FDA: Acetaminophen one of the most dangerous drugs on the market
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"The best advice is very simple. Read the label. Acetaminophen is safe if you know how much you're taking. And be sure when combining medications not to exceed four thousand milligrams each day."
As with any medication, you have to follow the directions, be safe, and smart.
"White grapefruit juice increased concentrations of acetaminophen in mice both 1 hour and 2 hours after feeding compared to controls. In contrast, pink grapefruit juice increased acetaminophen concentrations 2 hours after feeding compared to controls."[1]
'P450 Drug Interactions'
Edit - Add;
List of Cytochrome P450 Modulators : https://en.wikipedia.org/wiki/List_of_cytochrome_P450_modula...
'Acetaminophen and Alcohol Hepatotoxicity, Liver damage'
N-acetyl-para-aminophenol (APAP), Acetaminophen, Tylenol, Paracetamol, Panadol, others : https://en.wikipedia.org/wiki/Acetaminophen
They even sell extended release acetaminophen, which prolongs liver processing. Though, I'm not a fan because I think it is rougher on the liver. But health damaging risk is another issue.
That's all very well if people adhere to the instructions but many don't. It's pretty clear why this is so. First, it's an OTC drug and most people associate that with not being as efficacious as drugs that are prescribed by a doctor. Second, people believe OTC drugs to be safe because they are OTC drugs. Third, with the other two factors in mind, given that acetaminophen (paracetamol) is barely an effective painkiller, they opt to up the dose in the hope of obtaining relief.
When I take the drug I'm careful not to take more than 4000mg because of its dangers, in fact I don't ever recall ever taking the maximum daily amount.
I also know the reasons why acetaminophen is dangerous and that further raises my caution. A metabolite of acetaminophen, NAPQI, is toxic to liver cells, it also reduces production of glutathione the agent the liver uses to mop up toxic metabolites. Thus, all's well until the glutathione runs out, after that NAPQI is free to do its damage.
The FDA, doctors and the medical profession need to explain in very simple terms by way of major campaign the reasons for why the drug becomes very dangerous after a certain threshold.
I'm sure an advertising agency could produce a pithy explanation the public would understand (and it should be printed on the box). Irrespective, we urgently need to do something to reduce the thousands of annual acetaminophen poisonings.
Essentially, the fallback drug is acetaminophen because there's nothing else. Unfortunately, acetaminophen is an ancient drug discovered in the mid Nineteenth Century and it's been in service for about a century but mainly since WWII. It's classed as coaltar antipyretic which covers a whole range of similar drugs that were or are manufactured from precursors that come from coal. Many of them are related and some are very dangerous (many were withdrawn in the first half of the 20th Century because they literally killed people).
The precursor to acetaminophen is phenacetin which until about thirty years ago was a principal painkiller but was withdrawn from the market after mixtures of it, aspirin and caffeine were found to be rotting people's kidneys out. Phenacetin is also considered carcinogenic.
We still have to rely on this ancient 150+ year old dangerous drug that's barely effective because of a major failing of medical science/pharmaceutical research.
It really is high time we researched much better more effective and safter painkillers and ditched all current coaltar antipyretics, they really aren't that effective and none have been found to be safe.
The reasons we have acetaminophen with all its risks is because there is nothing better.
Even after the opioid epidemic and those disreputable Sackler bastards came to worldwide prominence there's been no national initiative like, say COVID research. The problem is that there is not enough research. That's clearly obvious—or it ought to be.
I disagree 100% it's not a priority. The companies know they could make a ton of money off of an effective, but more safe pain medicine.
Of course there are better drugs. But they are not patentable, they are not profitable, and they are not synthesized by chemical factories like the Union Carbide in Bhopal. All of that makes them really unpopular!
There are many active pharmaceutical ingredients that are natural products, modified natural products, or analogues of natural products. See Metformin and French Lilac.
In fact, a big part of what medicinal chemists do is designing “better” molecules. And some well capitalized pharma companies even come out and say their strategy is “best in class, not first in class”.
Please list these "better" drugs, I'm eager to start a business around them.
There is, but we care more about stopping people getting high than we care about stopping people from being in pain.
