Comment by rabboRubble | Hacker News Reader

Comment by rabboRubble | Hacker News Reader

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Acetaminophen is one of the more dangerous over the counter drugs available. It is right up there with alcohol for causing liver failure.

http://www.mayoclinic.org/diseases-conditions/liver-failure/...

The tricky thing with acetaminophen is that it is included in products without adequate warning. If I'm sick, I have a headache and take 2 tylenol, plus cold medicine, plus whatever, and BAM I've killed my liver because those 3 things all had acetaminophen in it. The tipping point between being 100% healthy, and 100% needing a liver transplant is really narrow.

http://www.dailymail.co.uk/news/article-2064964/Warning-hidd...

http://www.esquire.com/lifestyle/health/a235/esq1103-nov-bod...

Nevermind what acetaminophen does to fetuses, this drug needs to be treated with a lot more caution. I have dialed my intake waaaaaaay back. I'm sure my liver is happier with me.

If you take tylenol, make sure you take no more than the suggested dose. Make sure you aren't getting duplicate dosing bundled with other medications. Make sure you don't routinely take it longer than the bottle dose instructions indicate.

I never take acetaminophen anymore and generally only take ibuprofen, and only a few times a year. Serious question: Why do people even take acetaminophen anymore?

Acetaminophen isn't an NSAID, which makes it your first choice if you need pain relief and are at risk for bleeding or are on blood thinners.

Relevant to the article, ibuprofen is a pregnancy category D drug, which is basically "do not take this, period". It substantially increases the chance of heart and lung issues in the child, reduces amniotic fluid levels, and puts the mother at severe risk of excessive bleeding during delivery. Thus, if you're in need of pain management when you're pregnant, acetaminophen tends to be the go-to recommendation.

Personally, I take Excedrin for the occassional headache, because the combination of acetaminophen/aspirin/caffeine reliably kills my headaches in a way that ibuprofen doesn't. Ibuprofen tends to be my go-to for anything inflammation-related.

The reason I am freaked about acetaminophen is that I suffer from migraines. The most effective OTC medicine for me is Excedrin Migraine (a combo of acetaminophen, aspirin, and caffeine). I didn’t realize that this med contained acetaminophen. I also didn’t realize that the product name Tylenol equaled acetaminophen. Only put things together when I heard about people overdosing and examined my medicine cabinet and check product labels. I think I had 3-4 different medications that contained some amount of acetaminophen, mostly cold medications. I know I’ve taken most of them in combination and probably in an unsafe way.

I also had no idea the overdose margins were so thin. I’ve taken a shit ton of Excedrin Migraine over my life. And Theraflu. And double doses of Excedrin Migraine after a does of straight aspirin or Tylenol didn't work alone.

Given the easy ability to overdose, I am of the opinion that acetaminophen should be sold singly and not in combination with anything else. Even if that means Excedrin Migraine doses come in a two pill combo. This way, people could easily calculate a total daily dose without it being in an unexpected product.

It's a miracle I still have a functioning liver.

Why are you medicating with anything without looking at what it is? Read label. If not understood, quickly look up the medications involved.

Unless they are marketed very misleadingly (possible - opiates get tons of bad press, Tylenol doesn't), seems like you have zero reason to complain. You voluntarily consumed medications without even reading through the basic info that's on the box!

Splitting into two pills? Why would that work? Presumably most people will take both, so the packaging needs to reflect that. It helps nobody except people that are aware enough to know they want the caffeine but not acetaminophen, but not to just buy such a product in the first place.

I worked in a pharmacy (not a pharmacist), and this sort of thing is extremely common. I helped a nicely dressed fellow one night, who asked where the Advil was. I showed him, and pointed out the store brand (Much cheaper). The guy told me that ibuprofin doesn't work for him, only Advil. This happens with the cough and cold medicines as well - most are the same combination of drugs, sometimes with or without one, and folks will buy different labeled combinations at different times.

When the word got out about tylenol and liver damage, one of the causes they cited was the same situation as above - multiple drug compounds. Migraines. Folks thinking tylenol was the safe choice, impossible to overdose on. Folks generally think the stuff on the shelf is really, really safe.

It isn't like they teach this stuff in school. While I might have known to look out, I didn't always know this. And if this sort of information misses you when it was the 'big news'... well, out of luck.

I'd much rather the products be in different pills most of the time as I think it means consumers might think a bit more about what they take and match it up with symptoms. Either that, or have many be only available without receipt after asking pharmacist or trained personel.

Exactly... you hear that "Tylenol" causes liver damage if taken incorrectly. What I didn't realize that Tylenol = Acetaminophen = Paracetamol, in a long list of stuff.

I had a mix of stuff purchased from a couple of different countries and in 2-3 languages. So yeah label reading was a bit of a challenge.

You are quite right about reading the labels. The issue for me was 1) recognition that a particular OTC chemical is risky beyond expectation, 2) knowledge about all the product names that chemical is called (Tylenol = paracetamol = acetaminophen = APAP), and 3) having the knowledge that product A plus product B over period Y is harmful. I am not a pharmacist, so #3 is really beyond my knowledge base and ability even now.

Migraine sufferers are sort of known for desperate self medicating. Not an excuse but it happen.

One thing I was surprised to learn is that Excedrin Migraine is identical to regular Excedrin. It's just marketed differently.

There are different formulations of Excedrin (ex: Migraine Tension has no aspirin) but the Migraine formula is identical to the regular formula.

Nurofen's owner got into trouble over this in Australia recently:

https://www.theguardian.com/business/2015/dec/14/nurofens-ma...

> why do people even take acetaminophen anymore?

- why did you stop? If you're an otherwise healthy person (not an alcoholic or don't have liver disease) then paracetamol is a great drug. A low level anti-inflammatory that doesn't cause GI upset or have anti platelet action

It's very safe at the recommended dosage, and has effectively zero side effects. Ibuprofen very commonly causes upset stomach / heartburn.

Apparently it works better for fever type pain than ibuprofen.

When in real pain, I combine half a regular acetaminophen dose with the regular ibuprofen. Works miracle since the two have different acting mechanisms and they are safe taken together or so I've been told by my doctor. Oh, and a little caffeine will further boost the effect for some reason.

But yes, acetaminophen ridden medication is dangerous, especially with flu and cold stuff since we can be in quite a confused state when sick. I always select a product without acetaminophen when possible.

The combination you described is essentially Excedrin, which contains acetaminophen, aspirin and caffeine. Works miracles for me.

If you somehow manage to damage yourself from taking too much paracetamol then that's the least of your worries - it's probably a sign that you need a carer.

> I never take acetaminophen anymore and generally only take ibuprofen, and only a few times a year. Serious question: Why do people even take acetaminophen anymore?

Because taken properly, its often the safest drug for pain and/or fever reduction there is? NSAIDs aren't exactly without risks, either, after all.

(The dangers are mostly from people either deliberately taking more than the recommended dose, or doing so accidentally by combining different multi-drug products without realizing that they all contain acetaminophen.)

Ibuprofen isn't free of side effects either.

My understanding was that the biggest risk of Acetaminophen is that it's easy to overdose and it's relatively safe when one knows that and stays well below the safety limits (and likely with less side effects than ACC and Ibuprofen).

But the bottom line is probably that all painkillers have risks and one should avoid taking too much of them and consult a doctor if one takes them on a regular basis.

It doesn't thin the blood.

Ibuprofen certainly isn't safe either for the kidneys.

Everything, around here at least, with acetaminophen in it says so right on the front of the box, with a fairly prominent warning not to double dose with other meds. I don't know what it would take to make an "adequate" warning.

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