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Tylenol Extended Relief overdose

E W Cetaruk1, R C Dart, K M Hurlbut

  • 1Rocky Mountain Poison Center, Denver, CO, USA.

Annals of Emergency Medicine
|July 1, 1997
PubMed
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Tylenol Extended Relief (TER) acetaminophen overdose shows prolonged absorption in some patients. A single acetaminophen level measurement may miss toxicity, necessitating a second measurement for accurate assessment.

Area of Science:

  • Pharmacology
  • Toxicology
  • Clinical Medicine

Background:

  • Acetaminophen overdose is a common clinical problem.
  • Tylenol Extended Relief (TER) is a formulation of acetaminophen designed for prolonged drug release.
  • Understanding the toxicokinetics of TER overdose is crucial for appropriate patient management.

Purpose of the Study:

  • To investigate the toxicokinetics of Tylenol Extended Relief (TER) acetaminophen in human overdose cases.
  • To determine if the absorption and elimination profiles of TER differ from immediate-release acetaminophen.
  • To inform clinical guidelines for managing TER overdose.

Main Methods:

  • Retrospective analysis of 41 human overdose cases involving TER.
  • Inclusion criteria: single TER ingestion, confirmed ingestion time, at least four acetaminophen levels, normal liver function tests.

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  • Treatment with N-acetylcysteine (NAC) guided by the Rumack-Matthew nomogram.

    • Main Results:

    • The acetaminophen elimination half-life in TER overdose was similar to immediate-release acetaminophen (3.1 +/- 0.8 hours).
    • However, in a subgroup of patients, drug absorption continued beyond 4 hours post-ingestion.
    • Some patients initially below the 'possible toxicity' line later exceeded it, indicating delayed absorption.

    Conclusions:

    • The elimination half-life of TER acetaminophen is comparable to immediate-release formulations.
    • Delayed absorption beyond 4 hours can occur with TER, potentially leading to underestimation of toxicity with single measurements.
    • Serial acetaminophen level monitoring, with a second measurement 4-6 hours after the first (if taken 4-8 hours post-ingestion), is recommended for TER overdose.