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Observational Study
. 2022 Oct;88(10):4565-4572.
doi: 10.1111/bcp.15394. Epub 2022 May 23.

Paracetamol dosing in hospital and on discharge for older people who are frail or have low body weight

Olivia Reid  1 , Janet Ngo  1 , Samanta Lalic  1   2   3 , Elizabeth Su  1 , Rohan A Elliott  1   2   4
Affiliations
Observational Study

Paracetamol dosing in hospital and on discharge for older people who are frail or have low body weight

Olivia Reid et al. Br J Clin Pharmacol. 2022 Oct.

Abstract

Aims: To describe paracetamol dosing and liver function test (LFT) monitoring in older hospital inpatients who are frail or have low body weight.

Methods: Retrospective observational study, at a 790-bed metropolitan public health service in Australia. Patients aged ≥70 years, with body weight <50 kg or frailty index based on laboratory data (FI-Lab) score ≥0.3, who were administered paracetamol during an admission with length-of-stay >72 hours, were included. Data were extracted from electronic medical records. Paracetamol doses administered in hospital, and doses prescribed on discharge, were compared against consensus guidelines that recommended ≤60 mg/kg/d for older people weighing <50 kg, and ≤3000 mg/d for frail older people.

Results: In total, 240 admissions (n = 229 patients, mean age 84.7 years) were analysed. During 150 (62.5%) admissions, higher than recommended paracetamol doses were prescribed. On 138 (57.5%) occasions, patients were prescribed paracetamol on discharge, and 112/138 (81.2%) doses were higher than recommended. Most discharge prescriptions (97/138, 70.3%) were for regular administration. The median daily dose on discharge for patients <50 kg was 83.7 mg/kg (interquartile range 73.6-90.9 mg/kg). For frail patients ≥50 kg, the median daily discharge dose was 3990 mg (interquartile range 3000-4000 mg). LFTs were measured in hospital for 151/200 (75.5%) and 93/166 (56.0%) patients who received paracetamol for >48 hours and >5 days, respectively.

Conclusion: Majority of paracetamol doses prescribed for frail or low-weight older patients in hospital and on discharge were higher than recommended in consensus guidelines. LFTs were not measured for 44% patients who received paracetamol regularly for >5 days. Further studies are needed to explore long-term outcomes of this practice.

Keywords: acetaminophen (paracetamol); aged; frail elderly; inpatients; prescriptions.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Patient selection. FI‐Lab = Frailty Index based on laboratory and physiological test data. *Aged >70 years, not admitted under palliative care or psychiatry units or for an elective procedure, length‐of‐stay >72 hours
See this image and copyright information in PMC

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