Objectives Acetaminophen (paracetamol) use is prevalent in long-term care (LTC) on the premise that it is a safe medication that reduces pain and discomfort. However, evidence is accumulating that acetaminophen does not improve pain or quality of life and is also associated with adverse events including cardiac, gastrointestinal, and renal. There is also minimal literature on deprescribing acetaminophen in frail older adults.
Method Case series of four LTC residents deprescribed acetaminophen from January–December 2022 in Edmonton, Canada.
Results The four residents ranged in age from 80 to 93, female (n=3); dementia (n=3); severely frail per the Clinical Frailty Scale (n=4); chronic pain conditions (n=2); and severe osteoarthritis (n=2). On admission to LTC, these residents were on 11–16 medications per day, which included regularly scheduled acetaminophen (n=4); hydromorphone (n=1); codeine (n=1); Gabapentin (n=2); and pregabalin (n=1). The administration of acetaminophen was 650 mg 4 times/day (n=2); 500 mg 3 times/day (n=1); and 325 mg 3 times/day (n=1). Acetaminophen was gradually reduced each week by first reducing the dosage per administration to 325 mg and then reducing the number of administrations per day until acetaminophen was fully discontinued for all the residents. There was no noted increase in pain by the residents, family members, and nursing staff, and none of the residents had an increase in acetaminophen (as needed) or other pain medication.
Conclusions It appears possible to deprescribe acetaminophen in frail older adults. Further studies are needed to determine the prevalence and health care cost of acetaminophen in long-term care; the best approach to deprescribing acetaminophen; and the impact of deprescribing acetaminophen on pain, quality of life, and adverse events.
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