Talk:Paracetamol
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Paracetamol or acetaminophen?
I could not find any information about standard dosage amounts in the UK when sold as paracetamol. Is it similar to the US?
I believe acetaminophen is mainly just an American usage and the rest of the world and official authorities use paracetamol ?
Kpjas 14:39 May 13, 2003 (UTC)
- Yeah, in New Zealand we call in paracetamol, and it doesn't contain any codeine. Paracetamol is the name of the chemical by itself. Tristanb 09:21 27 May 2003 (UTC)
- acetaminophen doesn't contain any codeine either. acetaminophen is the generic USAN name. All USAN names are generic and refer just to the chemical itself -Nathan J. Yoder 14:55, 29 Apr 2005 (UTC)
- Well, in Canada, it is called acetaminophen as well. I take "American" to mean USA not North America.
RedWolf 05:28, Nov 20, 2003 (UTC)
- The World Health Organisation's list of recommended International Non-proprietary Names (rINNs) lists paracetamol. I believe acetaminophen is now only listed in the United States "Pharmacopeia" (as all European Union members use the rINNs in the European Pharmacopoeia). Much of the world recognises the British Pharmacopoeia, which has now standardised with the European Pharmacopoeia. (Just a quick explanation: pharmaceutical non-proprietary names are usually definitively listed in a pharmacopoeia such as the EP, BP or USP). Techelf 10:55, 27 Jun 2004 (UTC)
So why does the article repeatedly refer to acetaminophen if paracetamol is the correct international name? Shouldn't this be changed? Dan100 10:03, Dec 19, 2004 (UTC)
In accordance with Wikipedia:WikiProject_Drugs naming policy, I propose we move this page to the INN paracetamol. If you have any concern with this proposal, please discuss it on this page. Matt 17:55, 24 Dec 2004 (UTC)
None, I agree it should be moved. Dan100 17:59, Dec 24, 2004 (UTC)
Chicago poisoning event
This might be a good place to put in a discussion of the 1980's deliberate poisoning event that occurred in the Chicago area -- multiple deaths. No time right now, but this would also be a cross link to terrorism, crime, etc.
- I put the general history of the poisoning in. Not sure how to word it to link it in to terrorism or crime. Ksheka 22:06, Apr 14, 2004 (UTC)
This article conains a factual innacuracy. According to http://www.assistpainrelief.com/info/paracetamol/ Paracetomol is not a NSAID G-Man 23:46, 2 Nov 2003 (UTC)
- Not really, read more clearly, its written that aspirin and ibuprofen are NSAIDs
Sorry if I hijacked this page a bit. I changed the graphic of the structure to make it look better (The word "Acetaminophen" is no longer part of the picture -- This should display better in most browsers).
I also plan to add quite a bit in the next week about Tylenol overdose, treatment of Tylenol overdose, and stuff like that.
A side-effect of this is that the article (at least the overdose section) is going to be a bit more oriented to those with a technical/ scientific/ chemical/ physiological/ medical background.
Any objections? Ksheka 00:05, Apr 12, 2004 (UTC)
- Nope. Just a round of applause for a thorough and informative addition. I learned some things I did not previously know - and that's what it's all about. Thanks! Pollinator 12:55, 13 Apr 2004 (UTC)
- Thanks. I found it kind of fun. :-) I had some of it already written as part of a handout I gave students. It's nice to put it where anyone can gain from it. I'll try to fill out some of the empty links (ie: the coagulation factors) in the next couple weeks. Ksheka 02:07, Apr 14, 2004 (UTC)
- Okay. I added the overdose section. The length of the section overwhelms the entire article. I'd rather not cut parts of it out. Maybe, in the future, the rest of the article will expand.
- I will try to make some subsections out of it, however.
- Ksheka 12:18, Apr 13, 2004 (UTC)
General agreement on activated charcoal
What is the evidence that that is widely agreed upon? Kd4ttc 23:09, 11 May 2004 (UTC)
Featured article candidate
I'm nominating this article for featured article (see top of this page). Ksheka 22:29, May 8, 2004 (UTC)
It seems that this article has been copied (http://www.sciencedaily.com/encyclopedia/acetaminophen) (with a citation back to the wiki). I'm flattered! Ksheka 14:36, May 9, 2004 (UTC)
- well done! --e 22:44, 9 May 2004 (UTC)
I recommend changing the text of ==Treatment== to not say "Mucomyst". This is a brand name that isn't the same worldwide. In Singapore, for instance, intravenous N-acetylcysteine is known as "Parvolex". IMHO, I think it's better to go with an acronym like NAC instead of Mucomyst. Alex.tan 18:26, 9 May 2004 (UTC)
- Taken care of. Thanks for the idea. Ksheka 22:00, May 9, 2004 (UTC)
these are a few musing that could be integrated:
- because of widespread availability it's effectiveness is often underestimated
- Added to the Overview section. Ksheka 11:52, May 10, 2004 (UTC)
- need to emphasise need for early Px of OD
- ? mention phenomenom of deliberate od --> no effects --> remorse and desire to live ---> fulminant hepatic failure ---> death after a few weeks ???
