ACETAMINOPHEN
Place In Therapy
Randomized-controlled trials have found acetaminophen 1000mg is an effective alternative for the treatment of TTH (1-3), although, aspirin 1000mg (1) and ibuprofen 400mg (2) are more effective in achieving pain relief. When looking at naproxen 375mg (prescription dose) for treatment of TTH, acetaminophen was found to have better relief from baseline as the 1 hour mark (3). It has been noted that doses less than 1000mg of acetaminophen are less effective or no better than placebo (4, 5). Looking at adverse effects between alternative simple analgesics for the treatment of TTH, there have not been any significant differences between them (6), but NSAIDs are known to have more
gastrointestinal toxicities than acetaminophen (4).
Deciding on an analgesic for the treatment of TTH is very patient specific. The deciding factor may be depending on a patient’s ability to tolerate alternatives at the most effective doses (6). Acetaminophen 1000mg is an acceptable option for the treatment of TTH, as a dose-response relationship seems to exist (6). Although ibuprofen is generally the first choice for effectiveness, it may not be appropriate for all patients (6). Acetaminophen may be preferred when patients who present with TTH are allergic to NSAIDs, have gastrointestinal ulcers, on warfarin or any other contraindications to NSAID use (6). Acetaminophen should be used cautiously in patients with active liver disease, liver impairment, and/or consuming more than 3 alcoholic drinks per day, as it can increase liver toxicity (7). Acetaminophen is the analgesic
of choice during pregnancy, and should only to be used for short term intervals (7). It is important to not exceed 4 grams of acetaminophen in 24 hours. Overall, patient specific factors are essential to consider in the treatment of TTH and acetaminophen 1000mg is an adequate alternative for over-the-counter product selection.
References
1) Steiner TJ, Lange R, Voelker M. Aspirin in episodic tension-type headache: placebo-controlled dose-ranging comparison with paracetamol. Cephalagia, 2003; 23 (1): 59-66.
2) Schachtel BP, Furey SA, Thoden WR. Nonprescription ibuprofen and acetaminophen in the treatment of tension-type headache. J Clin Pharmacol, 1996; 36: 1120-25.
3) Prior MJ, Cooper KM, May LG, Bowen DL. Efficacy and safety of acetaminophen and naproxen in the treatment of tension0type headache. A randomized, double-blind, placebo-controlled trial. Cephalalgia, 2002; 22 (9): 740-48
4) Bendtsen L, Evers S, Linde M, et al. EFNS guideline on the treatment of tension-type headaches – Report of an EFNS task force. Eur J Neurol. 2010; 17 (11): 1318-25.
5) Lenaerts ME. Pharmacotherapy of tension-type headache (TTH). Expert Opin Pharmacother. 2009; 10(8): 1261-71.
6) Verhagen AP, Damen L, Berger MY, et al. Is any one analgesic superior for episodic tension-type headache? J Fam Pract. 2006; 55(12):
1064-72.
7) Lexicomp Online. Acetaminophen [Internet]. 2011 [updated 2012 Mar 08; cited 2012 Mar 08].
Available from: http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/patch_f/6264
gastrointestinal toxicities than acetaminophen (4).
Deciding on an analgesic for the treatment of TTH is very patient specific. The deciding factor may be depending on a patient’s ability to tolerate alternatives at the most effective doses (6). Acetaminophen 1000mg is an acceptable option for the treatment of TTH, as a dose-response relationship seems to exist (6). Although ibuprofen is generally the first choice for effectiveness, it may not be appropriate for all patients (6). Acetaminophen may be preferred when patients who present with TTH are allergic to NSAIDs, have gastrointestinal ulcers, on warfarin or any other contraindications to NSAID use (6). Acetaminophen should be used cautiously in patients with active liver disease, liver impairment, and/or consuming more than 3 alcoholic drinks per day, as it can increase liver toxicity (7). Acetaminophen is the analgesic
of choice during pregnancy, and should only to be used for short term intervals (7). It is important to not exceed 4 grams of acetaminophen in 24 hours. Overall, patient specific factors are essential to consider in the treatment of TTH and acetaminophen 1000mg is an adequate alternative for over-the-counter product selection.
References
1) Steiner TJ, Lange R, Voelker M. Aspirin in episodic tension-type headache: placebo-controlled dose-ranging comparison with paracetamol. Cephalagia, 2003; 23 (1): 59-66.
2) Schachtel BP, Furey SA, Thoden WR. Nonprescription ibuprofen and acetaminophen in the treatment of tension-type headache. J Clin Pharmacol, 1996; 36: 1120-25.
3) Prior MJ, Cooper KM, May LG, Bowen DL. Efficacy and safety of acetaminophen and naproxen in the treatment of tension0type headache. A randomized, double-blind, placebo-controlled trial. Cephalalgia, 2002; 22 (9): 740-48
4) Bendtsen L, Evers S, Linde M, et al. EFNS guideline on the treatment of tension-type headaches – Report of an EFNS task force. Eur J Neurol. 2010; 17 (11): 1318-25.
5) Lenaerts ME. Pharmacotherapy of tension-type headache (TTH). Expert Opin Pharmacother. 2009; 10(8): 1261-71.
6) Verhagen AP, Damen L, Berger MY, et al. Is any one analgesic superior for episodic tension-type headache? J Fam Pract. 2006; 55(12):
1064-72.
7) Lexicomp Online. Acetaminophen [Internet]. 2011 [updated 2012 Mar 08; cited 2012 Mar 08].
Available from: http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/patch_f/6264