Home » L484 pill  — L484 pill Side effects, Warning, Uses, Overdose

L484 pill  — L484 pill Side effects, Warning, Uses, Overdose

L484 pill

L484 pill is a white capsuled shape pill that has an imprint of L484 pill on it and it has been identified as Acetaminophen 500mg. This medication is being supplied and manufactured by Kroger company.

L484 pill

L484 pill is a non-opioid analgesic that belongs to the analgesics (pain remedies) class of medications. L484 pill possesses antipyretic properties, making it a common fever reliever. L484 pill is a common pain reliever that is used all around the world to treat headaches, osteoarthritis, and infection-related fevers. In some countries, it is also used alongside antimalaria medications such as artemether-lumefantrine.

The fact that the L484 pill can be utilized as a pain reliever in people with ulcers is one of the main reasons for its widespread use. Some pain medications, such as nonsteroidal anti-inflammatory medicines, are not to be used by ulcer patients because NSAIDS causes bleeding in ulcer patients.

NSAIDs have been reported to induce ulcers, holes, and bleeding in the gut and stomach. Such complications might come up without warning symptoms and at any point during therapy, potentially might result in death if proper care is not taken well. NSAIDs such as ibuprofen, diclofenac, and others, on the other hand, may cause persistent issues in ulcer patients, whereas research has shown that acetaminophen is safe to use in ulcer patients.

Usage


One of the best ways to use this medication is to read the L484 pill label carefully and to follow all of the instructions on the label. It should never be taken in excess of the recommended dose.

When the L484 pill is misused, it can be extremely hazardous to the human body. Misuse of acetaminophen, according to addictionhope.com, can result in abrupt liver failure. Although the L484 pill is generally believed to be harmless, when it is misused, it can be extremely damaging to the body.

Dose

When taking the L484 pill, keep in mind that combining it with other brands that contain acetaminophen as an active ingredient can result in an overdose. L484 pill can be taken by people of all ages in the recommended doses.

The Following Are The dose for Children: Although all doses are based on body weight, acetaminophen is no exception. Children’s dosages are typically estimated as 10 to 15 milligrams per kilogram of real body weight and it should be taken every 4 to 6 hours.

Children should not take more than 5 dosages in a day (24 hours) unless their doctor advises them to. It’s also a good idea to see a doctor if your child is under the age of six months old.

Adults: 325 mg 650 mg 8 hourly is the dose for an adult.

When used for pain, all acetaminophen medications that are accessible without a prescription (over-the-counter drugs) should not be used for more than 5 days in a row. It’s also a good idea to avoid some other medications that contain acetaminophen such as; t194, and t258. Also, make sure you avoid alcoholic drinks while taking this medication as this may increase the side effects of this medication.

Body weight, medical problems, and drug interactions are only some of the factors that can influence the doses of medication that a patient requires.

If your doctor has prescribed a dose that differs from those described in this article, you must follow your doctor’s recommendations and not alter them.

It is recommended that you take the L484 pill or any other acetaminophen medication according to your doctor’s instructions.

It is commonly used to treat pain and fever. If you miss a dose of the L484 pill and realize it within an hour, you can take it as soon as you remember. However, if you forget until it’s almost time to take another dose, you can just ignore the prior dose and go on with your regular dosing plan. Do not try to double a missing dosage or overuse drugs.

However, if you are unsure about what to do if you miss a dosage, you should consult your pharmacist or doctor for more information and assistance.

Storage of L484 pill


L484 pill should be stored at room temperature and protected from moisture and light. It should also be kept out of the reach of youngsters, as they may misuse the medicine.

How can you get rid of acetaminophen once you’ve used it?


This drug should not be flushed down the toilet or poured down the sink. It must be properly disposed of by tossing it in the trash or asking your pharmacist for instructions on how to do so.

Who should avoid acetaminophen?


Although acetaminophen is a safe pain reliever and fever reducer. Unlike NSAIDs, which can induce ulcer bleeding, ulcer sufferers can take acetaminophen. However, in rare circumstances, acetaminophen is not recommended.


Acetaminophen intolerance ( L484 pill )

It is not recommended that anyone who is allergic to acetaminophen take the tablet L484 pill. Because everyone who is allergic to something can have an adverse reaction when they use it.

