Nonopioid Analgesics

Acetaminophen is the most common toxic ingestion in the United States, causing 400 deaths per year. Poisoning occurs both intentionally and unintentionally, with suicidal intent, overuse for treatment of pain, and ingestion of multiple medications containing acetaminophen all contributing. Aspirin poisoning remains a concern even though its popularity as an analgesic and antipyretic has decreased over time. Among nonaspirin nonsteroidal antiinflammatory drugs (NSAIDs), ibuprofen and naproxen are the most commonly encountered in overdose, likely due to their easy availability as over-the-counter medications. This review covers the principles of toxicity, immediate stabilization, diagnosis and definitive therapy, and disposition and outcomes related to acetaminophen, aspirin, and ibuprofen and other NSAIDs. Tables describe N-acetylcysteine dosing, King’s College criteria for acetaminophen-induced liver failure, and indications for hemodialysis in aspirin poisoning. Figures include a pie chart showing acetaminophen metabolization, the Rumack-Matthew nomogram, and a graph showing frequency of hepatotoxicity in patients receiving N-acetylcysteine. This review contains 3 highly rendered figures, 3 tables, and 97 references.