My wife had an outpatient surgery, and had muscle spasms from incisions. She was SCREAMING in pain. She was brought in by ambulance (who did not give her anything - sort of understandable because sometimes you need to have the patient identify the pain).
Despite continuing to SCREAM in pain, the nurse refused to do anything or contact the doctor, because she was sure she was a druggy just faking it. It took all my energy not to start throwing punches. (A doctor finally got her pain meds.)
Our society is unjust.
As for me, whenever I take an NSAID (including Aspirin), my chest feels like it's going to explode. It's not a painful feeling, but it is not a good feeling. It also sometimes gets difficult to breathe. And it's been this way my entire life, so I shun them completely.
As for acetaminophen, the dangers mainly stem from overdose, overuse, and using it with alcohol consumption. Avoid that and it's pretty safe.
[1] - https://www.mayoclinic.org/diseases-conditions/heart-attack/...
Acetaminophen is similar to NSAIDs in many of its beneficial effects but is sufficiently different chemically as to not trigger many of the (rarer) negatives that NSAIDs can trigger.
No it's because we care more about stopping people from getting high than stopping them from being in pain. You said it yourself:
> the big guns—the opiates—are totally inappropriate painkillers in all but the most severe pain because of potential for addiction
Who cares??? It's better to be addicted than suffer. And I have lots of doubts about their addiction potential, because of all the people who have a backwards sense of medicine.
Quite safe when taken as prescribed or directed though.
https://www.federalregister.gov/documents/2018/12/11/2018-26...
Approximately 150 people die in the US each year due to accidental overdoses of acetaminophen.
At the peak, 16,500 people died in the US from NSAIDs (aspirin, ibuprofen, etc) each year, mostly from GI bleeds.
Acetaminophen looks massively safer than the other alternatives right now.
And I'm not sure what your point is. Acetaminophen is very effective for lots of pain. And it doesn't kill as many people.
You're likely right on the grounds that it's not a particularly good painkiller—my own experience is that it's marginally better than nothing (which is also pretty much the official position)—and on its now well defined dangers.
The combined assessments would likely be insufficient for approval.
Unfortunately, that's how it goes for many people.
BTW, where I live, all OTC acetaminophen tablets are 500mg (and often come in packets of 100 tablets), and the usual recommended single dose is 1000mg (max 4000mg daily).
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Edit: https://thenewdaily.com.au/life/wellbeing/2021/04/05/paracet....
They have different kinds of danger.
Acetaminophen's best pain relief profile is when it is mixed with aspirin in Excedrin. Neither work that well on their own. Together, they do a great job with virtually no side effect if you dose it as instructed.
And opioids certainly aren't psychologically safer. It can take years of adjustment to come out of depression even from regularly using a drug that indirectly tickles the opiate receptors. Let alone from opiates themselves.
Opioids should be as freely available as the other pain relievers. I highly doubt addictions would increase.
I guess that makes sense. There are so many people in my life that I've heard saying "X medicine has done wonders for me, better than paracetamol", but I've had to explain to them that X is just a fancy way of saying paracetamol/acetaminophen.
This is the worst thing. Every drug manufacturer likes to take whatever product they’ve been making, stick Acetaminophen in there, maybe some Dextromethorphan… put “Super Severe Cold Annihilator” on the label and let the marketing machine go to work.
I find it amazing that people buy these cocktails rather than literally the cheapest generic versions of their constituent compounds, usually in the same dosages. It’s depressing the education doesn’t seem to be there that these are the same exact things. I’d so much rather take a few pills of drugs I actually need rather than a swig of a bunch of random stuff and wish my kidneys and liver godspeed.
Also, having it available avoids the risk of doctors over-oveprescribing for complaints that acetaminophen is perfectly suited to handle with much less side effect.
Not ODing on Acetaminophen isn't hard. Read the label. Understand that it doesn't mix with alcohol. Don't take it like an asshole. You have to take over 2 grams to exceed the daily limit for meds like Excedrin, and it takes something like 4 grams (16 Excedrin for example) to be in OD territory.
Recommended doses are something like nothing over 500 mg every six hours.
The vast majority of overdoses are people swallowing a handful while drunk. There's a wide variety of drugs that you can't do that with.