And, in the case of acetaminophen, anyone who is allergic to it should avoid taking it. You can also talk to your doctor about it. Antihistamines are another technique to stop responses (Texa pills which is an example of antihistamines).

Side effects of the L484 pill

Almost every prescription has one or two negative effects, and acetaminophen is no exception. It has some adverse effects, despite the fact that it is safe for you and provides the best outcomes by alleviating pains.

Although not everyone who uses or takes this drug will suffer the negative effects discussed on this page, they are common. If you want to learn more about acetaminophen side effects or are concerned about them, you can simply discuss all of the benefits and risks of this drug with your doctor or pharmacist, who will be able to better inform you.

You should be aware that many of the acetaminophen’s adverse effects may be handled, and some of them may even go away on their own over time.

If you are experiencing any severe or annoying side effects, do not hesitate to call your doctor for assistance.

The Side Effects of the L484 pill are listed below;

  1. Anemia symptoms: Anemia is defined as a reduction in the number of red blood cells in the body. These symptoms include a pale complexion, weakness and exhaustion, disorientation, and shortness of breath.
  1. Signs of a kidney problem: Blood in the urine, increased urination at night, changes in urine color, and decreased urine production are all signs of kidney disease.
  2. Nausea: Nausea is when you feel sick to your stomach and want to puke
  3. Diarrhea
  1. hives, rash, and itching
  2. You could get liver damage symptoms.
  3. Pain in the abdomen
  4. irritated skin
  5. a decrease in appetite

However, if you have a long-term negative effect, get medical attention right away and stop taking the medicine.

Frequently Asked Questions about L484 pill


Are there any other acetaminophen precautions or warnings?


First and foremost, you must tell your health practitioner (doctor) of any allergies or medical issues you may have before taking medication. You must also inform them of any medications you are taking, as well as whether you are pregnant, breastfeeding, or have any other health concerns. All of these things will help them understand how to utilize this drug effectively.

Warnings Before using Pill L484 pill

  1. Alcohol: Excessive alcohol use might raise the risk of liver damage caused by the L484 pill (acetaminophen). Even if acetaminophen is taken at a reasonable dose, alcohol consumption can still increase the risk of liver damage.

Because the concentrations of each chemical in the body rise, the danger of serious liver damage from alcohol and acetaminophen is extremely high. Having three or more alcoholic beverages per day can raise the risk of liver damage and perhaps death

As a result, it is strongly advised that anyone who consumes alcohol refrain from doing so when taking acetaminophen.

  1. Avoid overdosing: Acetaminophen is a safe medication that is used all over the world to treat pain and fever. Abusing this medicine, on the other hand, can have catastrophic side effects, including poisoning in infants and toddlers. Keep this drug out of the reach of children at all times.

When administering a dose to a child, it’s best to utilize an oral syringe to ensure that the dose is accurate. You can either read the label carefully to learn how to use the correct dose, or you can speak with your doctor or pharmacist to determine the optimal dose for your kid.

Adults are also at risk of acetaminophen overdose since acetaminophen is a popular element in nonprescription drugs that are used to treat the flu, pain, colds, and fever.

The best strategy is to always verify the ingredients of the medication before taking it. Any medicine you are intending to use should have its reflectivity checked by looking at the active ingredient.

The format is usually something like this: “Each active ingredient includes

Overdosing on acetaminophen (L484 pill) can result in catastrophic liver damage.

So, if you are unsure or puzzled about the medicine you are going to take, you can always seek advice from your doctor or pharmacist, who can assist you and provide you with the most up-to-date information about the medicine.

  1. Pregnancy: It has been reported that the L484 pill is safe to use in pregnant women when taken in the authorized doses for a short period of time.
  2. Liver: Several studies have shown that this medicine can cause serious and even fatal liver damage. Although the risk of liver damage increases when acetaminophen is taken for longer periods of time than the prescribed amounts. Furthermore, alcohol can raise the risk of liver disease.

According to some studies, the total dosage of L484 pill (acetaminophen) in a day for any child and adult over the age of 12 should never exceed 4000 mg. However, it is always a good idea to see your doctor or pharmacist for more specific information about acetaminophen dosage.

