PSA: Tylenol (aka acetaminophen or paracetamol) is quite dangerous

[browngirl]

The liver-destroying overdose is only about twice the effective dose recommended daily maximum dose (redbird, thank you for the correction), which is way too close for comfort. siderea posted an excellent explanation, including a partial list of OTC and prescription medications containing acetaminophen, inspired by an NPR report which nancylebov wrote about.

Comments

[shirebound]

That's a VERY important reminder. Thank you for the link.

[bikergeek.livejournal.com]

Acetaminophen is, IIRC, prescription only in Australia. Thirty years ago, perhaps it made sense for it to be OTC, because in the U.S. there were only two OTC pain relievers, aspirin and acetaminophen, and there's a need to have two in case someone can't take one of 'em for some reason or another. Now there are at least two other alternatives, naproxen sodium (Aleve) and ibuprofen (Advil), that don't have the toxicity problems that acetaminophen does, so maybe acetaminophen should be taken off OTC status.

[drglam]

The disadvantage is that aspirin, ibuprofen, and naproxen are all in the same family; if someone can't use one of them, they quite likely can't use all of them.

That said, it has amazed me for decades that acetaminophen isn't, if not prescription only, plastered with very large warning labels, and prohibited from multi-ingrediant formulations.

It's also mighty damn toxic when consumed with excessive alcohol, which can be as little as one drink with Tylenol.

[bikergeek.livejournal.com]

I think, given the legal climate in the U.S., the makers of acetaminophen don't want to admit how dangerous the stuff is. (And, to be sure, millions of people take it every year without problems.)

NyQuil contains acetaminophen + EtOH, which seems to me like a particularly bad idea. NyQuil contains so much ethanol that people have been known to try to get drunk off of it, with some success. (Was a thing for high school kids back in my day.)

[vass]

Acetaminophen is, IIRC, prescription only in Australia.

No, it's not. We call it paracetamol, and the brand name everyone knows is Panadol, not Tylenol, but it's the same stuff and it's very, very widely available.

[bikergeek.livejournal.com]

Hunh. I could swear reading that it was prescription-only there. I'm probably misremembering something about some other medication containing it. Sorry.

[vass]

No worries.

I wonder if you're thinking of codeine? I know how we handle that is different from the US.

In the US you need a prescription for codeine, right? In Australia you can get a combination of codeine and paracetamol or codeine and ibuprofen, and you don't need a prescription but you do need to talk to a pharmacist and tell them why you need it, and they'll probably take down your name and address and put it in their system, like for Sudafed.

[bikergeek.livejournal.com]

Yeah, codeine is prescription-only in the U.S. In Canada, they sell a mixture of codeine + paracetamol known as "Tylenol 3" over the counter. Plenty of people who visit Canada bring some back home to the U.S., although I'm pretty sure that's illegal.

[tibicina.livejournal.com]

They actually don't sell tylenol-3 in Canada, they sell Tylenol-1. (It has less codeine than Tylenol-3, thus being schedule 1 instead of schedule 3. In the US, we just generally don't /bother/ with Tylenol-1 because if you're getting a prescription anyway and have a legitimate reason to have it, then the Tylenol-3 almost always makes more sense.)

[tibicina.livejournal.com]

Or, well, they sell tylenol-3, but only with a prescription, the over-the-counter stuff, however, is Tylenol-1.

[spacehawk.livejournal.com]

I know someone with an aspirin allergy who can't take naproxen or ibuprofen because of the same allergy.

[tibicina.livejournal.com]

the other thing to note is that acetaminophen is the only one which can be /combined/ with the others. Naproxen Sodium and Ibuprofen actually make each other less effective if you try to take them in combination, and because they're both in the same family with aspirin, you aren't supposed to take either of them at the same time as aspirin unless you're very careful about dosages. (Which also means that if you're on a low-dose aspirin regimen, you need to be careful about how much extra aspirin you take, but also how much of the other two you take as well.) Also, Tylenol is safer for children (as long as you are careful to give them the children's dose of it.)

All of which really means that acetaminophen should remain over the counter, people just need to know that over the counter medication is dangerous if you use it incorrectly or take more than you're supposed to or combine it with things you really shouldn't, like alcohol.

[lyonesse.livejournal.com]

*nods* an advantage to aspirin is that "it is the only drug that contains its own warning bell" -- your ears will ring due to thinned blood quite awhile before you reach a toxic dose.

(some folks do have trouble with its acidity, of course, and there are several good alternatives on the market. but tylenol isn't really safe, except iirc in particular for children or the pregnant.)

[gingicat]

*clings to my Excedrin*

(Seriously, the mode of action of acetaminophen is what's necessary for certain headaches. I have to be careful of triggers such as driving in bright sunlight and forgetting to have a daily vasodilator such as caffeine.)

[spacehawk.livejournal.com]

Yeah, I get (atypical) migraines and only taking both Tylenol and Advil together seems to help it somewhat.

