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SOLID EVIDENCE OF THE RISKS FROM PHENACETIN ABUSE.

It has been suspected for nearly 40 years that analgesic abuse produces renal dysfunction. Phenacetin, the substance most often incriminated, has been removed from analgesics in many countries. Yet past studies of analgesic abuse have had contradictory results, and no prospective, longitudinal study has been reported.

A team from Switzerland has prospectively followed two groups of women since 1968: 623 initially healthy women who regularly used analgesics containing phenacetin, and 621 matched non-users. Over 20 years of follow-up, the phenacetin users had higher rates of overall mortality (relative risk, 2.2), death from urologic or renal disease (RR, 16.1), death from cancer (RR, 1.9), and death from cardiovascular disease (RR, 2.9). Phenacetin users also had higher overall rates of cardiovascular disease (RR, 1.8) and hypertension (RR, 1.6). The increased risk of hypertension was seen primarily in women taking large amounts of phenacetin for many years. In contrast, regular use of analgesics with salicylate did not confer higher disease or mortality rates after adjustment for phenacetin use.

This study solidly demonstrates the risks associated with chronic phenacetin use and emphasizes the need for more information about the effects of long-term use of acetaminophen, a widely used metabolite of phenacetin that may confer similar risks (see accession number 890519002).

— ALK

Published in Journal Watch General Medicine January 25, 1991

Citation(s):

Dubach UC et al. An epidemiologic study of abuse of analgesic drugs: effects of phenacetin and salicylate on mortality and cardiovascular morbidity (1968 to 1987). N Engl J Med 1991 Jan 17 324 155-160.

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