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Paracetamol is a commonly used and easily accessible drug with antipyretic and analgesic properties. Its overdose leads to severe liver failure. In diagnostic procedures, an important role is played by the determination of paracetamol concentration in blood serum, which not only confirms poisoning but also helps assess the risk of hepatotoxicity. The aim of this study was to retrospectively analyze the data on paracetamol concentration tests performed at the Toxicology Laboratory of the Ludwik Rydygier Provincial Polyclinic Hospital in Toruń between 2018–2022. The serum of patients suspected of poisoning was tested using the immunoassay method. The study demonstrated an upward trend in the number of paracetamol concentration tests performed. It was observed that the highest percentage of patients were female, and the largest age group ranged 3–17 years old. The positive paracetamol concentrations most often fell within toxic levels and were most frequently obtained from female patients.

Paracetamol, also known as acetaminophen, is a painkiller that is popular throughout the world because it does not irritate the stomach. Paracetamol was first discovered to have both analgesic and antipyretic properties in the late nineteenth century. The aim of present work was to Formulate, develop and evaluate Paracetamol Tablets by Moisture Activated Dry Granulation (MADG) process to short manufacturing time and process variables as compared with convention process. Colloidal anhydrous silica is used in the formulation to absorb the extra moisture present in the MADG process formulation. A total number of five formulations were prepared and weight of all tablets kept constant. i.e. 595 mg. All the formulations resulted in acceptable limit. The final batch F3 (contained PVPK 3% and Kollidon 90F 4%) considered as optimized batch which gives the release up to 95.38 % in 30 min. All Pre-compression parameters like Carr’s Index, Hausner’s Ratio and Angle of Repose met the standard values indicating good flow properties. The average weight, friability and hardness were within compendia limits. Drug content uniformity was within acceptable limits. The result of stability study of the batch F3 showed that there was no significant change in Hardness, Friability, In-vitro Disintegration time, The optimized formulation batch F3 showed better drug release profile with other formulations. The PCM tablets prepared by MADG process had advantages such as short manufacturing time and few critical formulation and process variables when compared with convention wet granulation process.

IntroductionAlthough the use of analgesics is generally not recommended during pregnancy, several studies have reported a high prevalence of use among pregnant women. In this study, we assessed the prevalence of early pregnancy use of analgesics in a Brazilian population, as well as potential sociodemographic and lifestyle predictors.MethodsPregnant women up to 16 weeks of gestation (N = 275) were recruited in Curitiba, Brazil, and specifically asked about the use of paracetamol, dipyrone, ibuprofen, acetylsalicylic acid, and diclofenac, including common brand names and indications.ResultsThe consumption of any analgesic up to the point of recruitment was reported by 61.5% of women, most commonly for the treatment of headaches. Paracetamol was the most used analgesic (55.3%), followed by dipyrone (13.5%) and ibuprofen (12%), and the use of more than one analgesic was reported by 18.5% of participants. The self-reported health status was a significant predictor. Women reporting fair/poor health were more likely to use any analgesic and paracetamol than those who reported good/excellent health status (OR = 3.05; 95% CI = 1.44–6.50). Among paracetamol users, women reporting the consumption of paracetamol and other analgesics ingested more paracetamol pills than those participants who reported the use of paracetamol-only. Similarly, the use of pharmaceuticals other than analgesics was also positively associated with the heavy use of paracetamol (OR = 3.70; 95% CI = 1.08–12.74).DiscussionOverall, the high prevalence of analgesic use during early pregnancy, particularly paracetamol and the combination of different analgesics, highlights the need for further research across different global regions and their potential implications for maternal and fetal health.

SummaryLapatinib is a tyrosine kinase inhibitor used for the treatment of breast cancer. Paracetamol is an analgesic commonly applied to patients with mild or moderate pain and fever. Cancer patients are polymedicated, which involves high risk of drug interactions during therapy. The aim of the study was to assess the interaction between lapatinib and paracetamol in rats. The rats were divided into three groups of eight animals in each. One group received lapatinib + paracetamol (IL + PA), another group received lapatinib (IIL), whereas the last group received paracetamol (IIIPA). A single dose of lapatinib (100 mg/kg b.w.) and paracetamol (100 mg/kg b.w.) was administered orally. Plasma concentrations of lapatinib, paracetamol and its metabolites – glucuronide and sulphate, were measured with the validated HPLC-MS/MS method and HPLC-UV method, respectively. The pharmacokinetic parameters of both drugs were calculated using non-compartmental methods. The co-administration of lapatinib and paracetamol increased the area under the plasma concentration-time curve (AUC) and the maximum concentration (Cmax) of lapatinib by 239.6% (p = 0.0030) and 184% (p = 0.0011), respectively. Lapatinib decreased the paracetamol AUC0-∞ by 48.8% and Cmax by 55.7%. In the IL + PA group the Cmax of paracetamol glucuronide was reduced, whereas the Cmax of paracetamol sulphate was higher than in the IIIPA group. Paracetamol significantly affected the enhanced plasma exposure of lapatinib. Additionally, lapatinib reduced the concentrations of paracetamol. The co-administration of lapatinib decreased the paracetamol glucuronidation but increased the sulphation. The findings of this study may be of clinical relevance to patients requiring analgesic therapy.

