Be careful of sodium intake in some drugs! Example of effervescent paracetamol for hypertensive or heart failure patients

Background The World Health Organisation9s(WHO) recommendations for hypertension or heart failure is to reduce sodium intake to less than 2g (which equals 5g of salt). A link between raised blood pressure and sodium excipient content of soluble or effervescent analgesic has been previously reported 1 . Paracetamol 500 mg effervescent is the drug referenced in our hospital that contains more sodium (412.4 mg). It was prescribed to only a few patients, according to their preference or to nasogastric tube carriers. Purpose The aim of our study was to evaluate the use of effervescent paracetamol by patients suffering of hypertension and heart failure and find solutions to decrease it. Materials and Methods The authors made a retrospective study over a period of one year by selecting all the patients in our hospital with a prescription of effervescent paracetamol, with Pharma ® ‘s software (computer Engineering). Results A total of 42 patients took effervescent paracetamol. The dosage most prescribed was 3g per day, the equivalent of 6 tablets of 500 mg each. This corresponds to an amount of 6.3 g of salt, more than the maximum recommended by the WHO and regardless of the recommended daily amount of food and other drugs. This amount increases to 8.4 g for a dose of 4g per day! 19 patients (45%) were also taking an antihypertensive or medicine against heart failure. The solutions implemented in our hospital were to provide information in multidisciplinary meetings, displaying the amount of sodium in data sheet on the software to alert doctors at the time of prescription and writing pharmaceutical notifications when prescribing effervescent paracetamol for an hypertensive or heart failure patient. Finally, a lyophilisate tablet of paracetamol (negligible sodium level) was referenced. Conclusions This study was used to realise some effects of the prescription of effervescent paracetamol for hypertensive or heart failure patients. Four measures to reduce this consumption have been set up and a future audit will estimate their possible impact.