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  #1  
Old 07-27-2010, 06:03 AM
godix godix is offline
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Lethal over the counter medicines?

My wife has a diagnosed mental illness, bad enough she's on disability for it. Recently she was hospitalized for suicidal tendencies. Her plan involved overdosing on her medicines. To be cautious, I've gotten a home safe to store her prescriptions in and she doesn't know the combination.

However, I got to thinking of normal over the counter medicines. Obviously I won't have sleeping pills in the house since they're the classic suicide overdose method, although after investigating, the LD50 on them is actually rather high. I don't want to get so extreme I'm locking up asprin since that would be a total pain in the ass getting it every time she had a headache, an asprin overdose is relatively harmless, and I want to show as little distrust of my wife as possible while still being safe. What common over the counter medications are actually fatal if a whole bottle is taken at once?

Also, if worse comes to worse and she does overdose on something, what's the proper course of action? Obviously calling 9/11 is first, but I'm wondering about some hypothetical where emergency services weren't available for whatever reason. Should I get a emetic just in case, and if so which one? What general actions should I take in this hypothetical, keeping in mind that I don't know which exact medication might be involved.
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  #2  
Old 07-27-2010, 06:20 AM
Ferret Herder Ferret Herder is offline
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I'd call the Poison Control number for your area. Last I heard, they were downplaying vomiting in most cases.

Acetaminophen/paracetamol, especially combined with alcohol (which cuts down the amount of medicine needed), is a very bad way to kill oneself. It pretty much destroys your liver, which is a long and painful death.

This sounds like something to check with her doctor about, since you can specify there what meds you have at home, and he/she can discuss plans with you.
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  #3  
Old 07-27-2010, 07:48 AM
SanVito SanVito is offline
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Quote:
Originally Posted by Ferret Herder View Post
Acetaminophen/paracetamol, especially combined with alcohol (which cuts down the amount of medicine needed), is a very bad way to kill oneself. It pretty much destroys your liver, which is a long and painful death.
I was just dropping in to say paracetemol. I actually knew someone who died from taking too many cold and flu tablets (I have no idea how many she took). I also know someone else who made a 'cry for help' suicide attempt with paracetemol and has permanent liver damage. A very bad drug as it doesn't upset your stomach, unlike Aspirin.
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  #4  
Old 07-27-2010, 08:07 AM
Thudlow Boink Thudlow Boink is online now
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Quote:
Originally Posted by Ferret Herder View Post
Acetaminophen/paracetamol, especially combined with alcohol (which cuts down the amount of medicine needed), is a very bad way to kill oneself. It pretty much destroys your liver, which is a long and painful death.
Yep. Here's the Straight Dope.
Quote:
Originally Posted by Cecil Adams
The real problem with drugs like Tylenol is that the difference between a therapeutic (that is, medically effective) dose and a toxic one is surprisingly small. In adults the maximum safe dosage is four grams (eight 500-milligram tablets) over a 24-hour period. The toxic dose is a mere seven grams taken all at once.

You can make the margin even thinner by drinking too much and eating too little.
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  #5  
Old 07-27-2010, 08:18 AM
Whack-a-Mole Whack-a-Mole is offline
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For a poison emergency in the U.S. call 1-800-222-1222
American Association of Poison Control Centers (cite)

You may find a local poison control number as well although I think one is as good as the next (presuming a legitimate poison control center that has 24-hour phone access).

Unfortunately for someone who is suicidal there are all too many ways to pull it off. Drugs are but one and even with drugs things as simple as aspirin can be dangerous if taken in large quantities (hell...too much water can kill you).

I guess the best advice is to do what you can. Keep the more dangerous drugs locked away as you are doing, keep a poison control number handy and have a plan in place for yourself that if the unthinkable happens so you can respond efficiently and appropriately. Freaking out, while understandable, tends to be the difference between life-and-death in an emergency situation. Preparing yourself mentally ahead of time, like any practice, will hopefully keep you on the best path if something goes badly.