- Added to the Natural history section. Ksheka 11:52, May 10, 2004 (UTC)
- There's actually two different scenarios. If someone more elequoent that I would like to write them up, I would be much obligded. :-) Ksheka 01:33, May 10, 2004 (UTC):
- An individual ingests acetaminophen in a suicide attempt, changes their mind, and then develops hepatic necrosis
- An individual ingests acetaminophen, not as a suicide attempt, but just as a call for attention. They choose acetaminophen because they think it's harmless. Then they develop hepatic necrosis.
- can be taken in combination with NSAIDs providing additive analgesic effects
- ???used to be recomended prophylacticly before childhood immunistations but not any more?? don't know details or why thinking changed... ?alex? --e 22:44, 9 May 2004 (UTC)
- I'm not sure. My baby's pediatrician tells us to take it. :-) Ksheka 01:33, May 10, 2004 (UTC)
There was a question about the 150 mg/kg number. I don't recall where I got it from, but a google result came up with this (http://lib-sh.lsumc.edu/fammed/intern/aceta.html). Ksheka 00:14, May 10, 2004 (UTC)
History
This page has a bit of history of acetaminophen. Googling for some of the names & terms on this page should find more information. http://www.assistpainrelief.com/info/paracetamol/
Ksheka 02:55, May 14, 2004 (UTC)
- Added to article page. Ksheka 02:01, May 15, 2004 (UTC)
Featured article
This article has gone through the review and is now a featured article. Congrats, everyone! Ksheka 20:05, May 16, 2004 (UTC)
Splitting the page
what do people think about splitting the toxicity out of this page into a separate article? I think toxicity is so common and so well covered it is deserving of going solo! Erich 04:35, 14 Jun 2004 (UTC)
On toxicity - is it possible to tone down the medical language somewhat? For instance, I have no idea what "gastric lavage" is beyond schoolboy Latin which tells me it's a "bowel wash" of some kind. Similarly we could just say "liver poisoning" for "hepatotoxicity".
What would be very good (for the very keen) is some kind of diagram of the metabolism of the stuff.
NSAID?
In http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11113024&dopt=Abstract I read that acetaminophen is counted among the NSAIDs, yet our articles claims otherwise. AxelBoldt 20:00, 21 Oct 2004 (UTC)
- Some people group paracetamol as an NSAID because of its mechanism of action. However, since paracetamol has no appreciable antiinflammatory effect, it would be inappropriate to classify it as an NSAID. (see NSAID for more details). Techelf 08:06, 4 Nov 2004 (UTC)
Isoniazid
I removed the reference to isoniazid and stimulation of cytochrome P450. Isoniazid actually inhibits cytochrome P450 (perhaps there was confusion with rifampicin?). The mechanism of isoniazid-induced hepatotoxicity is not fully understood. Isoniazid is metabolized by N-acetyltranferase. The gene for this enzyme has polymorphisms that cause variation in the enzyme's activity. These different phenotypes are commonly called 'slow acetylators' and 'fast acetylators'. Once the acetylation pathway becomes saturated, metabolism switches to cytochrome P450. Slow acetylators typically have a higher incidence of hepatotoxicity, probably because the cytochrome P450 degradation products are toxic. [Cytochrome P450 inducers, such as barbiturates and rifampicin, lead to increased risk of isoniazid toxicity.] Isoniazid does increase the risk of paracetamol toxicity, but this is probably due to an additive effect of isoniazid degradation products with NABQI. Axl 17:08, 10 Nov 2004 (UTC)
- Isoniazid is an inducer of CYP2E1 [1] (http://medicine.iupui.edu/flockhart/table.htm). In any case I've put additional references in the main article concerning interactions. You are right though about the complexity of isoniazid-induced hepatotoxicity; it seems that the hepatotoxicity of the combination with paracetamol may not necessarily relate to CYP2E1 induction. Techelf 07:22, 11 Nov 2004 (UTC)
- I accept that my claim that isoniazid is an inhibitor of cytochrome P450 is simplistic. Isoniazid inhibits CYP1A2, 2A6, 2C9, 2C19 and 3A (and probably many others). However even your reference is too simplistic. Isoniazid has a complex interaction with CYP2E1, involving first induction, later followed by inhibition.
