'Safe' Painkiller Is Leading Cause Of Liver Failure

New Scientist ^ | 12--8-2005 | Alison Motluk

[blam]

'Safe' painkiller is leading cause of liver failure

08 December 2005
NewScientist.com news service
Alison Motluk

A POPULAR over-the-counter painkiller is now the leading cause of acute liver failure in the US - and almost half of those cases are accidental overdoses.

Paracetamol (or acetaminophen as it is known in the US) is used by millions of Americans each year, and is commonly thought to be safe. Until 1980, paracetamol was not even listed as a cause of acute liver failure. But between 1998 and 2003, the proportion of cases of liver failure caused by the drug nearly doubled.

William Lee at the University of Texas Southwestern Medical Center in Dallas and his colleagues followed patients with acute liver failure who were in a coma. Of the 275 people with paracetamol poisoning, 8 per cent received a liver transplant, 65 per cent survived without one and 27 per cent died.

Initially the researchers had suspected a direct relationship between how much of the drug is in the liver and for how long, and the extent of the damage. But people who intentionally overdosed, who tend to be identified and treated more quickly, had similar damage to those who overdosed accidentally. That suggests a clear threshold for what constitutes a safe dose of the drug.

Many of the people who had accidentally poisoned themselves did so by taking just 10 grams of the medication each day for about three days - the equivalent of about 20 pills per day instead of the recommended eight, an overdose that might be less serious with other drugs. Other people had unwittingly taken two products that both contained the drug (Hepatology, vol 42, p 1364).

Lee thinks American drug enforcers should follow the lead of the UK, which requires products that contain acetaminophen to be packaged in blister packets and sold in small quantities. "I think we should talk about limiting package size," says Lee. "You can buy 500 at a time. They're like M&Ms."

[ninergold3]

**I have a bottle of 500 in my medicine cabinet**

Don't you LOVE Costco?!

[Forte Runningrock]

"Don't take more than 20 in 24 hours.

20!!!! Do you have a deathwish? If you have a bad pain, and not just a headache, 8 tylonol (325 mg) is max. if it doesn' work, ask for something else. Demorol, morphene. And if it's "just" a headache, see a doctor.

[tutstar]

Tylenol and ibuprofen are useless for my pain. They don't even touch a headache.

[Kieri]

(Sigh) I am so screwed.

I can't move unless I'm on anti-inflammatories. I've taken Vioxx which worked great, but my doctor took me off it years ago. I've been switched over to Arthrotec, which is ok, and I take Claritin-D for allergy-related sinus headaches. If I get truly desperate I reach for the Tylenol #3 but I hate the side effects.

I'm very low risk for diabetes and heart disease, but I'm growing more convinced my obit will say liver failure or cancer.

[rdcorso]

I remember reading that a few drinks of alcohol can do serious damage when mixed with Acetaminophen.

[blam]

I was just prescribed some Diclofenac today for pain and inflamation. Click on the link for details.

[RightWhale]

20 a day is a lot. One a week is maybe more like it. I wouldn't dare take 20 in one day, not even during recovery from major surgery.

[TexasTransplant]

I know of at least one casualty to Tylenol, Alcohlics should avoid this drug even more than alcohol.

We had a Foreman working Offshore that would get plastered for a week then work for a week, returning to work one week, he was hung over ate some Tylenol and he DIED. He was 24 and in very good shape physically.

Major Oil Companies do not lecture morality, but unofficially they also do not recommend Tylenol (at safety meetings).

TT

[Xenalyte]

Many of the people who had accidentally poisoned themselves did so by taking just 10 grams of the medication each day for about three days - the equivalent of about 20 pills per day instead of the recommended eight, an overdose that might be less serious with other drugs.

If you're stupid enough to take 2½ times the recommended dosage of anything, you deserve what you get.

[BunnySlippers]

Alka Seltzer too.

[hoosierham]

I agree. I find Tylenol ineffective compared to aspirin;and found out the hard way that while asprin is safe for a hurt dog, even one Tylenol is deadly.I also avoid Nutrasweet.

[Siouxz]

They beat us over the head with this information in nursing school. My instructor just told us that they're thinking about changing the warning stating that if you drink 3 or more alcoholic beverages a day not to take Tylenol, to NO alcohol with Tylenol. Very nasty stuff.

