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Comment by jonnathanson | Hacker News Reader

Side note, but I learned about the dangers of acetaminophen when I was on Vicodin while recovering from a major surgery a few years back. Back then, a lot of Vicodin tablets (and generics) had doses as high as 500mg of acetaminophen per pill, and I could have sworn I saw them go as high as 750 in some instances. (The FDA has since lowered the cap to 350, in light of the huge risk of liver damage).

The drug was almost banned from the U.S. market entirely in 2009, and not because of the hydrocodone. The acetaminophen is more deadly than the hydrocodone in the quantities consumed per day.

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The cynic might think that acetaminophen was added in such massive quantities with hydrocodone (Vicodin) and oxycodone (Percocet) [usually 500/50 ratios] as a way to discourage people from attempting to take more than the recommended dosage of opiates.

Kind of like how they used to put methanol into alcohol during prohibition, knowing full well it would kill some people, in an effort to scare people away from alcohol.

Even if that's not the case, it does seem reckless to put so much acetaminophen into each individual pill. I'd be very curious what percentage of those deaths were from overdoses on Vicodin and Percocet.

That's not cynicism, it's just realism. The drug companies don't want their product associated with drug abuse, so they add a megadose of something that eventually causes liver failure (acetaminophen). You get a lot of dead addicts, but fewer abuse scandals.

Acetaminophen doesn't actually reduce swelling (although it does reduce fever). Ironically, it's mostly... a mood-altering drug. http://www.theatlantic.com/health/archive/2013/04/whats-tyle...

Do 500 mg or even 750mg sound that high?

Paracetamol (the non-US name of acetaminophen) here in France is usually available either in 500mg or 1g doses, and Wikipedia seems to say we had 6 deaths in 1990, and the number has been stable since then, so more than five times less than the US relative to population size.

So, I'm not sure that dosage is the most important factor here.

How many grams in total do you get in a pack?

In a lot of Europe (certainly UK, I heard also France), you can only buy 16 pills (about 8g) at a time, unless your doctor writes you a ticket.

The pills themselves may contain a lot of chemical, but the whole pack doesn't contain enough grams for a successful impulsive suicide. You would need to go to a second drug store, by which time you'd probably decide not to do it. Hence the reduction in death rate.

The problem of liver damage due to chronic over use continues .

Right, I had not thought about this aspect of things, both the 500mg and 1g tubes I have at home contain a total of only 8g.

It doesn't seem difficult to accumulate more than 8g at home over time though, I'm not a big consumer of these and I have 12g at home, in three tubes. I remember my grand parents having a lot more packs at their place.

It's not the dosage per pill that's unsafe; it's the concentration over a period of time. Acetaminophen builds up in the system.

I'd venture to guess that most acetaminophen/paracetamol users aren't popping Tylenol (etc.) every four hours for weeks at a time. But four Vicodin pills a day, taken over the course of a week or two -- not an unusual dosage for pain relief from major surgery or illness -- will concentrate an extremely large amount of acetaminophen in your system, because acetaminophen is eliminated fairly slowly from the body (and at great cost to the liver).

You're probably not going to kill yourself taking that much acetaminophen. I've done it a few times, and I'm still here. But you might do some serious, potentially irreversible damage to your liver. It's sort of like heavy metal poisoning: it takes a lot to get an acutely toxic dose, but a slowly toxic dose can accumulate over time.

you can take acetaminophen 1gram ever 4 hours. So long as you don't do it for any length of time(1 week+), thats the issue. (Assuming your liver isn't comprised. )

If you keep to the NHS guidelines you'll be fine (http://www.nhs.uk/Conditions/Painkillers-paracetamol/Pages/I...)

your issue is that you had an opiod mixed in. That is where the "huge risk" is. Both opiates (especially ones like codine that require the liver to work) and acetaminophen (paracetamol) hammer you liver, which is fine so long as you don't take the piss.

Co-codolmol (the UK equivalent of vicodin ) is still available over the counter with a 8/500mg is available without prescription here in the UK.

update

Reading the article its very hard to see what point they are trying to make. The evidence they offer to suggest that its unsafe is vague. Prolonged exposure is bad, and almost doubling the dose is doubly bad.

The basic rule of thumb here for any medicine is this: READ THE LEAFLET. DON'T MIX AND MATCH. TALK TO A DOCTOR.

Most medicine is toxic, and if you double the amount you take bad shit happens. If you OD on codine you stop breathing, why is it a surprise that if you OD

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