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Acetaminophen: Very safe except when it isn't - Input Junkie
October 2nd, 2013
07:34 pm

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Acetaminophen: Very safe except when it isn't
This American Life did an hour about acetaminophen (the active ingredient in Tylenol).

(Transcript)

The short version is that acetaminophen is a safe and useful painkiller, easier on the digestive tract than aspirin.... except that the dose that might fry your liver is only about twice the useful dose.

I feel like I dodged a bullet. Fortunately, I've had very little need for medications, but when I'd read the directions, I'd always have a feeling of "I'll use my own judgement" when I'd read the bit about how much to use how often for how long. The sensible thing seems to be to research it *all*.

A good bit of the hour is spent on the 30 years it took the FDA to upgrade the warnings on acetaminophen. Neither the FDA nor McNeil Consumer Healthcare (the maker of acetaminophen) exactly cover themselves with glory, though both were making vague efforts to improve matters. It's plausible that McNeil was more of the problem.

There's also somewhat about the problem of the baby doses having been higher than the child size-- the hypothesis was that a some of the liquid version for babies would dribble out, so it was reasonable to have some extra acetaminophen...

Well, now the concentration for babies is the same as that for children, and the warnings are better, though not as strong as they are in Europe.

However, a lot of over-the-counter combination meds have acetaminophen in them, so it's not too hard to overdose by accident. "More than 600 products contain acetaminophen now, including Excedrin, Theraflu Dristan Tablets, Sudafed Cold and Cough, Robitussin Cold and Flu, Alka Seltzer Plus Cold and Sinus, several types of Mucinex and Midol, most kinds of NyQuil, and stronger prescription painkillers like Percocet and Vicodin."

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From:metahacker
Date:October 3rd, 2013 12:39 am (UTC)
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A friend's mother was the poor soul who got to field the fallout when a dozen hospital babies got fed 10x the proper dose of acetaminophen. (Something like a "1mg" vs ".1mg" mixup.) Imagine having to tell those parents, yes, your babies look fine now, and yes, they're going to die soon, and no, there is nothing we can do about it.

I stay away from Tylenol now.
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From:asakiyume
Date:October 3rd, 2013 04:19 pm (UTC)
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How very awful :-(
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From:chomiji
Date:October 3rd, 2013 01:14 am (UTC)
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This is why I avoid combination medications whenever possible. I have to take about a dozen prescription medications anyway, and if I'm going to add something to the mix, I want to know exactly what it is.

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From:st_rev
Date:October 3rd, 2013 02:34 am (UTC)
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Note that one of the points of putting Tylenol in opiate combo medications is in fact to increase the risk of death or serious injury for opiate abusers.
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From:nancylebov
Date:October 3rd, 2013 06:18 am (UTC)
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Source?
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From:xiphias
Date:October 3rd, 2013 11:10 am (UTC)
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It's not something anybody's ever admitted to, but a lot of us think it, anyway. The acetaminophen is the limiting factor on how much Percocet or Vicodin you can take. You COULD safely take a lot more hydrocodone or oxycodone than is in those, but you can't, because they're mixed with acetaminophen.

So it may be a bit paranoid to think they're doing it on purpose in order to lower the maximum safe dosage of the opioids. But that's what I think, anyway.
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From:nancylebov
Date:October 3rd, 2013 03:13 pm (UTC)
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This would make sense if there were clear warnings about how much acetaminophen you could take safely or if a little too much acetaminophen made people feel bad.

Since neither applies, the only way I can see the acetaminophen in combined drugs situation being deliberate is that it's an effort to drive money to hospitals and/or kill people who use pain meds.

These seem unlikely-- I think it's greed and carelessness.
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From:st_rev
Date:October 3rd, 2013 04:32 pm (UTC)
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Time isn't the most reliable source in the world, but:
Although the inclusion of acetaminophen in the combination pain-killers is intended in part to deter abuse of mild opioids, ironically, for some pain patients it’s the ingredient that proves more dangerous.

In a statement, Sandra Kweder, MD, deputy director of the Office of New Drugs in the FDA’s Center for Drug Evaluation and Research said, “Overdose from prescription combination products containing acetaminophen account for nearly half of all cases of acetaminophen-related liver failure in the U.S., many of which result in liver transplant or death.”

Similar attempts to deter alcohol abuse during Prohibition by including poisonous chemicals in industrial alcohol that was being diverted for use by bootleggers resulted in the deaths of roughly 10,000 people; more recently, chemicals added to anti-anxiety and pain medications to prevent injection have instead resulted in limb amputations after the substances caused blood clots or other complications.

Source: http://healthland.time.com/2011/01/13/fda-cuts-acetaminophen-dose-in-opioid-painkillers/

Poisoning drugs of abuse has been a recurring element of US policy since Prohibition.
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From:st_rev
Date:October 3rd, 2013 05:30 pm (UTC)
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It's interesting that This American Life barely mentions prescription combination meds, even though they account for nearly half the acetaminophen-related poisonings (and suicides/suicide attempts must account for a large fraction of both prescription-related and non-prescription-related poisonings).
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From:st_rev
Date:October 3rd, 2013 05:43 pm (UTC)
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It also appears that most acetaminophen poisoning cases are suicide attempts--over 80%, judging from http://www.gpo.gov/fdsys/pkg/FR-2009-04-29/pdf/E9-9684.pdf There were 100 unintentional overdose fatalities between 1996 and 1998. That's negligible, honestly.
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From:nancylebov
Date:October 3rd, 2013 06:26 pm (UTC)
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It wouldn't surprise me if there's a good bit of accidental liver damage.
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From:st_rev
Date:October 3rd, 2013 06:44 pm (UTC)
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56,000 emergency room visits, 26,000 hospitalizations, 458 deaths during 1996-1998. But unintentional overdose accounted for only 13,000 emergency room visits, 2,189 hospitalizations, and 100 deaths during that period. (And a correction: intentional overdose, i.e. suicide attempts, accounted for over 75% of emergency room visits and deaths, not over 80%.)
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From:andrewducker
Date:October 3rd, 2013 06:49 am (UTC)
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Supermarkets in the UK won't sell you Lemsip and acetaminophen at the same time, for precisely this reason.
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From:sodyera
Date:October 3rd, 2013 08:03 am (UTC)
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I am allergic to the crap. It creates a neurological short ckt that causes me to bite my tongue.
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From:asakiyume
Date:October 3rd, 2013 04:23 pm (UTC)
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I heard this story too. The thing about the infant Tylenol being stronger than the children's Tylenol, and the tragic results, was the most horrible thing from me.

Something that got glossed over in the story but which I noted due to my editing work was that a main reason why the FDA hadn't moved faster was that it was horribly overburdened and understaffed. If you're going to have a federal mechanism for ensuring drug safety, but then you're going to underfund it, then it's not going to be able to act in a timely fashion. It sounded like the whole process is also terribly bureaucratic, and that could/should be fixed too, but if you don't have much manpower, then things slide.
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From:dr_zrfq
Date:October 7th, 2013 04:52 am (UTC)
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This is why I read the labels. Always. Have done since childhood, which must have annoyed my mom because I'd most often ask her what some (possibly mispronounced) chemical was. (At least if I was in a position to ask her father the dentist, he had better info to hand.)

And I get real pissy if the labels don't have enough information -- pissy enough that I might not take the med at all. I want to know what's in the meds I'm taking so I can make sure I'm doing it safely.
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