[2] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=8354023&dopt=Abstract)
[3] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15528841)
[4] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12668988)
Axl 12:20, 11 Nov 2004 (UTC)
NSAID side-effects
"Unlike NSAIDs, in normal doses acetaminophen does not irritate the lining of the stomach, or affect blood coagulation, the kidneys or the fetal ductus arteriosus." - that seems to imply that those side-effects are possible with normal dosages of NSAIDs, which I don't believe to be true (only true with extraordinary high doses or prolonged usage). Should the sentence be revised? Dan100 23:41, Dec 17, 2004 (UTC)
- Dan, NSAIDs can cause those side-effects at normal doses. Of course, the risk is increased with high doses or prolonged use. Axl 10:05, 18 Dec 2004 (UTC)
- Especially considering what Americans think are "normal" doses of NSAIDs... =) (often twice what we use in the rest of the world) -Techelf 11:17, 18 Dec 2004 (UTC)
Well, this is the English-language wikipedia, not the American one ;). Axl, yes NSAIDs can cause those side-effects. That doesn't mean they do. A very important difference. I think I should've been clearer - while GIT irritation is possible with NSAID use, it doesn't happen every time you take one, so the statement is incorrect and misleading. Also, only aspirin affects blood coagulation, not all NSAIDs. Dan100 16:54, Dec 18, 2004 (UTC)
Well, I rephrased the line to imply 'can' instead of 'do'. What do people think? Dan100 10:03, Dec 19, 2004 (UTC)
- From Patrono C et al. Platelet-activating drugs: the relationships among dose, effectiveness and side effects. Chest 2001;119:Suppl.39S-63S.
- "A variety of NSAIDs can inhibit TXA2-dependent platelet function through competitive, reversible inhibition of platelet COX-1. In general, these drugs, when used at conventional analgesic dosages, inhibit reversibly platelet COX activity by 70 to 90%. This level may be insufficient to block adequately platelet aggregation in vivo because of the very substantial biosynthetic capacity of human platelets to produce TXA2.... The only reversible COX inhibitors that have been tested in randomized clinical trials for their antithrombotic efficacy are sulfinpyrazone, indobufen, flurbiprofen, and triflusal.... The conflicting or negative results obtained in randomized clinical trials of sulfinpyrazone in patients with MI or unstable angina are not surprising in light of the drug being a weak COX inhibitor with no other established antiplatelet mechanism of action. In contrast, indobufen is a very potent inhibitor of platelet COX activity.... Thus, at therapeutic plasma levels achieved after oral dosing of 200 mg qid, indobufen inhibits TXB2 by >95% throughout the dosing interval and reduces urinary TXA2 metabolite excretion to an extent quite comparable to aspirin."
- The article also discusses antiplatelet effects of flurbiprofen and triflusal. [The split infinitives were included by the author. ;-) ]
- To summarise, some NSAIDs may cause significant platelet inhibition, even at standard doses. Axl 18:53, 20 Dec 2004 (UTC)
Dan, regarding your recent edit, it is fine. Axl 19:04, 20 Dec 2004 (UTC)
I stand corrected on the coagulation issue! Dan100 23:15, Dec 20, 2004 (UTC)
Aspirin Reference
"While aspirin acts as a competitive inhibitor of COX..."
I believe aspirin permanently acetylates COX enzymes, rather than inhibiting it by competition with it's natural substrate (the page on aspirin - [5] (http://en.wikipedia.org/wiki/Aspirin) - appears to agree)
- It is irreversible, and the main article has been corrected. -Techelf 11:51, 12 May 2005 (UTC)
Two wikiprojects are relevant: Drugs and Chemicals
The paracetamol article is listed both in the Drugs wikiproject as well as the Chemicals wikiproject. Both wikiprojects have developed a standardized infobox for providing drugs cq. chemical data information. Obviously they are different. How should this be handled: both infoboxes, merged infoboxes, the largest infobox (= Chemicals). My preference goes to completeness, i.e., do the Chemicals infobox and specially include the (only 4) extra entries of the Drugs infobox. How to people feel. This is a FA already, so I'm hesitant in doing this boldly. Wim van Dorst 13:59, 2005 Jun 4 (UTC).