Comment by gliese1337 | Hacker News Reader

Comment by gliese1337 | Hacker News Reader

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I have little sympathy for people thinking "oh, it's safe, so it must be safe to take more than the maximum recommended safe dose", but that might be partially because I'm married to a nurse. If I try to be a little more objective about it, I suppose its sensible given how prevalent the drug is and how little you ever hear about people having problems with it- you wouldn't really assume that overdosing would be that dangerous.

When your pain is bad, it is tempting to just keep taking more drugs until it starts working, and everyone knows (er... everyone I know; again, probably biased 'cause married to a nurse) you're not supposed to take too much ibuprofen 'cause it's bad for your stomach, so might as well take tylenol. Fortunately, one of the genuine good features of acetaminophen is a lack of negative interactions with other drugs, so the safe way (as far as I know / have experienced, not a medical professional, don't take my advice, etc., etc.) to assuage that temptation is to vary the types of painkillers you use- little bit of ibuprofen, little bit of tylenol, and unless it gets really bad (at which point you should probably be seeing a doctor and not self-medicating anyway), that generally keeps you within safe limits for both (if you wanna add more types to the rotation, though, you do have to do some research and make sure that the additions don't cause bad interactions or have similar mixtures of active ingredients; e.g., if you take Aleve, that counts towards your total ibuprofen dosage limits).

Wow. But let's play along. Which other OTC medicines could being forgetful and accidentally taking a second dose cause death? Not to mention it's hidden in other medications which require careful label reading to discover. fta:

   "The 4 gram per day recommended dose is also the maximum safe dose, one that 
   must not be exceeded, an unusual situation for any drug, particularly an OTC 
   drug, one placing a large fraction of users close to a toxic dose in the 
   ordinary course of use," the report said.

that sounds like something extraordinarily dangerous to be handing out OTC and allowing companies to bury in other medications requiring people to be very careful to not accidentally double dose.

Where did you get the idea that an extra 1g dose can be fatal? "Maximum safe dose" does not mean "exceeding this dose once is fatal".

I don't subscribe to the belief that people deserve to die for not doing exhaustive research on the over-the-counter medications they take. You might want to rethink your position, since you apparently didn't do enough research yourself when you said that acetaminophen has "a lack of negative interactions with other drugs." Acetaminophen interacts with a lot of commonly taken drugs, such as alcohol, ephinedrine, and lomitapide, not to mention things that most people don't consider drugs like white grapefruit juice.

The reality is, unless you're a child or a teenager, you should just take aspirin. It won't damage your liver or give you an ulcer like acetaminophen or ibuprofen. And it is actually an anti-inflammatory, not just a fever reducer and mood-altering drug.

    You might want to rethink your position

That was kind of my point. I should perhaps have been more explicit about it. I was unsympathetic, but, hey, now that you mention the problem and make me think about it, I can see how most people could have problems with this; while for me it's just plain obvious that you don't ever take more than the recommended maximum dose because you don't want to deal with side effects, other people do that with no expectation that death is a possible side effect.

As far as interactions, you're right, it does interact with other drugs and non-drugs (the fact that lots of other OTC medications contain acetaminophen is also troubling, but a different issue in my mind), but in my experience as a guy who has to take a lot of painkillers and who's married to a nurse who takes care of figuring out what's safe, acetaminophen is one of the less worrisome drugs to deal with. On re-reading, I pretty clearly chose a bad way of expressing myself with the word "lack"- I meant "fewer" rather than "none at all"- so sorry about that, but with the appropriate disclaimers about don't take my advice, etc., I stand by my statements as regards my own experience- acetaminophen is very safe and very convenient when you don't overdose. Unfortunately, as I have just learned, it's really easy to overdose, and that's really sad and a big problem.

Aspirin does cause ulcers. If you have references showing that ibuprofen is more dangerous (or even differently dangerous) than aspirin I would be interested to see them.

That's a good point. I don't really have any hard information on which is more dangerous in terms of ulcers. I find conflicting information online. One thing is for sure: you should NOT take either aspirin or ibuprofen on an empty stomach. Always eat something first.

I tend to lean towards aspirin for a few reasons. It's older (100 years versus 30 years old) so we've had more time to figure out what other side effects it has, as well as interactions with other drugs. The blood thinning effect reduces the chance of heart attack or stroke (while it's in your system), which is always nice. There are some studies which seem to show that aspirin has anti-cancer properties, but I'm not sure if I believe them, because they have not proposed a mechanism of causation. Finally, ibuprofen seems to be sold in higher doses in general and have a more intense effect, which isn't really want I want. I just want something that does the minimum most of the time.

Do you understand that most people do not take painkillers for more than a few days at a time, and rarely at anything like the maximum daily dose?

You're worried about effects that occur with chronic high dosages. That's not the typical use-case.

You can kill yourself with Aspirin, in fact I thought that Aspirin was the #1 choice for that (without research). In any case, take too much and you are dead - I think not because of stomach ulsters, but because of bleeding in the brain. Again, that's just from memory, but google for it and you'll find some negative side effects. I think there is also a problem in combination with other stuff, for example grape fruit juice.

(Edit: Googling for "aspirin suicide", find it in top 20 list of suicide methods http://wantdeath.blogspot.de/2011/07/method-5-of-suicide-asp... )

You can kill yourself with almost anything, including water.

Did you read the article? The whole point of it is that the dose of acetaminophen found in many pills in the US is dangerously close to the level at which liver damage occurs.

The same can't be said for other painkllers.

The reality is, unless you're a child or a teenager, you should just take aspirin.

For me ibuprofen is a miracle. I get bad headaches from time to time that aspirin and acitominphen have negligible impact on. Ibuprofen knocks them out completely.

I don't subscribe to the belief that people deserve to die for driving off the cliff. The reality is they should just take the bus.

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