[Ragnar54]

From lef.org:

"When a person takes acetaminophen, it is metabolized by a number of metabolic systems in the liver, including one called the P450 system. This results in an intermediate by-product, or metabolite, that is very reactive and can kill liver cells. This intermediate metabolite is normally converted to a harmless final metabolite by an antioxidant in the liver called glutathione (Uhlig et al. 1990; Deleve et al. 1991; Richie et al. 1992). A large dose of acetaminophen reduces the glutathione supply, resulting in progressive necrosis of the liver, sometimes evidenced in as little as 5 days. Alcoholics and those on certain medications that stimulate the P450 system are at particular risk because, with increased P450 activity, more toxic intermediate is created than there is glutathione available to further metabolize it to something harmless. Although not fatal, chronic acetaminophen use decreases the functional capacity of the liver.

Acetaminophen can also cause permanent kidney damage when taken over extended periods of time. This damage can be lethal to those with underlying kidney disease. The Food and Drug Administration does not require the manufacturers of Tylenol and other brands of acetaminophen to adequately warn people with kidney disease to avoid this pain medication. However, for those in chronic pain who cannot find relief from natural pain relief therapies (see Pain and Arthritis protocols), it is suggested that Tylenol and other brands of acetaminophen be used sparingly.

To illustrate how dangerous acetaminophen can be, studies show that people who used acetaminophen on a regular basis more than doubled their risk of kidney cancer (Kaye et al. 2001; Gago-Dominguez et al. 1999; Derby and Jick 1996). Kidney cancer is very difficult to treat. The liver-kidney-heart muscle toxicities and the cancer risks of analgesic drugs have not been reported by most media sources, which reap tremendous profits from the advertising of pain relief products.

Acetaminophen poisoning is a toxic reaction resulting from the ingestion of excessive doses of the drug. In adults, dosages exceeding 10-15 grams can produce liver failure and dosages exceeding 25 grams can be fatal. Symptoms such as nausea and vomiting, profuse sweating, pallor, and oliguria (scanty amounts of urine) are associated with the onset of acetaminophen poisoning. Jaundice and pain in the upper abdomen, hypoglycemia, encephalopathy, abnormal functioning of brain tissue, and kidney failure may become apparent as drug toxicity increases."

Acetaminophen Poisoning

[HonestConservative]

I am a nurse as well.

If you drink 3 alcoholic beverages a day, with or without Tylenol, you have a head start on liver problems that needs to be addressed. Moderation in everything..............except moderation.

[shield]

Milk Thistle...several folks were on the waiting list for liver transplant...they started taking Milk Thistle daily 3 caps a day...within 6 months they were NO longer on the transplant list...their livers had repaired itself because of the Milk Thistle.

[Clara Lou]

I'm with you. If I need a pain-killer, I use aspirin. If I need non-aspirin, I use ibuprophen. However, I don't use any of them regularly. Acetomenaphin never worked well for me. I gave it to my children sparingly.

[Kieri]

I was just prescribed some Diclofenac today for pain and inflamation. Click on the link for details.

If you scroll down to the end of the document, it lists the brand name. It's Arthrotec, which I'm already on. Thanks for helping, though!

[mysterio]

That's what we need! More drug laws. Because goodness knows, we poor citizens are utterly incapable of deciding for ourselves what to put in our bodies without the nod from our pal the government.

[MRMEAN]

I have long avoided acetaminophen because of reported liver problems; for back and knee pain I was using multiple prescription naxoprofen and/or ibuprofen daily until I discovered, in October, an exercise program that is only practicable outdoors in non-freezing weather...and I'm starting to stiffen up again (It's cold!)...and I'm concerned about NSAID cardiac issues. Here's one alternative:

For example, cannabis has also been found useful in the treatment of osteoarthritis. Aspirin is believed to cause more than 1,000 deaths annually in the United States. More than 7,600 annual deaths and 70,000 hospitalizations caused by non-steroidal antiinflammatory drugs (NSAIDs) are reported. Gastrointestinal complications of NSAIDs are the most commonly reported serious adverse drug reaction.4 Long-term acetaminophen use is thought to be one of the most common causes of end-stage renal disease.5 Cannabis smoked several times a day is often as effective as NSAIDs or acetaminophen in osteoarthritis, and there have been no reports of death from cannabis.

[Crawdad]

I was just sarcastically referencing the article. I would never take more than what the dosage says on the bottle.