When I was in pharmacy school, a guy came and spoke to our class who had lost his license because he used his own drugs. (A decade later, one of my classmates lost his LIFE this way; looking back, I really think he became a pharmacist so he could get drugs, and trust me, this is NOT the easy way to do it!) He mentioned drinking bottles of Tylenol #3 elixir, and chasing it with acetylcysteine as an antidote to the Tylenol content, and I was one of a few people who gasped because we knew how dreadful that stuff smelled, and presumably tasted.
Is there any other kind?
Other kinds of drugs? Or other kinds of addictions?
So says Mom:
I was once in the ER for hypoglycemia-- sugar refused to stay up no matter what I ate.
They discovered i was running a temp, and decided to give me 500mg Tylenol. I sat up and quickly informed them that I had recently taken 2 of the slow-release, 8hr Tylenol, so my system was maxed out.
The nurse assured me that I could take more Tylenol. I forget her exact words, but she implied that I could take quite a bit more and be OK.
So, apparently the limits on the bottle aren’t the line for liver damage; I’m not sure what they are-- they probably aren’t random, but they may be something like 1/2 what the actual max is for a very small person-- say, someone who weighs 100lbs. Lucas_Johnson was probably still ODing, but maybe not by as much as we are assuming. If he started out with an exceptionally healthy liver, and a lot of luck, well, here he is.
I worked with a guy that (according to him) suffered migraines and he was, effectively, living medicated from the start of the day to the end of the day, drinking headache medicine powder at all times. (I forget which particular molecule he was doing.)
I’d assume that the limits are targeted more towards that sort of chronic use than short term, acute usage.
I’m reminded of a scene from Scrubs where newbie JD is pestering Perry for what dosage of extra-strength Tylenol to prescribe and the response is somewhere along the lines of, “Throw a handful at her; whatever lands in her mouth - that’s the dosage.”
It seems like since that joke the issues with Acetaminophen dosing have become more widely known and doctors are legitimately more careful with just giving it out.
The linked article says he referred to Perry as a “moron,” and wondered how much he could soak him for. And he hoped he could become Perry’s go-to source. What a scumbag.
I’m glad Perry’s personal assistant got arrested, too.
Sorry, just saw this.
You are probably right, albeit, we are warned about acute doses-- red letters on the lid of anything with acetaminophen (generic Tylenol) specifically say “CONTAINS ACETAMINOPHEN! do not take Tylenol, or acetaminophen-containing products while taking this medication.”
I think an acute dosage can put you in ICU, but not something like a double dosage-- something more like 10x the recommended dose.
In the hospital, when the nurse assured me that I could have more Tylenol, what interested me most was that more would be effective. The line I always got was "there’s no point in overdosing, because once you take the max recommended (1000mg every 4 hrs), taking more won’t produce a better effect.
That, apparently, is not true.
It’s also good to know that if I’ve got some pain, and I have a break at work, and want to take my next Tylenol dose, but it’s been 3.5hrs, not 4, not to worry-- because if I don’t take it then, my next chance might not be for a couple more hours.
Like many drugs, a particular person’s liver’s ability to safely process acetaminophen varies. Body weight is also a factor. The dosage limits are set to something more or less typical, plus a safety margin.
It certainly is possible to destroy your liver in one go with sufficient Tylenol at one sitting. In fact, this sort of thing is one of the leading causes of needing a liver transplant in the industrialized world.
My information (and I am not a pharmacist - being the daughter of one does not count) is that exceeding 150mg/kg of body weight is likely to cause liver damage. That is not the same as completely destroying your liver, which would require a higher dosage but it is apparently near where damage starts to happen. “Safe” daily doses seem to vary between 3 grams and 4 grams or 3,000 to 4,000 mg. That may still be too much for someone small, or with impaired liver function, or other medical issues.
A really big person with no liver issues and the correct version of liver enzymes (granted by genes) might be able to tolerate higher doses safely, but that’s not something you can reliably eyeball.
I don’t know, but we did have a student try to overdose with 2x the listed dose, wake up alive, feel kinda bad, and go into acute organ failure, so for at least some people, double the max dose on the bottle is toxic. (The student was immediately helicoptered to a major hospital for major intervention and organ transplant. I don’t know if they survived.)
Yikes!
I mean, I guess it does depend on the health of your liver to begin with.
The latest news:
I heard an interesting (CBC) podcast episode recently about ketamine; I didn’t know much about it before.