Not easy stuff, do the best you can. It's all that can be expected.
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  #6  
Old 07-27-2010, 12:04 PM
needscoffee needscoffee is offline
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The problem with an emetic is that unless you know exactly what she took, it can cause more damage coming back up.
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  #7  
Old 07-27-2010, 12:05 PM
outlierrn outlierrn is offline
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Tylenol is present in quite a few combination 'coughing, sneezing, sniffling' type OTC meds, so check.

The risks of aspiration outweigh the benefits of emetics, at least in the hospital setting, I've never used them in the ER.

The sleep aid, Ambien, is actually pretty safe. Seconal has a bad reputation, I not sure which others.

I'm sure your doctors are on this, but certain anti-depressants can be quite dangerous:
The tricyclics such as amitryptiline are dangerous in an overdose
SSRI can increase suicidal ideation in normal doses for a minority of people.

good luck
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  #8  
Old 07-27-2010, 01:11 PM
txloopnlil txloopnlil is offline
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I recently heard that the recommendation on emetics and poisoning has changed, and they DO NOT advise home administration of them any longer in most circumstances, as they can interfere with more effective treatments in the ER.

Probably one of the most dangerous OTCs is Tylenol (acetoaminophen) http://emedicine.medscape.com/article/820200-overview,

http://en.wikipedia.org/wiki/Paracetamol_toxicity

I knew two people who delibrately committed suicide with it - not a fast or nice way to go either.

I don't keep acetoaminophen in my house any more, except for a few individually packaged tabs that came in a first aid kit. My sister was an ER nurse and said they mostly get accidental acetoaminophen ODs in elderly (& drunk) patients who don't remember taking the pills and retake them and/or combine multiple medicines containing it, but with teens/adults it is almost always delibrate ingestion.

One of my toddlers drank half a bottle of OTC cough medicine once (Yes a 3 y.o. CAN open child-proof caps!) and poison control's main concern was if it was just cough medicine or if it was one of those combined "Cough & Cold" medicines. I never liked combined products, so we were OK - he would have had to drunk nearly 3 bottles of what he did, before it reached toxicity concerns even warranting an ER trip. However, if it HAD contained acetoaminophen though, we probably would have spent a few days in a pediatric ICU.

Check with the doctors or pharmacists and don't forget the cleaning products and pesticides too.
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  #9  
Old 07-28-2010, 12:15 PM
godix godix is offline
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Huh. I didn't realize Tylenol was so easy to hurt yourself on. I know asprin is absurdly difficult to OD on , one bottle is not enough to OD on really. I guess I just mentally put Tylenol in the same category of reasonably safe like asprin. Fortunately, we don't have any acetoaminophen around since for whatever reason it has never been that effective at pain relief for either of us.

Thanks for the cautioning about inducing vomiting as well. I thought that was, generally, the typical practice except for extremely caustic solutions.
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  #10  
Old 07-28-2010, 07:43 PM
KarlGauss KarlGauss is offline
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Quote:
Originally Posted by godix View Post
I know aspirin is absurdly difficult to OD.
I don't think that's the case. Especially if there's been any sort of prior build-up in the blood (say from mild kidney problems), aspirin can kill after ingestion of little more than normal therapeutic doses. Even with normal kidneys and taken one-time only, the lethal dose of aspirin is between 10 and 30 grams (i.e. between 20 and 60 500 mg tabs), not too hard to do. (Cite for lethal dose of aspirin)
Quote:
Originally Posted by Ferret Herder
Acetaminophen/paracetamol, especially combined with alcohol (which cuts down the amount of medicine needed) . . .
Actually, coingestion of alcohol and tylenol (by a habitual non-drinker), protects against the development of tylenol toxicity. Rephrasing, if you wash your tylenol OD down with booze, then so long as you're not a habitual drinker, the booze will tend to prevent the tylenol from killing you.

Here's how it works (based ona recent post I made):
Quote:
Originally Posted by KarlGauss
To clarify a bit, the potential toxicity of the combination of alcohol and tylenol (acetaminophen, paracetamol) depends on whether the person taking them is a daily (or habitual) user of alcohol or not. It also depends on whether the tylenol and alcohol are taken simultaneously or not.