  1. Breastfeeding mothers should be aware that acetaminophen goes into their breast milk when they take or use it, although research has shown that it has no negative effects on the newborn when taken at the prescribed dose.

In conclusion, here’s all you need to know about the L484 pill ( Overall About L484 pill)


L484 pill is a white circular pill with the number L484 pill imprinted on it. As previously stated, this medication contains the active component acetaminophen, which is a pain reliever and fever reducer.

Acetaminophen is a pain reliever that is widely used by a variety of people. It is typically used in conjunction with antimalarial medications such as Artemether lumefantrine. Unlike NSAIDs, which cause bleeding when used by ulcer sufferers, this drug is safe for use by those who have ulcers.

When it is misused, it might result in long-term negative effects such as liver damage. As a result, it is important to follow your doctor’s or pharmacist’s instructions when taking this drug.

This medication is safe to take during pregnancy because it causes no harm when used properly. Anyone who breastfeeds should be aware that this medicine passes through the mother’s breast milk, but it is not harmful to the baby’s health when given at the proper dose.

Recent research suggests that acetaminophen is a hormone disrupter (i.e., it interferes with sex and thyroid hormone activity, both of which are necessary for normal brain development) and hence should not be used during pregnancy. Finally, new research reveals that, while cyclooxygenase inhibition is the most common mechanism by which acetaminophen produces its therapeutic impact, several other pathways also contribute to its analgesic effect.

Research

Based on the available information, indiscriminate use of this medicine is not recommended. and it should be administered with extreme caution to a pregnant patient.

Acetaminophen is the most commonly prescribed over-the-counter painkiller and antipyretic, and it can be found in over 100 different medicines, either alone or in combination with other medications. One of the most common side effects of acute acetaminophen overdose is liver damage.

Acetaminophen overdose is responsible for more than 56 000 emergency room visits in the United States and is linked to approximately half of all acute liver failure cases. According to the most recent yearly poisoning data from the American Association of Poison Control Centers (AAPCC, 2010), acetaminophen alone and in combination caused 130 and 240 deaths, respectively.

Overdosing on acetaminophen (APAP) can result in hepatotoxicity and potentially rapid liver failure. Hepatotoxicity is caused by the reactive metabolite N-acetyl-p-benzoquinone imine, which forms protein adducts on mitochondrial proteins, causing mitochondrial oxidant stress and peroxynitrite formation, as well as activation of c-jun N-terminal kinase and its translocation to the mitochondria, along with Bax.

This causes a change in mitochondrial membrane permeability and the release of intermembrane proteins, which travel to the nucleus and break nuclear DNA, triggering programmed necrosis. As a result, a sterile inflammatory response is triggered, which aids in the clearance of necrotic cell debris in preparation for regeneration.

Understanding the mechanism of APAP hepatotoxicity led to the development of mechanistic serum biomarkers that predict the outcome in patients after an APAP overdose. It is hoped that a better understanding of the process will lead to the identification of novel therapeutic targets that will aid in the development of better antidotes.

Toxicity Biomarkers
In experimental models of acetaminophen toxicity, acetaminophen protein adducts have been routinely employed as a marker of metabolism [23,53,54]. Early attempts to detect adducts in clinical samples relied on sophisticated and time-consuming procedures that were not suitable for large-scale study [55]. In patients with high ALT increases for acetaminophen overdoses, Hinson and Poulsen reported the successful use of a competitive enzyme-linked immunosorbent test for acetaminophen protein adducts [56].

The invention of an accurate, sensitive, and specific high-performance liquid chromatography assay with electrochemical detection (HPLC-EC) in patients with acetaminophen hepatotoxicity allowed for deeper research into adduct levels. [57]

Adducts were found in patients with documented acetaminophen ALF but were undetectable or minor in patients with alternative ALF etiology [58]. Furthermore, adducts were found in 19% of individuals with ALF of unknown cause, implying that the assay could be used for diagnostic purposes. In patients with acetaminophen ALF, adducts were found to correlate with AST and ALT (R=0.86) [59].

Adduct values of >1.1 nmol/mL serum exhibited a sensitivity and specificity of 97 percent and 95 percent, respectively, in patients with ALT values of >1,000 IU/L, according to a receiver-operator-curve analysis.

