[edit] > "It is the most common cause of liver injury. Period. Full stop," said Dr. Michael Rieder, a pediatric clinical pharmacologist at Western University in London, Ont.
[1] https://www.cbc.ca/news/health/acetaminophen-toxicity-health...
[edit] > "It is the most common cause of liver injury. Period. Full stop," said Dr. Michael Rieder, a pediatric clinical pharmacologist at Western University in London, Ont.
[1] https://www.cbc.ca/news/health/acetaminophen-toxicity-health...
> Each year, about 4,500 hospitalizations in Canada occur due to acetaminophen overdose, and about 16 per cent of these are accidental, Health Canada says.
So this affects only a tiny minority. It’s absurd that the tens of millions of people who use acetaminophen without an issue need to have their access to the drug restricted because of these 700 people.
To be absolutely clear, the maximum recommended dose is 4000mg over 24 hours. That’s eight extra strength pills. According to your article, the people who still accidentally overdose apparently take two pills every 2-3 hours and then forget how many they took. No wonder the vast majority avoid this fate, we simply take one pill instead.
It annoys me to no end when some folks trying to win the Darwin Award make medical professionals change guidelines in a misguided attempt to “protect” us. No, we don’t need that protection. Just keep it available while educating people about concerns around pregnancy and lower doses for younger children.
Everyone involved with writing, editing or contributing to this nothing burger of an article should be ashamed of themselves.
It's also included as a secondary ingredient in a lot of other medicines, which makes it easy to take more than you thought. Additionally, other common drugs (like alcohol) use the same metabolic pathways, so they can dramatically lower the safe limit for acetaminophen.
When you look at the rate of death and serious injury due to overdose, acetaminophen comes out very badly. The only medicines that kill more are opioids.
One other thing is that many compound otc drugs (marketed as 'get through this' for ) also have acetaminophen...
I'll also say that being pregnant is the medical wild card. You shouldn't do, eat, take, catch anything. It doesn't help discriminating between the level of risks you're taking when anything you do is forbidden.
Having such a risky drug at hand mechanically increases the risk of overdose and we should strive to find better alternatives, I think. It doesn't have to be more control, since it won't help you at home and will just make suffering people more miserable, but tech could help here, with delivery or packaging for example. 700 dead people isn't nothing. And putting a 'Darwin Awards' tag on them feels the same as 'pilot blaming' in aviation: not likely to increase safety.
In Spain you can get 1000mg paracetamol pills OTC, so that's 4 of them. It's not that unusual doctors prescripting "one every 8 hours" for acute cases. People are probably not aware that hitting themselves with that dosage could probably hurt them in the long term: next time, you self medicate again.
Any drug where the toxic dose is that close to the suggested dose is going to be dicey when we let people buy it OTC. Notice I'm not saying we should prevent it from being OTC -- as someone who is not a doctor I have no clue on that. Just saying that I don't think it's fair to categorize people who take took much Tylenol without realizing the potential deadliness Darwin Award candidates.
* I'm also going to make an edit to say, you suggest education, but isn't that exactly what this article is doing? If you want people to take warnings seriously, the warnings need to be serious.
Consider that maybe the restriction is why overdoses are so are.
That may well be true, but that doesn't mean it's especially dangerous. The number of people injured by a paracetamol overdose is tiny compared to the number of people who take it. Other drugs are significantly more dangerous when you consider per patient injuries.
This is compounded by the fact that paracetamol overdose with alcohol is a common way for people to attempt suicide - all those who are discovered and rescued will end up with acute liver damage. Doctors (in the UK) usually recommend that people who have damaged their liver in this way avoid drinking alcohol for about a decade afterwards.
Really? I thought it was advised to not drink alcohol for life if you had liver damage. I thought the damage was permanent, no?
Saying the damage is caused by regrowth is silly as without it the liver would have failed at the first injury.
Your skin does not regrow if you chop off a large patch. It can only heal damage.
Alcohol is a poison. If you didn't deliberately build up a tolerance to it your reaction is normal.
I read this like you had a chance to build up tolerance earlier
> they can't metabolize it well
Also a possibility orthogonal to tolerance factor.
Compare that to the three alcoholic cirrhotics I am currently caring for (which is a fairly common number where I work), and I personally don’t think acetaminophen is a very big deal for most people.
Also, we (hospitalists in the US) certainly see far more bad outcomes from OTC NSAID use contributing to GI bleeds and heart trouble (I’d say I care for a couple/month on average).
Not “active dose”, recommended daily limit.
Additionally, it's no wonder that it's a paediatrician speaking, because many Tylenol intoxications are actually intentional in children (suicide). It's one of the most common suicide plan in teenagers.
The medical gate-keeping/lobbying for keeping anything effective prescription-only is strong. (Of course the other side is that people will not read the leaflet and take some stuff willy-nilly)
As even the article says, having a fever is also dangerous in pregnancy.
In the UK, for basically any medicine you buy OTC in a pharmacy/drug store, the store assistant will ask you if you're taking any other medication, and will tell you the dosage to take (by reading the packet). It's not fool proof by any means but it does mean that people get _some_ advice.
Without acetaminophen your only option for pain relief without going to much stronger drugs would be the NSAIDS like aspirin or ibuprofen.
While not toxic to your liver, if you take them often enough you’ll end up with GI bleeding pretty reliably.
It doesn't work. It is the leading cause of liver failure in western societies. And yet the "common knowledge" of its utility surpasses those facts among doctors and pharmacists.
They keep prescribing it and adding it to other medicines, but there's no good medical reasons to do so.
There is a massive body of evidence showing that it's far more effective than placebo. There are even recent tentative evidence that show it increases risk taking behaviours and reduce emotional response to various stimulus.
You can find the studies with scihub. Tylenol doesn't seem to work for fever or anti inflammatory purposes either. It's great at hurting and killing people, though, in overdose and chronic use scenarios.
Small changes to a trial can completely blow it up. Same with antidepressants or anything where the trial outcome is a subjective measure by the patient.
What? Not sure what alternate universe we're talking about, but paracetamol definitely works on fever in this one.