Smaller Pack Sizes Reduce Paracetamol Deaths

The number of deaths and liver transplants due to paracetamol (acetaminophen) overdoses has been significantly reduced thanks to legislation to make pack sizes smaller, according to a new study.

Researchers at the University of Oxford (United Kingdom), King’s College Hospital (London, United Kingdom), and other institutions investigated the long-term impact of legislation implemented in September 1998 by the UK Government which restricted pack sizes to a maximum of 32 tablets through pharmacy sales, and 16 for nonpharmacy sales. The researchers reviewed data in England and Wales on poisoning deaths between 1993 and 2009 and liver unit registrations and transplantations for paracetamol induced hepatotoxicity between 1995 and 2009.

The results showed that compared with the prelegislation level, an estimated average reduction of 17 deaths per quarter involving paracetamol alone (with or without alcohol) that received suicide or undetermined verdicts. This decrease represented a 43% reduction (765 fewer deaths) over the 11¼ years after the legislation. A similar effect was found when accidental poisoning deaths were included, and when a conservative method of analysis was used. There was also a 61% reduction in registrations for liver transplantation for paracetamol-induced hepatotoxicity, but no reduction was seen in actual transplantations, nor in registrations after a conservative method of analysis was used.

“In spite of the apparent benefits, there continues to be a considerable number of deaths each year due to paracetamol poisoning, at an average of 121 per year,” concluded lead author Professor of psychiatry Keith Hawton, DSc, director of the University of Oxford center for suicide research, and colleagues. “Further measures may be required to limit this death toll including stronger enforcement of the legislation, further reduction in pack sizes, and possibly a reduction in paracetamol content of tablets.”

Paracetamol is classified as a mild analgesic, commonly used for the relief of headaches and other minor aches and pains, and is a major ingredient in numerous cold and flu remedies. Paracetamol hepatotoxicity is, by far, the most common cause of acute liver failure in both the United States and the United Kingdom, and is the result of its quinone metabolite. In many countries, self-poisoning with paracetamol is a common method of suicide and nonfatal self-harm, and is also responsible for many accidental deaths.

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University of Oxford
King’s College Hospital