These findings suggest that measuring adduct levels in patients with ALF of unknown cause would be an important addition to their diagnostic evaluation [61].

Paracetamol’s dose forms and kinetic characteristics

Solid dosage forms, such as tablets and capsules, are available, as are liquid dosage forms, such as solution and suspension, and a semi-solid dosage form (as a suppository). Although research literature implies that injectable dose forms of paracetamol could be made, there is no injectable or infusion paracetamol accessible. 11 Paracetamol is readily absorbed from the gastrointestinal tract when taken orally.

Within 10–90 minutes, the blood concentration reaches its peak. The following is a pharmacokinetic profile of paracetamol (Tylenol).

Acetaminophen; Nonsteroidal Anti-Inflammatory Drugs

Although its analgesic mechanisms are unknown, acetaminophen (also known as paracetamol in Europe) is the most often used over-the-counter painkiller. Although acetaminophen does not have strong anti-inflammatory properties, it remains a mainstay in treatment guidelines for osteoarthritis, particularly in older persons who are more likely to have ill effects from NSAIDs and adjuvants.

The maximum daily dose of acetaminophen has been 4 g, although a reduction to 3 or 3.2 g/day is being considered. The maximum amount of acetaminophen per pill in combination products combining acetaminophen and an opioid will be limited to 325 mg. In many cases, combining acetaminophen with traditional NSAIDs (NSAIDs) provides little benefit, and in some cases, additional adverse effects may occur. However, for some persons, a combination of acetaminophen and an NSAID may be more effective than either medicine alone (as seen in human experimental data). NSAIDs are more effective analgesics than acetaminophen in head-to-head studies; the main advantage of acetaminophen is a better side effect profile, especially in the elderly. Intravenous acetaminophen (Ofirmev®) infusions of up to 1 g can be given for acute pain or in the perioperative environment.

Pain Assessment and Management in Pediatric Patients

Acetaminophen (e.g., Tylenol, Tempra, and Datril) is the most commonly used analgesic in pediatrics today. It is an analgesic and antipyretic that is as effective as aspirin in the treatment of mild to moderate pain. Acetaminophen, unlike aspirin, does not inhibit platelet function. 40 It also causes less gastric upset and isn’t linked to Reye syndrome. Acetaminophen’s primary disadvantage is that it lacks clinically significant anti-inflammatory properties.

Toxicity from an overdose can cause acute liver failure with serious or fatal hepatic necrosis. The pathophysiology is linked to transient increases in serum aminotransferase levels in a subset of hepatocellular injury patients. It is estimated that an adult requires 15 g of acetaminophen to cause liver damage, while a child under the age of two requires more than 3 g.

Allergic reactions are extremely uncommon. In patients who do not require an antiinflammatory effect, acetaminophen is a good alternative analgesic.

Osteoarthritis Treatment

Several associations advocate acetaminophen (paracetamol) for the symptomatic treatment of people with OA and mild to moderate pain due to its efficacy, safety, and low cost. Several systematic reviews and meta-analyses of randomized placebo-controlled studies of acetaminophen for knee OA found that it had a small but substantial effect on pain relief without affecting functional improvement or stiffness.

The safety profile of acetaminophen has been reexamined, especially when considering a daily dose of 4000-mg. According to the findings of a pharmacoepidemiologic investigation, high (3000 mg) dosages of acetaminophen may carry the same risk of upper gastrointestinal problems as nonselective NSAIDs.

Similarly, observational studies imply that long-term acetaminophen usage is associated with the same risk of hypertension as typical NSAIDs. 39 Although selection bias in research design cannot be ruled out, acetaminophen is a poor inhibitor of both cyclooxygenase-1 (COX-1) and COX-2, which explains its apparent upper gastrointestinal and renovascular effects. 40 In addition, mixing acetaminophen with oral NSAIDs should be avoided; however, acetaminophen and topical NSAIDs can be used together.

Concurrent use of acetaminophen with over-the-counter combination products that also include acetaminophen is also a cause for concern. In the United States, acetaminophen is the most common cause of drug-induced liver failure and the need for hepatic transplantation.

