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Sep 25 2013

The unrecognized dangers of Tylenol and acetaminophen

That excellent independent investigative journalistic outfit ProPublica has been running a series of articles about the dangers posed by people not knowing what harm Tylenol and other acetaminophen-based drugs can do to them if they are not careful about its use, and says that the FDA hasn’t acted quickly enough to alert people to the dangers and the need to be really careful about dosages.

One of the serious problem is that children’s versions can come in different concentrations that can result in harm to children being given wrongs dosages.

Based on their investigations, the final article suggests nine steps that could be taken to reduce the dangers, many of which have been adopted by other countries already.

  1. Drop the Daily Total

  2. One Concentration and Dosing Instructions for Kids’ Products
  3. Take Acetaminophen out of Prescription Pain Killers
  4. Restrict Pill Quantities
  5. Dose Up Slowly
  6. Limit Pill Strength
  7. Require Side Effect Warnings in Advertisements for OTC Drugs
  8. Acetaminophen Icon
  9. Grab Consumers’ Attention by Warning Them an Overdose Can Kill

14 comments

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  1. 1
    Stella

    Take Acetaminophen out of Prescription Pain Killers

    When I learned that I would need to be on prescription pain killers for the rest of my life I asked the doctor to write the prescription for the formulation that did not include acetaminophen. I insisted that I could add the acetaminophen if and when I felt it was needed to potentiate the action of the opioid. The doctor was not happy to do this, but she eventually agreed. After nine years my liver function tests are still very good.

    Her stated reason for her reluctance to remove the acetaminophen was that the DEA considered controlled drugs to be less abusable if they contained acetaminophen. I can see how the combination drugs would be more deadly but not how they would be less abusable.

    Stella

  2. 2
    invivoMark

    The futile crusades of the DEA should never get in the way of health-conscious pharmacology. That’s a ridiculous reason to add acetaminophen to prescription painkillers.

  3. 3
    Stella

    @invivoMark,

    Oh, I agree with you completely. I encourage others to forego the acetaminophen in their pain control.

    The doctor, however, gets audited by the DEA as to how many patients are prescribed how many scheduled drugs for what period of time. In this state there have been prosecutions and losses of medical licenses. I don’t blame her for her concerns, but I don’t think poisoning me is a solution.

    The DEA has made treatment of long term, serious pain difficult for both doctors and patients.

    Stella

  4. 4
    erickuritzky

    It’s very simple: once the patient dies from liver failure, she will cease to abuse opioids.

  5. 5
    unbound

    Yeah, the DEA has made pain management in the US the laughing stock of the world. The insane assumption that everyone will be addicted to narcotics in just a few doses is laughable.

    It was a horrible fight to get my wife sufficient painkillers after a major surgery to her heel bone (known to be among the most painful surgeries). Deep down the doctors knew that the minimum recommended pain killer dosage is not sufficient, but we had to argue for hours to get it bumped up just one level to get the edge off…and I’m certain she really should have been another level above that, but at least the pain was tolerable at that point (at least compared to the minimum dosage). I have little doubt worries about the retarded DEA was at the root of all of this.

    I also have strong doubts about the percentage of the population that is easily susceptible to narcotic addictions. Neither my wife nor myself have ever maintained any interest in continuing the narcotics after our surgeries. In fact, Motrin always worked better for me after surgeries once I was able to take that in lieu of the supposed overly strong and evil narcotics.

    In regards to the acetaminophen, neither myself nor my kids even respond to using it anyways, so it has never been an issue. I’ve been told in the past that the reason it was the #1 recommended pain medication is because it was supposed to be safe (it apparently doesn’t interact with other medications), not because it was ever considered a good pain medication.

  6. 6
    Anniemouse

    Agreed that pain management in the USA is a joke. I had a fairly major surgery in my 30s and experienced a great amount of pain in the hospital. I asked for pain meds but was told I couldn’t have them–to repeat, I had just had a major surgery, and the pain I was experiencing was completely predictable, yet I couldn’t have any relief? I kept insisting that the pain was unbearable and was called a drug addict. The doctor had my medical records; I had no history of drug or alcohol abuse, and again, *I had just had major surgery*, when any person might be expected to be in pain. Then the doctor had the nerve to tell me I just wasn’t healing fast enough. Perhaps if I hadn’t been sleepless and in agony all day, every day, I might have put my energy into healing.

