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Old 11-26-2011   #1
 
Andy H.'s Avatar
 
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Dangers of acetaminophen (aka Tylenol or paracetamol)

As we all get a little older and those aches and pains nag a little more, we have to bear in mind that those OTC pain and inflammation remedies can be bad for us.

I've long tried to stay away from Tylenol because I've heard about the liver damage it can cause. Now there's even more evidence that just a little more than the max dosage can be really bad for you. Here's an article from Discover Magazine on just how bad it is for you.

The stuff's in everything ranging from cold meds to prescription pain killers. Alcohol greatly exacerbates the liver toxicity.

After some recent dental work I discovered acetaminophen was in all the standard the prescription pain meds they wanted to prescribe for me and I realized how easy it would have been for someone unaware of the danger to take a little OTC Tylenol as well. Any time a doctor is writing a prescription, you may be able to get an alternative without the acetaminophen (aka Tylenol or paracetamol) by asking for it up front.

Treat your liver right and avoid the Tylenol.

-AH
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Old 11-26-2011   #2
 
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When one of my kids was little they managed to get the cap off of a bottle of children's OTC pain reliever, and drank almost the whole bottle. We called the pediatrician who lived just up the street from us and he made me get the bottle and read it over the phone to him because he was VERY concerned about it. When I read him the bottle and it turned out to be Ibuprofin he sighed relief and told us our kid would be fine other that probably an upset stomach. He then made a comment that really stuck with me. He said, "Good thing that wasn't Tylenol, that could have killed him". I've been a little leery of Tylenol ever since
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Old 11-26-2011   #3
 
oh yeah
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asking for hydrocodone or oxycodone (the narcotic found in Vicodin and Percocet respectively) for pain relief is a red flag for drug seekers in the er. better to say you're allergic to Tylenol.
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Old 11-26-2011   #4
 
Westminster, Colorado
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Actually, having listed allergies to non-narcotic pain meds is a huge red flag too. As is a prescription history of oxycodone / hydrocodone alone - narcotic prescriptions are tracked so prescribers can look up your history before giving a script.

You can take up to 4000mg of acetaminophen per 24 hours (2000mg when combined with alcohol), and up to 3200mg of ibuprofen. Those numbers decrease with some chronic conditions - ask your doctor.

A good pain management strategy combines non-pharmacologic (i.e. ice & stretching), non-narcotic (i.e. Tylenol), anti-inflammatory (i.e. Advil), and psychologic (mentally prepared for a tolerable level, not no pain) approaches. Skipping any of those makes the narcotics less effective. Telling people to completely avoid Tylenol is doing them a disservice.

It's sort of like alcohol. One drink a day makes you more healthy, but lots will kill you. That article was talking about people taking 24,000mg of acetaminophen over several days. If you're 6 days into max doses of OTC pain meds without seeking evaluation, you probably have other problems brewing as well. Being well aware of what is in all the OTC meds you are mixing, however, is very sound advice.

My $0.02
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Old 11-26-2011   #5
 
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Watch out for Ibuprofen in excessive amounts as well. It's metabolized by the kidneys and has been known to contribute to renal failure (most often in combination with other stuff-ie dehydration, kidney stones, hypertension).

Beer's a pretty good painkiller for achy joints at the end of the day.
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Old 11-26-2011   #6
 
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Interesting topic here on the buzz. If you're really concerned you can try to get percocet which comes as 5mg oxycodone/325 mg Tylenol (APAP). Your dose of APAP is significantly lower if you're taking them every 6 hours when compared to vicoden/loratab which generally comes as 5mg hydrocodone/500mg APAP. Taking two vicodens every 6 hours puts you right at the 4000mg recommended limit daily.

There has been some new research suggesting that even the 4000mg APAP dose can be hepatotoxic. This is a pretty good article I found:Overdoing acetaminophen

Of curious note, in Europe, APAP overdose is one of the most common ways to commit suicide. Seems crazy to me because it will definitely kill you, but over a couple of days or weeks. Somewhere in there, after the decision is done, you've got to regret it, right? Weird.

