IV Tylenol No Better than Pills, Not Helping Crisis
Using acetaminophen rather than addicted opioids pills post-surgery seems like a logical plan to help curtail the epidemic. However, the topic is more complicated than it seems.
Sales of IV acetaminophen accounts for more than $300 million in sales last year, as hospitals and their staff are scrambling for a pain management alternative to opioids. However, injectable Tylenol, the brand name for the drug, costs $40 for a 1,000-milligram dose. This is a far cry from the pills, which cost just a few dollars for a bottle at the local drug store. And, the price has caused some hospitals to rethink stocking it and reconsider the benefits of administering the injections rather than pills post-procedure.
Studies are now showing that there is very little difference in effectiveness between administering Tylenol in either form. What’s more, some are asserting that opting to use acetaminophen rather than an addictive painkiller post-surgery has done little to curtail the crisis.
“It was going to cost us, without the intervention that happened, more than any other drug on our formulary. Think of the most expensive cancer drug,” said David Twitchell, Boston Medical Center’s chief pharmacy officer. “To me, that didn’t seem justified.”
Steven Lucio, associate vice president at the Center for Pharmacy Practice Excellence at Vizient agreed. “Just putting acetaminophen in an IV form doesn’t seem to correlate with a huge, demonstrable benefit that is repeatable. Some studies show a little bit of benefit; some studies don’t show benefit.”
The company behind the push for the intravenous alternative, Mallinckrodt, begged to differ. In a statement, it said studies showing the drug has not helped to ease the epidemic are “significantly flawed.” Mallinckrodt suggested instead that patients are simply not getting enough of the IV to benefit and should be given doses at the federally approved levels.
Boston Medical Center has decided to cut down on costs of administering IV acetaminophen. The protocol is to offer a single dose after surgery unless doctors sought further authorization.
“Based on the review evidence available, it doesn’t seem like the IV formulations are significantly better than oral formulations of these medications,” said Will Vincent, a clinical pharmacy specialist for Boston Medical Center. “For some of our patients who are critically ill, if we’re not able to use oral medications, we’re forced to use the injectable route.”
“It just seems very often, physicians have magical thinking about a new preparation of an old drug,” said Andrew Leibowitz, system chair of the department of anesthesiology, perioperative and pain medicine at the Icahn School of Medicine at Mount Sinai. “Doctors do seem, in general when a patient is in the hospital, to favor IV medications as a knee-jerk reflex, even when equally effective oral medications are available.”
“I think part of the reason we got into such a mess with opioids was really a lack of training and understanding of pain management,” added Erin Krebs, a staff physician at the Minneapolis Veterans Affairs Health Care System. “It’s a symptom of how little research we’ve done on the appropriate management of these really common conditions. These are some of the most common human ailments, and they have not received enough research attention, research funding or education.”