This is not true for most folks, especially as far as tylenol goes. One can safely take 3 grams a day for years, in the vast majority of people.
Tylenol does nothing for me, including failing to reduce fever. Neither did Tramadol, and most opioids tend to nauseate me terribly. Ibuprofen works pretty well, and for post-surgicsl mastectomy treatment, a low dose benzo helped decrease muscle spasms. Mostly I meditate.
3 grams in 24 hours is the maximum recommended dose. If you want to tell people that is safe to take for years go right ahead.
For selected patients, I do just that. I’ve had patients get significant relief for osteoarthritis over a couple of decades with that sort of dosing, without significant liver or other organ issues.
Sadly, all too many don’t get real relief from acetaminophen. If I can find an NSAID that gives them decent relief, they need more monitoring over time, but can often do well with chronic use there too. But they tend to have more side effects and problems on the whole with NSAIDs than with acetaminophen.
I’m not saying acetaminophen can’t be dangerous. Acute overuse (as in suicide attempts) is real problematic. And chronic use in folks with liver disease and/or significant alcohol abuse makes it dangerous.
Surgery? Yeah, they dont want you taking NSAIDs - they can cause bleeding at the site. Yeah, 800mg ibuprofen is wonderful, but my Doc said no NSAIDs for a week after surgery.
Acetaminophen works on my headaches, not much else, but I do take 800mg ibuprofen for arthritis pain. Or Mobic. And Tylenol-3 does make me a bit drowsy but gives me constipation.
That was a mistake. Massive bleeding could have occurred.
It is just generic tylenol (Acetaminophen), aspirin and caffeine. Get the generic, you will save a bundle. That combo is great for headaches.
1960?!?
Yes.
In the US
My late first wife had metastatic cancer in her guts. Which eventually produced a bowel obstruction needing surgical repair. Post-op she still needed pain management for both the ongoing cancer and the bowel resection. But her usual opioids (fentanyl) were a bad choice due to the bowel slowing side effects while getting things moving again was the key objective to her recovery.
She was on 8000 (yep, eight thousand) mg of acetaminophen per day for 2 weeks. With a couple jumps to 10K mg when she really hurt. With active liver health monitoring. She was already in rather raggedy shape, but the acetaminophen did not cause any incremental problems. And worked to keep her from climbing the walls in pain until we could safely restart her fentanyl. That was a bit of a desperate situation calling for desperate measures. But it wasn’t foolhardy or reckless medical practice either. Rather it was a norm for a corner case.
Many ignorant people seem to think all OTC meds are harmless even in grossly higher than recommended doses. As a result, the manufacturers try real hard to scare the people who can and do read into thinking that if 4 pills/day are the normal dose, 5 will be fatal. The reality is just not that true.
The people with cirrhosis who think that if the bottle says take 2 every 6 hours they should take 5 every 3 hours, now those people are asking for it.
There is a middle between those two extremes.
For me personally, acetaminophen is perfectly good for the occasional headache, and for post-op pain for the minor skin cancer surgery I get all too often. Some cutting, some burning, or a 1"+ row of stitches following a larger excision, 2 ordinary strength (325mg) acetaminophen work great. And are the doc’s recommended analgesic, mostly for the benign side effect profile in his retirement aged patient population often on several other meds for [whatever].
He is a Doctor and you are not, afaik. But yes*, if you know your patient,* and they are not a heavy drinker, etc, then that dose can be safe.
From my experience the pain effectiveness of OTC drugs depends on what is causing the pain. Most of my pain is better dealt with using Ibuprofen (NSAID). But not all. Having said that it is in a different category than acetaminophen so they are not interacting with each other. In other words, you can take them both at the same time. It’s not an either/or situation. Consult your doctor as to how much you can take of both at the same time.
ORAL surgery….mostly tooth extractions.
I’m aware of the formulation. They’re eight cents a pill for the name brand, five cents for the generic.
When I fell off a ladder and injured my hamstring badly, I was instructed to take 4 Aleve a day, and given a script for what I think were muscle relaxers. Tylenol wasn’t even mentioned (nor was anything stronger, which I probably could have benefited from the first 2 weeks while my knee was immobilized)
Acetaminophen does nothing for me in terms of pain. Ibuprofen and naproxen chew up my stomach, with or without food, and don’t alleviate pain. Opioids make me nauseated, so I only take them if the pain without them is worse than the nausea with them. Just thinking about them makes me queasy. I also don’t like the grogginess.
The exception was a time-released opioid I had when I developed endophthalmitis. It took care of the pain without side effects. Yay! Then someone broke into my house and stole them. I thought the joke was on them because they wouldn’t get high, but a doc told me that addicts crush them so they get all the opioid at once in a big rush.
Dammit.
And then there are cats. Even a single dose of acetaminophen can kill a cat. Cats have a deficiency in a metabolic pathway in the liver that breaks down certain drugscalled the glucuronide conjugation pathway.
A few statistics from the CDC and NIH for perspective:
It’s estimated that in the US, there are about 500 deaths per year from acetaminophen. Meanwhile there are about 16,000 deaths per year from NSAIDs.
Just for comparison, there are about 40,000 deaths from auto accidents and 140,000 deaths from alcohol every year. And 480,000 deaths from tobacco.
For me, at least, ibuprofen is much better for headaches, and aspirin is much better for sore muscles (I do varied physical work, and while muscles sore enough that I want to take something aren’t continuous it does happen.)
Codeine is what works for severe cough or for pain worse than that. It doesn’t make me groggy, it doesn’t screw up my sleep or digestion (all of that at least in the low doses that are all I’ve ever taken), and it’s never given me any desire to take more of it once the reason for taking it is gone. My mother took low-dose codeine for pain intermittently through most of her long life, never wanted or needed her dose increased, and never had any difficulty stopping it when she didn’t need it for a while.
She had trouble getting it during the last years of her life – especially getting it straight, not mixed with Tylenol, which made her feel significantly worse. (Me it just doesn’t do anything to, either way.) And I’m afraid to ask for it at all. I’d really like to be able to have a bottle of the old codeine cough syrup in the house, so if I get a really bad cough in the middle of the night I don’t have to suffer through that night and then try, the next day, ill, coughing, and groggy from lack of sleep, to pry a prescription out of a doctor, who will probably first prescribe me something that doesn’t work and that I’ll have to drive into town to pick up, and then suffer through another sleepless night before I can report that it doesn’t work and hope to, just maybe, be able to get the stuff that does – and hope that I won’t be written down as “drug-seeking” for it.
At least attempting to keep from getting covid has resulted in my not getting anything else, either, for the last several years. The pain from my pacemaker insertion I just suffered through; I was afraid to ask for codeine.
Thank you for your input, I appreciate it very much.
As an aside, I’m more strongly considering the “Watchman” device, which of course has its own risks and benefits, which include potentially getting me of blood thinners.
I’m on a blood thinner, so ibuprofen is right out. Tylenol works fine for me, happily, but I’m not all that sensitive to pain so I take it infrequently.
Thinking about it more, many years back (pre Amazon) there was a much greater price difference. I think I’m only into Excedrin for around $30/year these days.