A few years ago, our doctor told us that it’s okay to replace a single dose of OTC tylenol with a double dose twice a day.
Today, however, a pharmacist griped me out for doing this, intimating that my wife (to whom I gave the pills this morning) ought to be going to the ER for possible liver damage. When I told her a doctor had advised me that it was okay, she simply said “No,” and repeated her stance.
Any way I can find out for sure whether the advice from my doctor is, indeed, bad advice? He said at the time that OTC tylenol is far below acceptable dosage levels. Is this not true?
Tylenol in too high a dose will destroy the liver and you’ll find out 24 hours later. Unless your wife has some liver problem, I’m sure your doctor’s advice is still relevant. The only cases I ever see articles on are doses way beyond double.
*Assuming standard 500mg pills. And don’t forget to check the labels of anything else you are taking. Often times cough or cold medicine will contain it as well and you have to add that in.
Correct me if I’m wrong…the only bottle of Tylenol I have in the house is missing most of the label because it got wet.
A standard dose of Extra Strength Tylenol is 2 - 500mg caplets (1 gram) every 4 hours. If you take this dose around the clock, you’d get 6 grams a day.
Do they assume you sleep 8 hours a day and won’t be taking the pills when you sleep?
Is 6 grams in a day going to shut down my liver? Or would it have to be 6 grams a day over a long period of time?
I’ve wondered that as well. I had a friend (and another person I spoke to once) that said she tried to kill herself one night by downing a bottle of tylenol and a bunch of vodka. She said she woke up the next day feeling like a million bucks (oddly, the other person said almost exacty the same thing, woke up feeling great). The feeling like a million bucks part I assume has something to do with spending a good deal of time very seriously and deeply contemplating their life. But from everything I had been told, I was surprised they woke up at all.
Hey, I just pasted the title. The original questioner was asking specifically about alcohol plus Tylenol. The interesting (and relevant) parts of the article were (1) the toxic dose is less than twice the maximum daily dose (the amount that Frylock was using to poison his wife), and (2) people with impaired liver function have overdosed on as little as 4 g.
We need a pharmacist to check in, but my vague recollection of pharmacokinetics is that there is a difference between fast, normal and slow metabolizers (cytochrome p450 system). For arguments sake, let’s say 10% of people are slow metabolizers, 80% are normal and 10% are fast. I would ASSUME that the directions would be the maximum dose for slow metabolizers so the company making the drug can cover their ass. Also, I think this would depend on zero or first order pharmocokinetics. Damn. I’m really not helping at all, but I’ve typed all this so I might as well submit it.
Whereas I worked at a college where a person tried an OD on Tylenol, woke up feeling a little fluey, and disregarded it. When the hall resident got wind of this, he sent the student for an evaluation that immediately sent the student to the local hospital, from which s/he was airlifted elsewhere. Last anyone on faculty or staff heard, s/he was in liver and kidney failure and being evaluated for organ transplantation.
The cases in the paper are often when a person tries to commit suicide. The parents or spouse catch them and they don’t seem to be dying. They make the mistake of not getting immediate medical help at that point, and a day later the person is dying, because the liver is destroyed.
Not shot, just a little winded. The liver needs glutathione to cope with tylenol or alcohol. If it uses it up on booze, and you don’t give it a chance to make more, it may not have enough left to detoxify the tylenol properly. One non-lush who had problems:
When my cousin was addicted to Percocet. He was taking upward of 30-40 a day for at least 3 years. Now, each Percocet has 325mg of Tylenol in each pill. 325 x 35 = 11,375. He should’ve been dead numerous times. DO NOT DO THIS EVER ! Obviously. But that goes to show the amount of acetaminophen that certain people’s bodies can handle. He was tested years later and his liver was fine.
But you should never exceed more than 8 pills of 500mg of Tylenol in a 24 hour period. I think the pharmacist was overreacting a bit, unless your wife has liver damage. Also, it never hurts to get a liver workup if you’ve taken Tylenol a lot in the past.
With Tylenol overdose, you get better before you get worse. In other words, if you took a lot, you would get sick with flu symptoms and then feel better for about a day. Then for the next two days, all of a sudden your liver would start to shut down and THEN you get REALLY bad off. Just google “liver failure” and read about it.
I am not a doctor and this is not medical advice, just my personal experience.
FWIW, perhaps he’s being overly cautious, but one of my physician friends absolutely refused to give me any acetaminophen after a night of moderate-to-heavy drinking. Luckily, he had ibuprofen on hand, but he was pretty explicit about forbidding me to ever take Tylenol for headaches caused by drinking.
So question: With the liver problems Tylenol can cause, why aren’t ibuprofen or aspirin more common pain relieving drugs of choice? All three seem to work equally well for me, is there any reason I would want to choose Tylenol over the others in some cases, while aspirin or ibuprofen in others? I know aspirin can cause stomach problems, but what about ibuprofen? What set of risks does it come with?
GI hemorrhage, basically. All NSAIDS increase the risk of this, including the cox-2 inhibitors, which are supposed to be less risky for the GI tract. Basically they’re not.
An estimated 16,500 deaths occur annually in the US related to NSAID use. This number has been dropping, probably due to the increased use of meds like Prilosec (omeprazole)