As a result, the US Food and Drug Administration’s Advisory Committee suggested that the maximum single daily dose of acetaminophen be reduced to 3000 mg and that combination products containing acetaminophen, such as acetaminophen-opioid analgesics, be taken off the market.

In patients receiving coumarin anticoagulation, high-dose acetaminophen has also been linked to a longer prothrombin time.

Acetaminophen’s Negative Effects
Acetaminophen is commonly used as a first-line pain reliever, owing to its effectiveness and safety compared to NSAIDs. There is little evidence of harm when used in amounts of less than 2 g per day. 135 The hazardous metabolite N-acetyl-p-benzoquinone imine, a highly reactive electrophilic molecule that depletes glutathione and then accumulates in hepatocytes, causes acetaminophen-induced acute liver failure.

Acetaminophen is a well-known hepatotoxin, with a dose threshold of 10 to 15 g in adults and 150 mg/kg in children (lower dosages have also been associated with hepatic injury). Most acetaminophen overdoses in the United States are unintentional, as most people take acetaminophen formulations for chronic pain. Intentional self-poisoning with acetaminophen is also a significant issue. Gastric lavage, activated charcoal, or inducement of vomiting are all options for treating acetaminophen overdose within the first three hours after injection.

Furthermore, early therapy with N-acetylcysteine, which replaces glutathione, and intensive support measures have reduced the mortality associated with acute acetaminophen intoxication. Other side effects from high doses of acetaminophen include GI ulcers and bleeding. 137,138 The use of acetaminophen on a regular basis has also been linked to an increased risk of chronic renal failure.

Oral hormonal contraceptives

Paracetamol
Paracetamol may have a similar impact to ascorbic acid, namely, competition for sulfation capacity in the gut with ethinylestradiol. The AUC of ethinylestradiol sulfate was considerably lowered by paracetamol, although plasma levonorgestrel concentrations were unaffected.

A single dose of 1 g paracetamol increased the AUC of ethinylestradiol by 22% and decreased the AUC of ethinylestradiol sulfate in six healthy women [399]. Levonorgestrel concentrations in the blood were unaffected.

This interaction may be clinically significant in women on oral contraceptives who use paracetamol on a regular basis or cease taking it suddenly, however it is unclear whether it has any practical implications.

There were no sex-related changes in paracetamol sulfation or oxidative metabolism, thus men’s clearance was 22 percent higher than women’s [400]. This was completely due to enhanced glucuronidation. The clearance of paracetamol was 49 percent higher in women who used oral contraceptive steroids than in women who did not. In contraceptive users, glucuronidation and oxidative metabolism were both increased (by 78 percent and 36 percent, respectively), but sulfation was not affected.

Although sex-related differences in paracetamol metabolism are unlikely to be clinically significant, stimulation of paracetamol metabolism by oral contraceptive hormones could have clinical and toxicological implications.

The purpose of this study is to assess the output of scientific research on paracetamol overdose around the world. The goal of this study was to look at the global research output on paracetamol toxicity, as well as the authorship pattern and citations that were obtained from the Scopus database over a decade.

Methods: Documents with particular words related to paracetamol poisoning as ‘keywords’ in the title or/and abstracts were searched. The scientific output was assessed using an approach that had previously been employed in other bibliometric research. The national population and nominal gross domestic product (GDP) per capita were used to adjust research productivity.

During the study period, 1721 articles from around the world met the requirements. All of the documents that were found were published in 72 different countries. The United States (US; 30.39 percent) had the most articles about paracetamol toxicity, followed by India (10.75 percent) and the United Kingdom (10.75 percent) (UK; 9.36 percent ). At the time of data analysis, there were 21,109 citations, with an average of 12.3 citations per document and a median (interquartile range) of 4 (1–14). The retrieved documents had an h-index of 57.

Conclusion: Our findings show that research production in the field of paracetamol poisoning has risen dramatically in recent years. In terms of research productivity, the United States clearly dominated. However, some tiny countries, such as Nigeria, have a high level of scientific production in comparison to their population and GDP. There was also a significant increase in the contributions of the Asia-Pacific and Middle East areas to the scientific literature on paracetamol poisoning.

