Tags: acetaminophen

green leaves

More about acetaminophen

Edited to add: This material is about the US. The laws are much more restrictive in (most of?) Europe, and I don't know about the rest of the world.

siderea took my post about Tylenol/acetaminophen/paracetamol and and ran with it.

Here's a prime bit, but really, read the whole thing and the comments:
3) Alcohol makes acetaminophen stronger, and lowers the fatal acetaminophen dose. Don't be drinking and taking acetaminophen.

3a) More specifically, acetaminophen is metabolized by CYP2E1 (among other CYP isoenzymes). Ethanol is a CYP2E1 inducer, and apparently, it's the metabolites of acetaminophen overwhelming the liver which is dangerous, so anything which increases the rate of CYP2E1 activity is dangerous with acetaminophen. You know what else is listed as a CYP2E1 inducer? Tobacco smoking.

3b) While we're at it, CYP1A2 and CYP2D6 are also involved. You know what interacts with CYP1A2 and CYP2D6? Everything. Inducers include tobacco, broccoli, brussel sprouts, Echinacea, chargrilled meat (hey, I'm just copying this from Wikipedia), cauliflower and insulin.

3c) Also, you'll want to have been very careful not to have inherited or mutated an extra copy (or multiple extra copies) of the gene for CYP2D6 (or presumably CYP1A2 or CYP2E1), something which it is speculated is the source of some people's unusually high susceptibility to acetaminophen overdose. Good luck with that.

4) There are legitimate reasons to prefer acetaminophen over ibuprofen and aspirin. You should know what they are if you're taking it, and you should take considered steps to prevent accidents. In a house with a child or other cognitively impaired party, it belongs in a locked medicine chest.

And I'm wondering whether having acetominiophen in prescription drugs which contain opiates might really be intentional murder. Or it might just be sloppiness-- opiates are bad, adding bad things to bad drugs might discourage use, fail to think about actual consequences because it's a bad drug.

Anyone else remember Triage? It was about a conspiracy of non-preference utilitarians who were using looser and looser standards to kill people who were "better dead".

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green leaves

Acetaminophen: Very safe except when it isn't

This American Life did an hour about acetaminophen (the active ingredient in Tylenol).


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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