The bottom lines, then, are
1. if the alcohol is taken at the same time as the tylenol, the chance of toxicity is actually reduced.
2. if the person uses alcohol on a daily, or near-daily, basis, the risk of toxicity from the co-ingestion of tylenol is increased.

To explain these statements, you need to understand, firstly, that toxicity due to tylenol is a result of (the accumulation) of one of its breakdown products, and not the tylenol itself. This toxic breakdown product is formed as the result of a particular enzyme working on the tylenol. As it turns out, this enzyme is also one of the ones that's involved in breaking down alcohol. Since our bodies have only a limited amount of this enzyme, if follows that if the enzyme is busy working on alcohol, there is less of it available to work on tylenol (and thus less available to generate the toxic breakdown product). In other words, drinking alcohol at the same time as taking tylenol should protect against tylenol toxicity.

The explanation for the second statement above is twofold: 1. habitual alcohol users tend to have limited supply of glutathione, the natural 'antidote' for tylenol. This makes them more susceptible to tylenol toxicity 2. daily alcohol use increases the amount/activity of the enzymes used to break down alcohol. And, one of those enzymes is the same one that breaks down tylenol into the potentially poisonous by-product. So, for a given amount of ingested tylenol, daily alcohol users will produce more of the toxic breakdown product of tylenol per unit time (i.e. alcohol "induces" that enzyme, a not uncommon phenomenon in biology where an enzyme's substrate is also its inducer). Again, the expected result is increased tylenol toxicity when a habitual drinker takes tylenol. In fact, even minimally excessive amounts of tylenol can be fatal in a "drinker"
(the above was a paraphrasing, not an exact quote)

And, finally, back to the OP's question, many OTCs can be deadly. Are cold and allergy products available OTC in your area? Around here, you can get standard antihistamines like Gravol and Benadryl without a script. Likewise, many, many meds containing things like pseudophedrine, neosynephrine, phenylpropanolamine, etc. can be had without a prescription. These are all basically forms of "speed" so, although it would take a large ingestion, they can be fatal in overdosage. Same for the antihistamines. And, don't forget antifreeze. It may be the worst of the lot (if it contains either methanol or ethylene glycol, as many do).
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  #11  
Old 02-15-2012, 11:38 AM
gaffersj gaffersj is offline
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I would buy a charcole solution in the event of an overdose on any medication. Especially Acetaminophen. The charcole binds to the drug and will keep the body from absorbing the lethal amount. But If possible call a poison control center right away for further instructions and whenever possible call 911. Treatment is neccesary.
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  #12  
Old 02-16-2012, 07:46 AM
ruritanian ruritanian is offline
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I can confirm that it's *very* difficult to keep someone from killing themselves once they really got it into their head. It happened to someone very close to me. Every clue, as small as it may be, should be taken seriously. Constant vigilance is very important and no relapse from it is admissible. Best of luck.

Since you already have the safe, you could keep whatever drugs you want in it as a "main supply", while also having a "regular" medicine cabinet, except that each container in the latter would only have a minimum amount of pills, e.g., 10 aspirin, 5 tylenol, etc. Having the illusion of an open, unrestricted cabinet may also help from a pshychological point of view.

Again, best of luck.
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  #13  
Old 02-16-2012, 09:25 AM
jz78817 jz78817 is offline
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Quote:
Originally Posted by txloopnlil View Post
One of my toddlers drank half a bottle of OTC cough medicine once (Yes a 3 y.o. CAN open child-proof caps!) and poison control's main concern was if it was just cough medicine or if it was one of those combined "Cough & Cold" medicines. I never liked combined products, so we were OK - he would have had to drunk nearly 3 bottles of what he did, before it reached toxicity concerns even warranting an ER trip. However, if it HAD contained acetoaminophen though, we probably would have spent a few days in a pediatric ICU.
must have been tripping balls for a bit, though.
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  #14  
Old 02-16-2012, 09:42 AM
Little Nemo Little Nemo is offline
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Not a medication, but sodium-free salt is surprisingly toxic. The most common variety is potassium chloride, which can be lethal in a relatively small amount.
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