Drug poisoning is an important area of study in South Africa as a treatable cause of mortality. While research has been conducted on poisoning, there is a paucity of literature on the availability of antidotes in South Africa. The objectives of this study were to assess the availability of antidotes in selected teaching hospitals in the Southern Gauteng City-Region and to explore doctors' experiences of antidote supply. The availability of antidotes in the emergency departments (EDs) and pharmacies was assessed and recorded using a data sheet that was completed in person at each of the teaching hospitals. A questionnaire exploring experiences of antidote supply was distributed to 126 doctors working in the EDs. Our results indicate that N-acetylcysteine, atropine, diazepam, clonazepam, sodium bicarbonate, vitamin K, calcium gluconate, naloxone, ethanol, and pyridoxine were present in all EDs; activated charcoal was present in 80%; lorazepam, glycopyrrolate, and calcium chloride in 60%; freeze-dried plasma in 40%; glucagon and desferrioxamine in 20%; and fresh frozen plasma, hydroxocobalamin, sodium nitrite, sodium thiosulfate, sodium calcium edetate, and intralipid were not present in any of the EDs. Doctors reported organophosphate poisoning and paracetamol overdose as the most common drug poisonings (81.7% and 14.3% of 126 respondents, respectively). Most doctors experienced no supply issues for N-acetylcysteine, calcium gluconate, sodium bicarbonate, or pyridoxine (85.7%, 83.3%, 87.3%, and 75.4% of 126 respondents, respectively). The antidotes to the most common poisonings reported by doctors were present in all EDs. However, concerns were raised about consistency of supply, which will be an important avenue for further research.Significance: • These findings highlight the lack of uniform availability of antidotes to common and critical drug poisonings in emergency departments. • The experiences of doctors in Gauteng concerning the most commonly encountered poisonings contrast with existing literature from South Africa, suggesting regional differences within the country.

The aim of this study was to evaluate the effect of paracetamol on patent ductus arteriosus (PDA) closure and clinical outcomes in preterm infants when used as standard intermittent bolus and continuous intravenous (IV) infusion. Preterm neonates with birth weight (BW) ≤ 1500 g and gestational age (GA) ≤ 30 weeks were included in this study. During the study period, IV paracetamol therapy was given to all infants with hemodynamically significant patent ductus arteriosus (hsPDA). The patients were divided into the standard IV intermittent bolus infusion group and the continuous IV infusion group. Standard IV intermittent bolus paracetamol therapy was administered in the form of 15-mg/kg doses as 1-h infusions every 6 h for 5 days, while continuous IV paracetamol infusion therapy was administered as a 60-mg/kg/day dose continuously for 5 days. During the study period, 247 patients were evaluated, of which a total of 137 patients with hsPDA were included. There were no significant differences between the intermittent bolus and continuous infusion groups in terms of mean GA or BW. The continuous paracetamol infusion group had significantly higher rates of PDA-related morbidities, multiple paracetamol courses, and PDA ligation procedure compared with the standard intermittent bolus group.Conclusion: Our results were the first in the literature to compare IV paracetamol infusion regimens for PDA. Our results indicate that standard intermittent bolus infusion is still the most appropriate IV paracetamol regimen for the treatment of PDA.Trial registration: ClinicalTrials.gov Identifier: NCT04469413What is Known:• Paracetamol has been proposed for the treatment of patent ductus arteriosus in preterm neonates.• There is no consensus on the duration and form of administration of paracetamol in hsPDA, and the information on this issue is insufficient.What is New:• Our study was the first in the literature to compare IV paracetamol infusion regimens for PDA.• Standard intravenous intermittent bolus paracetamol infusion was more effective in pharmacologic PDA closure compared with continuous intravenous paracetamol infusion and was associated with lower rates of PDA-related BPD, NEC, and need for ligation.

Paracetamol, ibuprofen and aspirin are among the most commonly used human analgesics, and antipyretics and ibuprofen and aspirin have antiphlogistic effect. They are found in every household all over the world. People use them every day to treat their pain or fever, and ibuprofen and aspirin to reduce inflammation. Dog owners often use these effective drugs to treat their pets, mostly dogs. They are not aware of their harmful effect on the health of their dogs and have no idea about the risks of poisoning. Intoxication of a dog with these human medicines can end in its death. The article provides a summary of basic information about the clinical symptoms of toxicosis caused by ibuprofen, aspirin and paracetamol in dogs and about their treatment.

ObjectiveThe aim of this study was to provide an overview of the recommendations regarding the diagnosis and treatment contained in current clinical practice guidelines for patients with non-specific low back pain in primary care. We also aimed to examine how recommendations have changed since our last overview in 2010.MethodThe searches for clinical practice guidelines were performed for the period from 2008 to 2017 in electronic databases. Guidelines including information regarding either the diagnosis or treatment of non-specific low back pain, and targeted at a multidisciplinary audience in the primary care setting, were considered eligible. We extracted data regarding recommendations for diagnosis and treatment, and methods for development of guidelines.ResultsWe identified 15 clinical practice guidelines for the management of low back pain in primary care. For diagnosis of patients with non-specific low back pain, the clinical practice guidelines recommend history taking and physical examination to identify red flags, neurological testing to identify radicular syndrome, use of imaging if serious pathology is suspected (but discourage routine use), and assessment of psychosocial factors. For treatment of patients with acute low back pain, the guidelines recommend reassurance on the favourable prognosis and advice on returning to normal activities, avoiding bed rest, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and weak opioids for short periods. For treatment of patients with chronic low back pain, the guidelines recommend the use of NSAIDs and antidepressants, exercise therapy, and psychosocial interventions. In addition, referral to a specialist is recommended in case of suspicion of specific pathologies or radiculopathy or if there is no improvement after 4 weeks. While there were a few discrepancies across the current clinical practice guidelines, a substantial proportion of recommendations was consistently endorsed. In the current review, we identified some differences compared to the previous overview regarding the recommendations for assessment of psychosocial factors, the use of some medications (e.g., paracetamol) as well as an increasing amount of information regarding the types of exercise, mode of delivery, acupuncture, herbal medicines, and invasive treatments.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.