For all purposes let us assume the patient is a average person with no hepatic problems in average health.
I see warnings that say anywhere from 2-4 grams in a 24 hour period COULD be deadly and to seek medical attention, yet many people routinely exceed this to scary degrees and don’t have an issue. I remember a woman who claimed to be taking around twenty vicodin a day due to addiction without issue, that was around 10 grams daily of aceto!
In fact a physician advised me to take OTC painkillers with what would total 4 grams of acetaminophen in a day, when I scoffed she said it would be fine just not to drink liquor while taking it:confused:
I’m guessing this is a better safe than sorry issue and the warning uses the smallest conceiveable amount that could cause a problem, but makes it unclear where the real line for concern is.
The dangerous thing about acetaminophen (paracetamol everywhere else in the world), and with many other drugs, is that the amount you need to have the desired effect is very close to the amount that is toxic. So you have to be very careful with the dosage.
You also have to consider that the warnings are directed at the population as a whole, which includes a lot of people who lie, justify or are in denial about their drinking.
Not to mention people who are taking other medications that affect the liver and can interact badly with the acetaminophen. It’s easy to figure it must be safe, since it’s available over the counter and really cheap, but the truth is it doesn’t take much for it to do a number on your liver, in the right circumstances.
A guy I know who takes large amounts of a narcotic-acetaminophen combo, does a simple extraction procedure to remove the acetaminophen. I don’t know how common this is.
this is a serious & ongoing problem, as everyday we hear about more side effects of whatever analgesic is taken. Just last year, a study came out saying there’s NO safe amount of time for anyone with heart issues to take an NSAID (like Alleve) - even 1 day could affect the heart. Of course, with Tylenol it’s the liver to be concerned about. The only alternative I’ve found is Norco, which has more codeine & less acetaminophen. Still, no more than 6 a day (assuming they call a day as 24 hours). The Holy Grail of pills would be an analgesic with no effects on any organ. None so far.
Which would mean it wouldn’t work at all - medicine must, by definition, affect something in the body!
I know, you meant no negative or unwanted side effects
Drug design is an interesting field (sorta… I almost went into it) and it would be awesome to be able to design a molecule that affects only the system/organ/chemical pathway/whatever that is causing illness. The problem is that the body isn’t compartmentalized in that manner - the enzymes and proteins in our cells often have more than one role and they are often “generalists” - able to function with a whole class of molecules rather than with one specific thing. Trying to tweak things with a different molecule (one created in a lab) will pretty much always disrupt something other than the intended system, to some extent. If that happens to be a very small disruption, that’s a good thing.
Think about it - you are putting stuff into your body with the intended purpose of screwing around with the way your body is currently functioning (to treat/stop/alter symptoms of illness/injury). Is it really a surprise, then, that the drug screws around with the way your body functions?
The Master Speaks
[QUOTE=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.
[/QUOTE]
It should be noted that taking acetaminophen the morning AFTER a night of drinking (i.e. as a hangover remedy) can be as bad or even worse than tanking it WITH alcohol.
I have to wonder…if acetaminophen was discovered today, would any drug company even bother to market it?
I mean…here you have a drug that, on paper, is no better at pain/fever relief than NSAIDS, but with a much smaller margin between therapeutic and toxic doses, and with worse long term side effects as well.
This is purely anecdotal, from one of the drug design guys at a contract pharmaceutical company I worked for - it was his *opinion *that were it to be wholly discovered today, acetaminophen would likely not be available OTC, but that historical reasons and public (or, perhaps, more likely corporate) pressure on the FDA keep it OTC.
I have no idea if there’s any truth to that, but based on my experience, it at least sounds plausible.
Right. But the other problem is that acetaminophen hides in quite a few other OTC medicines, like most “cold & flu” concoctions. So, some dude is sick, he takes his acetaminophen as per label…. Well maybe “just a little extra”. But then he also takes Dayquil then Nyquil. Meanwhile he is drinking and not eating much. WHAM- liver failure.
That’s a very good point, and is probably a larger contributor to patients with liver problems than people simply taking too many Tylenol straight up.
It’s pretty important to read medicine labels - and especially with cough and flu medications just buy the ingredients you need: you can always take acetaminophen separately if you need it for pain relief, but there’s not much need to take it if you don’t have symptoms it can treat.
Pain -> acetaminophen
Dry Cough -> detromethorphan (often things labelled “DM” also have acetaminophen, but some don’t)
Productive cough -> guaifenesin
Congestion - phenylephrine (pseudoephedrine)
(Drowsiness - caffeine)
All-in-one products are tempting from a cost and marketing perspective, but separate ingredients (or choosing the small package of particular ingredients instead of the big bottle for each time you get sick!) are probably smarter health-wise.
At my urologist today over blood in my urine, longterm complex problem. He asked about taking aspirin. I said no, but I am taking I Ibruprofen. He said to switch to Tylenol.
I’m Diabetic, with High Blood Pressure and High Cholesterol. My doctor has been monitoring my kidney function for quite some time now, and she finally spelled it out: I’ve got Chronic Kidney Disease, Stage 3. I’m not supposed to take NSAIDs, any more.
It’s one of those damned if you do, damned if you don’t. Because for a HELLUVA lot longer than I’ve had the Diabetes-Cholesterol-Blood Pressure business, I’ve had chronic migraines.
With chronic pain, you do whatever you can to survive. The doctors don’t like giving pain relief medication, so while you may get a prescription, you’ll also be told, “Try not to use this.”
Recalling Darvocet from the market was a horrible kick to the head!
Try not to use pain meds. Don’t use NSAIDs. Okay, here’s Tylenol, but if you take “too much,” you’ll blow up your liver.
~VOW
As a fellow chronic pain sufferer I feel for you. Especially the fact that you have migraines. I never had them and then I had post surgical migraines due to a dura tear. I have never felt such pain in my life, my God they were horrible. I would take my excruciating back pain over a migraine any day.
The sad part also is that drugs like Tylenol work so much better on migraines than drugs like morphine. At least that what I found out, the morphine didn’t do squat for the migraine, but a dose of Tylenol knocked it right down.
I hope that you get the headaches under control. I wish you the best of luck.