    In contrast, when my elderly dog was dealing with his terminal illness, the veterinarian was very good about helping us manage the dog’s pain and give him the best quality of life that could be expected, until there were simply no good days left.

  7. 7
    eigenperson

    I think one simple change could solve the problem of accidental overdoses: never putting acetaminophen in a medication with anything else. If you want to take acetaminophen, you should have to take something that contains only acetaminophen.

    But restricting pill quantities and strengths makes me a sad panda. If I have the flu, do NOT make me go out to the store to buy more acetaminophen because my tiny bottle of weak-ass pills only lasted a couple of days. Not only is it unpleasant to do that with a high fever, I’ll probably infect someone as well.

  8. 8
    WMDKitty -- Survivor

    So. This is why I can’t get adequate pain management, and have been shuffled from NSAID to NSAID. The DEA says “no.”

    The government has no business telling doctors what to prescribe.

  9. 9
    cotton

    Holy hell I wish I had known this a week ago! I just had my wisdom teeth removed and I’ve been taking loretab with acetaminophen. I’d never even heard of this issue.

  10. 10
    Cathy W

    I almost did this to myself. There was one weekend I was running a fever of 105-106 F, and I knew you could only take so much NSAID medication – but I was under the mistaken impression that acetaminophen was absolutely harmless, couldn’t overdose on it, so I was taking the recommended dose of Tylenol about every 2 hours, until I finally threw up a dose. (Fever impairing my judgment, yes?)

    It still didn’t bring the fever down, so I ended up in the ER – where I told them I’d been taking Tylenol with no results, but didn’t mention how much. (Fever impairing my judgment, yes?) Ironically the first dose of Motrin brought the fever down to 103 almost instantly, saving me from an ice-water bath… My liver seems to have come through the experience unharmed, but imagine my shock a couple weeks later when I learned that acetaminophen was kept behind the pharmacy counter in Britain because it’s one of the preferred methods of suicide there. I’ve mostly avoided it since then, although I didn’t hesitate to take it when prescribed in combination with an opioid after surgery.

  11. 11
    badgersdaughter

    I came much closer than you during a bout of food poisoning, ironically in the UK, from dodgy oysters… I took the paracetamol “as needed for pain” and not a whole lot more than the dosage on the box, but as soon as I got back to the US, I went to the doctor because I still felt ill, and my liver enzymes were so elevated he thought I had hepatitis. A scary round of tests later, no meaningful results. A month after that, my liver enzymes were back down to normal. Verdict: No more f***ing Tylenol for me.

  12. 12
    Mobius

    I had read years ago of a study showing that acetaminophen had been linked to liver problems. However, the study showed this almost always happened with people using the medicine daily in dosages exceeding the recommended dosage. I would be reading the articles you linked to.

    Plus one should always be careful with medications given to children. Sub-adults often react differently to drugs than adults. Parents need to research the effects of adult medications on children and not just give the children what works for the parents.

    I have sinus (hay fever) headaches and have found the OTC medications containing acetaminophen, aspirin and caffeine to be a very effective. However, mindful of the warnings I limit my use to one pill once or twice a day…or two pills if I am suffering a really severe headache, two pills being the recommended maximum dosage. One usually does the job. These pills are marketed by Excedrin under several different labels, but I always use the generic versions. I can tell no difference and the price is substantially lower.

    But even though I am a fan of the medication, I agree that people do need to be aware of the dangers of over medicating with acetaminophen. There are alternatives. Aspirin is wonderful stuff provided you don’t have stomach acid problems. And there is ibuprofen as well, which gives similar relief to aspirin and acetaminophen.

    But thank you for bringing this to people’s attention, and I will have to read the articles.

  13. 13
    augustpamplona

    For me it was learning of studies like this one a few years ago which made me realize that this is a dangerous drug with a very narrow therapeutic window.

  14. 14
    gworroll

    Acetaminophen really shouldn’t be such a goto pain drug. The gap between “enough to control pain” and “enough to kill you” is just way too small. It has its medicinal uses, but so does cocaine.

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