TY  - JOUR
PY  - 2019//
TI  - Relative toxicity of analgesics commonly used for intentional self-poisoning: a study of case fatality based on fatal and non-fatal overdoses
JO  - Journal of affective disorders
A1  - Hawton, Keith
A1  - Ferrey, Anne
A1  - Casey, Deborah
A1  - Wells, Claudia
A1  - Fuller, Alice
A1  - Bankhead, Clare
A1  - Clements, Caroline
A1  - Ness, Jennifer
A1  - Gunnell, David
A1  - Kapur, Navneet
A1  - Geulayov, Galit
SP  - 814
EP  - 819
VL  - 246
IS  - 
N2  - BACKGROUND: Analgesics are used most frequently in fatal and non-fatal medicinal self-poisonings. Knowledge about their relative toxicity in overdose is important for clinicians and regulatory agencies. <br><br>METHODS: Using data for 2005-2012 we investigated case fatality (number of suicides relative to number of non-fatal self-poisonings) of paracetamol, aspirin, codeine, dihydrocodeine, tramadol, paracetamol with codeine (co-codamol), paracetamol with dihydrocodeine (co-dydramol), ibuprofen and co-proxamol (paracetamol plus dextropropoxyphene; withdrawn in the UK in 2008 due to high toxicity). Data on suicides obtained from the Office for National Statistics and on non-fatal self-poisonings from the Multicentre Study of Self-harm in England. Case fatality was estimated for each drug, using paracetamol as the reference category. <br><br>RESULTS: Compared to paracetamol and based on single drug deaths the case fatality index of dihydrocodeine was considerably elevated (odds ratio (OR) 12.81, 95% Confidence Interval (CI) 10.19-16.12). Case fatality indices for tramadol (OR 4.05, 95% CI 3.38-4.85) and codeine (OR 2.21, 95% CI 1.81-2.70) were also significantly higher than for paracetamol. The results when multiple drug deaths were included produced similar results. The relative toxicity of co-proxamol far exceeded that of the other analgesics. LIMITATIONS: Data on fatal self-poisonings were based on national data, whereas those for non-fatal poisonings were based on local data. <br><br>CONCLUSIONS: Dihydrocodeine and tramadol are particularly toxic in overdose and codeine is also relatively toxic. They should be prescribed with caution, particularly to individuals at risk of self-harm.<br><br>Copyright © 2019. Published by Elsevier B.V.<p />  <p>Language: en</p>
LA  - en
SN  - 0165-0327
UR  - http://dx.doi.org/10.1016/j.jad.2019.01.002
ID  - ref1
ER  -