The rule of thumb with acetaminophen is to know the rules.
You should not expect everyone to be as chemistry-inclined as you.
My friend recently recommended a Walgreens med. It was generic Zyrtec. I told him that I had been using Zyrtec. He told me it wasn't zyrtec, and when I discussed the active ingredient with him, he just said the Walgreens bottle one works better, because he is ignorant and chemical names are meaningless to him.
Your comment is blatantly obtuse. People don't know the rules, they're not nerds, they don't know the difference between Advil, Tylenol, aspirin, Aleve, etc. Not everyone enjoys memorizing chemical names, and knows that Tylenol=Acetaminophen=Paracetamol=whatever.
You can't buy Nyquil, Robitussin, or Mucinex without getting acetaminophen in it. Recently sick, I scoured a pharmacy for Guaifenesin WITHOUT acetaminophen and was unable to find it, in fact Mucinex nighttime is literally tylenol and a random antihistamine... Mucinex has abandoned its main ingredient for acetaminophen.
A desperate night at the pharmacy will show you that acetaminophen is everywhere. People are not interested in reading chemical names that mean nothing to them, and we should be more interested in health outcomes than saying that someone who can't keep track of chemical formulas deserves liver damage.
Ummm? Looks like Dextromethorphan is still a listed active ingredient. Sure it has an added antihistamine and Acetaminophen, but that’s hardly “abandoning its main ingredient”.
https://www.mucinex.com/products/mucinex®-fast-max®-adult-li...
Recently they've revised their ingredients because Guaifenesin is a mild stimulant and they know that shoppers are not reading the active ingredients.
It was recently impossible for me to purchase pure Guaifenesin because the pharmacy only carries Mucinex DM/whatever rather than the original product, and all Mucinex day/night products contained Acetaminophen.
Adults know what they are taking. Children don't. Which is why we have child proof bottles.
Knowing how to take medication has nothing to do with being a nerd. It has nothing to do with enjoyment. You packed in an impressive number of silly accusations into your response. They don't substitute for making a point.
If you can wipe your rear end and pay your bills, you can read a bottle and understand what you are taking. To expect this isn't being obtuse, let alone "blatantly obtuse". Its an expectation of a basic concept of adulthood.
Adults don't chug bottles of dextromethorphan either, because its bad for them. But some children do, because they can in fact read labels and don't care about harming themselves.
You're telling me that it is uncommon for adults to have the OTC drug knowledge of DXM chugging 14 year olds?
The dosage rules are on every bottle.
The no alcohol rule is widely advertised.
Your position on epidemiologically justified public health policy and outcomes, in regard to acetaminophen, isn't upheld by the facts of public health outcomes.
I urge all adults to learn to wipe their ass (know what they are taking).
Your bog standard cold and flu sachet or whatever can just write on the side "eat me, then one 500mg paracetamol". Then no-one can accidentally eat 10 a day.
No, its not. Acetaminophen is not an NSAID (which is why NSAIDs are better on inflammatory pain.)
I'd add that confusion is only compounded when it's mixed with NSAIDs such aspirin and ibuprofen. Such mixtures are pretty popular.
Edit - Add;
'NSAIDs and Gastrointestinal (GI) Injury'
It is usually distinguished from them, especially as the one OTC painkiller typically usable by people with conditions for which they should not take NSAIDs, and which lacks the issues with long-term use of NSAIDs.
OTOH, with more digging, while most medical sources distinguish it, it is occasionally identified as an NSAID in the literature – ironically, the first source I could find that does that is a paper which both calls it one and contrasts it with NSAIDs, so it seems a bit confused – and it apparently has some (though weak enough compared to the things usually labelled NSAIDs that most sources just straight up refer to it as not being anti-inflammatory) anti-inflammatory effect.
Although I think this would be more controversial than the inclusion of paracetamol. Personally, I think many DMARDs might be considered NSAIDs as well (except by somewhat arbitrary-seeming exclusion).
When I really think about it, I think the nomenclature might just be conventional and not necessarily make much sense.
It doesn't mean it has the same mechanism of action, the same COX selectivity, the same side effect profile, etc, as all other drugs within the class.