Introduction
The labels acetaminophen (used in the US, Canada, various Latin American countries, Hong Kong, Iran, and Colombia) and paracetamol (used elsewhere)1 are both chemical names for the compound: para-acetylaminophenol and para-acetylaminophenol. In other cases, it’s simply referred to as APAP (N-acetyl-para-aminophenol). 2 Morse synthesized paracetamol in Germany in 1878, and it has since been manufactured in a variety of ways. Von Mering was the first to use paracetamol in therapeutic treatment in 1893.

In Germany, it was quickly replaced with phenacetin, which was seen to be safer than paracetamol. Paracetamol was discovered in the urine of phenacetin users and was identified as a metabolite of acetanilide, another phenacetin analog. 4 In 1948, Brodie and Axelrod found paracetamol as the predominant active hepatic metabolite of phenacetin while studying the effects of phenacetin. 5 By this time, phenacetin’s renal toxicity had been established, and paracetamol’s usage as an analgesic had been promoted in its place.

McNeil Laboratories originally sold paracetamol (Tylenol®) in the United States in 1955 as a children’s analgesic and antipyretic. In 1956, Frederick Stearns & Co. of the United Kingdom (UK) launched Panadol®, a 500 mg paracetamol tablet, and in 1958, they released a paracetamol-containing children’s elixir as a prescription pain reliever and antipyretic. 4 It is now the most used analgesic in the United States. 7 Although the British medical establishment was originally wary, paracetamol was added to the British National Formulary8 in 1963 and became more widely used as an analgesic as a result, especially after phenacetin was prohibited in the 1970s.

At suitable dosages, paracetamol has proven to be a surprisingly safe antipyretic–analgesic, making it the antipyretic–analgesic of choice for a variety of illnesses. 2 Paracetamol has the potential to cause hepatic and renal failure in excessive doses. 9–14 The extent of paracetamol exposure is determined from the stated amount taken, and serum paracetamol concentrations are compared to the Rumack–Matthew nomogram to determine the risk of toxicity. 15 Serum liver enzyme activity, prothrombin time, and creatinine concentrations are used to detect the amount of hepatic and renal injury.

As a multidisciplinary field of study, paracetamol poisoning is on the rise18–21, resulting in rising research that encompasses practically all of the fields that have had the highest gains in health care science production, such as hematology and clinical toxicology. The evolution of scientific output in the subject of toxicology, on the other hand, has received little attention to date, and there are few internationally published reports on toxicology research activities. 22–28 To our knowledge, there is a dearth of data from around the world on the evaluation of scientific research production in paracetamol toxicity.

Scientific advancement is one of the most important measures of a country’s community and economic development. 29 PubMed, Scopus, Web of Science (i.e. Thomson Reuters Institute for Scientific Information [ISI]), and Google Scholar are some well-known databases for indexing international papers in biological sciences. 30 The use of bibliometric studies for research evaluation is becoming more common. 31 They entail applying statistical approaches to scientific papers in order to collect bibliographic information for each country. These methods are mostly quantitative, although they can also be used to generate qualitative statements about scientific operations.

The goal of this study was to look at the global research output on paracetamol toxicity, as well as the authorship pattern and citations that were obtained from the Scopus database over a decade. This research will help researchers better grasp the existing and future state of paracetamol poisoning studies around the world.

This study used data from the Scopus database, which covered the period from January 1, 2003, to December 31, 2012. The last ten years are thought to provide the most accurate picture of the trend of publications and citations obtained in paracetamol poisoning research. SciVerse, Scopus, one of the world’s largest databases of peer-reviewed literature, was used to conduct a complete internet search. Scopus contains 41 million data and represents 100% of MEDLINE coverage, with approximately 18,000 titles from 5000 publishers worldwide.

Elsevier created the Scopus database, which combines the features of both Webs of Science and PubMed. These features enable better educational and academic service, as well as medical literature research and bibliometric analysis. Scopus allows you to conduct a basic or complex search. In addition to Scopus, the results for the given keywords can be narrowed by the date of publication, subject area, and document type in the basic search. 30 Scopus’ search results can be displayed as a list of 20–200 items per page, with extracted documents exportable to Microsoft Office Excel®. The results can be narrowed down by document type, author name, source title, number of publications per year, and/or subject area, and a new search can be launched from inside the results.

