FW: NATAP: Tylenol Overdose is Easier Than Many Realize
- Acetaminophen (Tylenol, Paracetamol) Overdose IS Easier Than Many Realize
"Most Popular painkiller is lead cause of acute liver failure"
Lauran Neergaard, Assoc Press, Dec. 25, 2005
Think popping extra pain pills can't hurt? Think again: Accidental
poisonings from the nation's most popular pain reliever seems to be rising,
making acetaminophen the leading cause of acute liver failure.
Use it correctly and acetaminophen, best known by the Tylenol brand, lives
to its reputation as one of the safest painkillers. It's taken by some 100
million people a year, and liver damage occurs in only a small fraction of
users. But it's damage that can kill or require a liver transplant, damage
that frustrated liver specialists insist should be avoidable.
The problem comes when people don't follow dosing instructions-- or
unwittingly take too much, not realizing acetaminophen is in hundreds of
products, from the over-the-counter remedies Theraflu and Excedrin to the
prescription narcotics Vicodin and Percocet. "The argument that it's the
safest sort of has overruled the idea that people cannot take any amount
feel like," says Dr. William Lee of the University of Texas Southwestern
Medical Center, who laments that acetaminophen is popped like M&Ms.
Acetaminophen bottle currently recommend that adults take no more than 4,000
milligrams a day, or eight extra-strength pills. Just a doubling of the
maximum daily dose can be enough to kill, warns Dr. Anne Larson of the
University of Washington. Yet, "if two is good, 10 is better in some
patients' minds," she says with a sigh.
The Food and Drug Administration has long wrestled with the liver risk,
warning two years ago that more than 56,000 emergency-room visits a year are
due to acetaminophen overdoses and that 100 people die annually from
unintentionally taking too much. A study published by Larson and Lee has
agency officials weighing whether to revisit the issue.
Over six years, researchers tracked 662 patients in acute liver failure who
were treated at 22 transplant centers. (Acute liver failure is the most
severe type, developing over days, unlike chronic liver failure that can
simmer for years because of alcohol abuse or viral hepatitis.) Almost half
were acetaminophen-related. More remarkable was the steady increase:
Acetaminophen was to blame for 28% of the liver poisonings in 1998, but
51% of cases in 2003. That makes acetaminophen the most common cause of
liver failure, the researchers report in the journal Hepatology.
While most patients pulled through with intensive care, 74 died and 23
received a transplant. Some 44% of the cases were suicide attempts. Bur
more, 48%, were unintentional overdoses, which "isn't hard to do," Larson
says. Say you take Tylenol Cold & Flue Severe for the flu's aches and
stuffiness-- 1000 mg if acetaminophen, every six hours. A headache still
nags so between doses you pop some Excedrin-- 500 mg more of acetaminophen.
Switch to Nyquil Cold/Flu at bedtime, another 1000 mg. Maybe you already use
arthritis-strength acetaminophen for sore joints-- average dose 1300 mg.
Depending on how often they're taken, the total acetaminophen can add up
That's the nonprescription realm. Surprisingly, 63% of unintentional
overdoses involved narcotics like Vicodin and Percocet that contain from 325
mg to 750 mg of acetaminophen inside each pill. Some were chronic pain
sufferers taking more and more narcotics as their bodies adjusted to the
powerful painkillers, not knowing they were getting ever-higher
at the same time. Or they added over-the-counter products for other
Just this month, Larson treated an 18-year-old whose liver crashed after
Vicodin for three or four days for car-crash injuries. "She was just taking
too much because her pain was bothering her."....
How strongly labels warn varies by product. A rule to standardize warnings,
urged by FDA's scientific advisers in 2002, still is working its way through
the agency. While FDA runs a consumer education campaign about the liver
risk, nonprescription drugs chief Dr. Charles Ganley says the new study
suggests the agency may need to further target narcotic-acetaminophen
Lee wants to copy Britain, which say a 30% drop in severe liver poisonings
after restricting how much acetaminophen could be bought at once. That's
unlikely. Meanwhile the advice is simple: read drug labels and add up all
your acetaminophen, avoiding more than 4000 mg a day.
For extra safety, Lee advises no more than 2000 to 3000 mg for more
people, who regularly use alcohol or have hepatitis.
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