Acetaminophen, NSAIDS and Opioids: Assessing Comparative Safety

With acetaminophen, the most important thing to think about is liver toxicity, and remembering to take age into account when you’re thinking about the maximum dosing. And it’s important to be sure that patients are aware that there are a lot of agents out there that have acetaminophen as an ingredient, and to check for this before taking more.

As far as the NSAIDS go, I think they’re a little underrated in terms of risk, and so it’s important for people to also be educated on what the potential toxicities are for those drugs. So if you know someone has a bleeding disorder, or a potential kidney disorder, perhaps avoiding or just using NSAIDs sparingly would be appropriate practice. We won’t have warning signs of these toxicities; they will just come on, and so it’s important to screen the patient appropriately.

And with respect to opioids, clinicians should consider increased risk of respiratory depression, which is obviously the biggest thing but also effects like immunosuppression that people don’t necessarily keep on their radar.  These agents can do that and they even have implications in cancer, as the literature is beginning to show. Minimizing opiate use is the best thing if we can, but recognizing that untreated pain also results in adverse effects,

The overall message to the clinician would be that screening patients is probably the most important part of the prescribing process, and then monitoring your patient very closely. Also make sure that you educate the patient in what to look out for with these drugs.