[ailbhe]

Here in the UK there are limits to how much you can buy at one time, which is awkward if everyone in the house has a fever.

slight clarification

[redbird]

That "twice the effective dose" is slightly misleading: the liver-destroying overdose is about twice the recommended daily maximum, not twice what you'd likely need to treat a headache once. If you're not drinking, and have a headache in the afternoon, you're not taking a huge risk by taking 500 mg of acetominophen at 5:00 and another 500 mg at 10:00 before going to bed.

I don't trust it and try to minimize my use of it—but I don't have one of the conditions that make NSAIDs (including aspirin, ibuprofen, and naproxen) risky for some people. With regard to that: my doctor advised against taking ibuprofen on an empty stomach, because taking it with food reduces the risk of kidney damage.


[I also left a version of this at siderea's journal.]

Re: slight clarification

[browngirl.livejournal.com]

I've edited my post -- thank you for that correction. :)

[acelightning.livejournal.com]

[ron_newman]

I'm looking at the last prescription bottle of cough syrup I got, six month ago. It's just codeine and guaifenesin, nothing else.

[acelightning.livejournal.com]

[kayliemalinza.livejournal.com]

thanks for posting this! there was a lot of new information for me--which is scary as hell, because i'm a pharmacy tech. @.@

one of my pharmacists did tell me that acetaminophen is the #1 drug ERs see people overdose on, so this needs to happen, but she was the only one, and she only works one night a week. we dispense apap a LOT, with instructions that bump right up against the max daily dose (or even go over it, though we add "take no more than 8 per day" or w/e) and i've never heard the pharmacists make a big deal out of it when they consult patients. they'll caution them against combining it with OTC tylenol but they certainly don't mention liver failure and death.

the FDA is finally doing stuff, though. it got children's tylenol taken off the market years ago (we *still* get people asking about it, ugh) they're restricting prescription doses. painkillers such as lortab and vicodin are combinations of hydrocodone and APAP aka acetaminophen. 500mg of APAP per pill is a common dose, but at the beginning of next year the highest legal dose per pill is gonna be 325mg. it's gonna be a total pain switching over (we buy 5/500 vicodin in bottles of 1,000, and have lots of patients on it for chronic pain) but it's long overdue, sounds like.

[margi-lynn.livejournal.com]

Thank you for posting the link! (here at your jounal via a signal boost from a friend)

[purlewe.livejournal.com]

a newly made doctor friend of mine comes to our knitting nite and gives us the latest stuff she learned in med school (now she is a resident! YAY!) But after she told us about tylenol Sue insisted we use the last of the bottle and get rid of it. We now only have aspirin at home and I have advil at work.

One thing she said that really struck Sue was that it wasn't that you shouldn't mix tylenol and alcohol (that was already understood.) what she said was "anyone who ever drinks alcohol, even occasionally like once a month should never take tylenol. ever." Supposedly your liver metabolizes alcohol so slowly (?) that even one drink a month would mean there was enough in your liver to interact with the tylenol. Sue and I drink ... a drink every 2 weeks? And our doctor friend said this was too much alcohol to be using tylenol at all. and so.. no more in our house.

strangely enough I have never had a good reaction to using any other NSAIDs. None of them work for me. And the one that did (sudafed I think) changed its prescription/active ingredient since the whole "you must get your name checked before you buy this b'c people cook meth" rules. So I can only take aspirin, advil, or aleve. I am largely unmedicated most of the time. Much to my chagrin.

[tibicina.livejournal.com]

pseudoephedrine (the active ingredient in sudafed) isn't an nsaid, or, indeed, a pain medication at all. It's a decongestant.

[purlewe.livejournal.com]

pseudoephedrine is ACTUALLY what I am allergic to. I guess the word other was a miss-type as I had two competing sentences in my head. I have never had a good reaction using *ANY* NSAIDs. Other than advil and aleve I don't take any drugs b'c of the terrible reactions I have.

pseudoephedrine has given me such horrible reactions that I won't take anything. I suffer more, but I would rather wait it out now than try and have a bad reaction.

Thanks for helping me clear up my meaning. Sometimes I am clear as mud.

[grendelgongon.livejournal.com]

I'm not a MD, but I was an alcoholism researcher for most of a decade--

I have to wonder about the accuracy of this. The body is quite good at metabolizing alcohol, and for a typical person the alcohol in one drink is pretty fully metabolized by a max of about 3 hours out.

Heavy drinkers do have higher CYP2E1 levels, however, and my understanding is that these higher levels cause more of the acetominophen to be metabolized into toxic metabolites, though how big an effect this is (relative to the effect of poor liver function in heavy drinkers) is a good question.

I'm a bit dubious that very occasional drinking raises CYP2E1 levels all that much, though I haven't found much in the quick literature search I did one way or the other.

http://www.uspharmacist.com/content/d/feature/c/23857/

has some info to this effect with the caveat that I don't know much about this source and how authoritative it is, but it agrees with what I thought was the case.

Either way, I think there are plenty of reasons to be cautious about acetominophen, though.