To the Editor.
—There were 102 619 cases of ingestion of acetaminophen-containing products, including 100 deaths, reported in the United States in 1994.1 Management of acute acetaminophen overdose is guided by the Rumack-Matthew nomogram, which assumes acetaminophen absorption in acute overdose is complete by 4 hours after ingestion.2 In August 1994, McNeil Pharmaceuticals (Fort Washington, Pa) introduced Tylenol Extended Relief, the first extended-release formulation of acetaminophen available in the United States.Patients presenting after overdose with extended release (ER) acetaminophen (Tylenol ER) which contains 325 mg of immediate-release acetaminophen and 325 mg of extended-release acetaminophen per tablet, pose a dilemma because the kinetics of acetaminophen ER in overdose are unknown, and it is not known whether physicians can rely on the nomogram to facilitate treatment. Douglas et al3 found no difference in time to peak concentration between acetaminophen ER and immediate-release acetaminophen in volunteers who ingested 75
Cetaruk EW, Dart RC, Horowitz RS, Hurlbut KM. Extended-Release Acetaminophen Overdose. JAMA. 1996;275(9):686. doi:10.1001/jama.1996.03530330030022