I tend to disagree with my comrads about asking specifically for hydrocondone or oxycodone. If you have a severe injury and the prescriber was planning to write for vicoden or percocet, they'll likely have no problems writing for just the hydro or oxy. You're probably not going to get either if they were just planning on giving you APAP anyway. Just explain your thought process. It's not really that hard to tell seekers from concerned educated patients if you take a minute to tell your provider. Realize, however, the reason the narcotic is packaged with the APAP is because the different medications relieve pain by affecting different receptors in the body. The two meds act synergistically and provide much better relief than either medication alone.

Also, I think that saying you're allergic to any pain medication is the biggest red flag that there is in medicine. It's definitely likely to be questioned seriously.

My 0.02 is that APAP is pretty much the safest analgesic we prescribe assuming you don't have liver problems and it's taken exactly as prescribed without alcohol or added OTC doses. Unless necessary for severe pain, I try to stay way below the 4000mg dose on a daily aches/pains/bruises basis.
Joe
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Old 11-26-2011   #7
 
Westminster, Colorado
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Quote:
Originally Posted by JCKeck1 View Post
Interesting topic here on the buzz. If you're really concerned you can try to get percocet which comes as 5mg oxycodone/325 mg Tylenol (APAP). Your dose of APAP is significantly lower if you're taking them every 6 hours when compared to vicoden/loratab which generally comes as 5mg hydrocodone/500mg APAP. Taking two vicodens every 6 hours puts you right at the 4000mg recommended limit daily.

There has been some new research suggesting that even the 4000mg APAP dose can be hepatotoxic. This is a pretty good article I found:Overdoing acetaminophen

Of curious note, in Europe, APAP overdose is one of the most common ways to commit suicide. Seems crazy to me because it will definitely kill you, but over a couple of days or weeks. Somewhere in there, after the decision is done, you've got to regret it, right? Weird.

I tend to disagree with my comrads about asking specifically for hydrocondone or oxycodone. If you have a severe injury and the prescriber was planning to write for vicoden or percocet, they'll likely have no problems writing for just the hydro or oxy. You're probably not going to get either if they were just planning on giving you APAP anyway. Just explain your thought process. It's not really that hard to tell seekers from concerned educated patients if you take a minute to tell your provider. Realize, however, the reason the narcotic is packaged with the APAP is because the different medications relieve pain by affecting different receptors in the body. The two meds act synergistically and provide much better relief than either medication alone.

Also, I think that saying you're allergic to any pain medication is the biggest red flag that there is in medicine. It's definitely likely to be questioned seriously.

My 0.02 is that APAP is pretty much the safest analgesic we prescribe assuming you don't have liver problems and it's taken exactly as prescribed without alcohol or added OTC doses. Unless necessary for severe pain, I try to stay way below the 4000mg dose on a daily aches/pains/bruises basis.
Joe
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Old 11-26-2011   #8
 
West By God, Wyoming
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So what is the best pain medicine for you if you like to drink a lot, besides, of course, alcohol?
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Old 11-26-2011   #9
 
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Quote:
Originally Posted by danger View Post
asking for hydrocodone or oxycodone (the narcotic found in Vicodin and Percocet respectively) for pain relief is a red flag for drug seekers in the er. better to say you're allergic to Tylenol.
drug seekers are allergic to the above drugs, and request the "one that starts with a d...what is is.. dilaudid?"


4grams of acetaminophen is the max daily dose. It is a very valuable drug that does wonder in combination with the opiate family. We even give iv tylenol these days in the hospital.
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Old 11-26-2011   #10
 
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mmmm.... the other NSAIDs are better. Ibuprofen is my personal choice, but it's pretty hard on the gut. If you drink enough to have ulcers, it's a bad choice as well. Narcotics don't mix with alcohol because acutely you significantly increase the likelihood that you will stop breathing and die. As my dermatologist once told me, if you decrease your drinking, you can decrease a lot of health problems.... including skin issues. He got paid a lot, seemed real smart. Go figure. Medicine for kayaking and skiing is always funny because we're always asking questions like, "What's worse, the fire or the frying pan?"
Joe
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