naproxen. Types of adverse events and outcomes were compared. Estimated numbers and rates of ED visits were calculated by analgesic groupings and patient age groups.The estimated overall rate of ED visits attributed to analgesic-containing medications was 1.6 visits /100,000 users per week. The very old and very young had the highest rates; there were minimal differences in rates by patient gender. Acetaminophen was the attributed drug with the most estimated ED visits and generally had the highest rates of ED visits. The highest estimated rate for a specific product group was among subjects 18-64 years of age taking narcotic-acetaminophen products (8.9 ED visits /100,000 users per week). Overall, 12% of patients presenting to EDs with analgesic-attributed events were hospitalized.Rates of ED visits due to analgesics vary depending on the age of the patient and the product; most do not result in hospitalization. Although the rate of emergency visits is relatively low, because of the wide use of the analgesics, public health impact is considerable.