Analytical statistics
Scopus data was converted to Microsoft Office Excel®, which was then imported into the Statistical Package for Social Sciences (SPSS; SPSS Inc., Chicago, Illinois, USA) program version 15 for analysis. Non-normally distributed variables, such as the number of citations, are expressed as median (interquartile range: Q1–Q3), while categorical data are expressed as numbers with percentages. The standard competition ranking was used to transform the bibliometric analysis measurements (e.g. nations, authors, cited papers, and institutions) into rank order. Only the top 20 ranking companies were considered. If the bibliometric analysis measurements all yield the same ranking number, there will be a gap in the subsequent rankings. The h-index for the data gathered from Scopus is shown.

Thomson Reuters’ Journal Citation Report (JCR; Web of Knowledge) 2012 scientific edition was used to assess the journal’s impact factors (IFs) (New York, NY, USA). The top 20 countries by population size and gross domestic product (GDP) gathered from the World Bank’s online databases34 were adjusted for publication activity. The following formula was used to determine an adjustment index (AI):

AI=(Total number of publications for the country per capita of the country)1000, where GDP per capita is equal to GDP divided by the country’s population. 35

Results
With an average of 172 documents per year from around the world, 1721 documents were retrieved using the methodology described above, including 1283 (74.5%) original journal articles, 179 (10.4%) review articles, 116 (6.7%) letters to the editor, and 143 (8.4%) other types of publications such as note or editorial. The annual number of documents published in the past decade (2003–2012) demonstrates that paracetamol overdose research output was low in the first few years of the decade, but quickly increased after 2009.

The most common language used to publish the materials was English (n = 1580, or 91.8 percent), followed by French (n = 28), German (n = 22), and Spanish (n = 19).

All of the documents that were found were published in 72 different countries. Table 1 displays a ranking of the 20 nations whose researchers published the most articles on paracetamol poisoning between 2003 and 2012. When the data was broken down by nation, the United States had the most articles about paracetamol poisoning (30.39%), followed by India (10.75%) and the United Kingdom (9.36%). (Table 1). India (124.2), Nigeria (18.6), and the United States (10.5) had the highest research productivity after correcting for the economy and population power. After adjusting for GDP, countries with substantial economies, such as the United Kingdom, Australia, Japan, China, and France, tended to rank relatively low during the whole study period.

At the time of data analysis (15 November 2013), the total number of citations was 21,109, with an average of 12.3 citations per document and a median (interquartile range) of 4 (1–14). The United States had the highest median (interquartile range) number of citations (10 (2–27) and Canada had the highest median (interquartile range) number of citations (10 (3–25), followed by Germany with 8.5 (0.8–16.8). The h-index of the retrieved documents was 57 (i.e. 57 documents had been cited at least 57 times at the time of data analysis on November 15, 2013). The highest h-index was 51 for the United States, followed by 24 for the United Kingdom, and 19 for Canada. The United States had the most international collaborations with 32 countries, followed by the United Kingdom with 21 countries.

Furthermore, Malaysia had the largest percentage of documents written in conjunction with overseas authors (42.9%), followed by the Netherlands (46.7%), Australia (43.9%), and Canada (43.6%). (Table 1).

The top 20 journals in which paracetamol poisoning-related studies from around the world were published are included in Table 2. A total of 51 documents (2.96%) were published in Hepatology, with 36 (2.09%) in Clinical Toxicology, 35 (2.03%) in Toxicological Sciences, and 31 (1.80%) in Toxicology and Applied Pharmacology. Two of the top 20 ranked journal titles did not have an official IF and were not included in the JCR 2012.

A list of the most cited papers from 2003 to 2012 is presented in Table 3. Table 4 lists the top 20 prolific authors from around the world who published the most publications about paracetamol poisoning, along with their affiliations and publication patterns; these authors wrote at least 11 articles throughout the research period. Table 5 shows the top 20 highly prolific universities around the world that published the most paracetamol poisoning-related articles. University of Kansas Medical Center, USA (2.85 percent of total publications), Royal Infirmary of Edinburgh, UK (2.50 percent), and the University of Arkansas for Medical Sciences, USA (2.50 percent) were the most productive institutions (2.44 percent )

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