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Comment by rdl | Hacker News Reader

Tangentially (since this article is boring, I don't think it's unreasonable): acetaminophen is one of the commonly-used drugs which I think is most dangerous.

Aside from liver-damage-suicide-through-overdose, and accidental overdose, there are a common conditions where you'd want headache relief (hangover, dehydration, ...) where the liver-damage risk for a normal dose is substantial (and people commonly take 2-3x the normal dose if they have "a bad headache, as more is obviously better...).

Another huge sin of the US drug war is mixing likely-to-be-abused painkillers like codeine with acetaminophen to lower their "abuse potential" -- but, with junkies not being rational, it leads to abusers destroying their livers.

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Indeed. For symptomatic relief, Aspirin is usually a better option at low doses (as long as your stomach does not suffer too much from it, since it causes stomach bleeding).

Perhaps this goes without saying but, I want to warn against taking medical opinion/advice that is found on the internet, especially from a forum that mostly revolves to Software, Tech, and Startups.

> Aspirin is usually a better option at low doses (as long as your stomach does not suffer too much from it, since it causes stomach bleeding).

http://en.wikipedia.org/wiki/Reye_syndrome

> I want to warn against taking medical opinion/advice that is found on the internet

This is excellent advice, but the scaremongering re Reye's is unnecessary. Many more lives & livers would be saved by people ceasing their use of acetaminophen than would be risked by people switching to aspirin.

It wasn't meant to be scaremongering, rather a counter to the statement that in all cases (save for stomach ulcers), aspirin is the better choice.

Perhaps this goes without saying, but most HN readers are adults and are astronomically unlikely to get Reye's Syndrome.

(In fact, Reye's syndrome was used as an example of something with a "vanishing" baseline risk in a study in Epidemiology recently.)

True.

But they may have kids.

Look, most of us don't need to be told that coffee is hot, and can burn you, but we're told anyway.

Come on. You are linking to something that was not even formally demonstrated.

> Epidemiological studies have demonstrated an association between aspirin taken for viral illnesses and the development of Reye’s syndrome.[8] But no animal model of Reye’s syndrome has been developed in which aspirin causes the condition.[9]

It's tiring to repeat it, but correlation and causation are two very different things.

<strike>So, you're saying it's okay to give aspirin to children?</strike>

My point wasn't to say Aspirin is or isn't better than Tylenol.

My point is to say taking medical advice on internet forums, isn't a good idea.

> <strike>So, you're saying it's okay to give aspirin to children?</strike>

Actually, in most cases, it seems many developed countries outside of the US think so, see my other post: https://news.ycombinator.com/item?id=7564311

> My point is to say taking medical advice on internet forums, isn't a good idea.

It may not be a good idea but if it exists, it means there's a lack of information out there.

Clinically, Aspirin is not prescribed to those under 19. While the link has not been proven, often in medicine it is best to err on the side of caution when safe(r) alternatives like ibuprofen and acetaminophen are available (I understand acetaminophen is controversial here but it is considered to be safer than Aspirin for the use in under-19s. see ref).

While this is a much lower risk for 20 year olds and up, which may in fact make Aspirin safer than acetaminophen it is not the case for pediatrics.

Considering this site has a not insignificant number of under-19s and many who have kids it is important not to spread misinformation and as always consult with a physician or pharmacist.

[1] http://www.aafp.org/afp/2009/1215/p1472.html [2] http://www.cdc.gov/ncidod/diseases/reye.htm [3] http://www.mayoclinic.org/diseases-conditions/reyes-syndrome...

> Aspirin is not prescribed to those under 19.

That's only the position in the US, I believe. In France, as long as you are more than 30 kg (children from 9 to 15) you can take aspirin.

> http://www.doctissimo.fr/medicament-ASPIRINE-UPSA.htm

I seriously doubt North American kids are facing lethal dangers while kids in France would be safe at the same age, it's not like the populations are very genetically different or something.

EDIT: Confirmed in Japan as well, you can give aspirin to children and even babies in Japan - there are no particular contraindications except prior patient history, and the discretion of the HCP. Link : http://www.info.pmda.go.jp/go/pack/3399007H1021_1_15/@Generi...

So, because FDA decides something does not mean everyone agrees with it universally.

I want to warn against taking medical opinion/advice that is found on the internet

My experience in obtaining information via the Internet goes back over a quarter century, and I've got to disagree with your advice in both the specific (medical) and general case.

I'm not saying "believe everything you hear", but take the information under advisement and evaluate claims.

Among the first stories I came across via the Net were the Fleischman-Pons cold fusion story (1989), 25 years ago this year, and the Intel "FOOF" bug (1997) [1,2], both of which largely predated the widespread adoption of the World Wide Web.

The first story turned out to be unsubstantiated research, and highly critical responses appeared almost immediately. The FOOF bug turned up with proof-of-concept tests, and eventually even a Linux kernel boot-time check (which I fondly remember scrolling past many, many times). In both cases, dissemination of information online eventually arrived at the truth.

And that's pretty much the case for all information. Hoaxes, including scientific and medical hoaxes existed before the Internet and WWW, and continue after. Shortly after the the cold fusion story, I was receiving, via postal mail, information on a laetrile cancer treatment (utterly unsubstantiated) as a result of someone who'd suggested same to me, in person, and passed on the information. Much as a useful therapy would have benefited someone I love and miss to this day, the hoax information was anything but helpful. The hepotoxicity of acetominiphen / paracetemol (Tylenol) is something I also first learned of by direct personal contact, in this case from someone who'd worked on drug safety trials with the compound, and absolutely positively refused to touch the stuff or allow anyone in his family to do so. That turned out to be pretty well substantiated.

One of the benefits of information conveyed through open forums is that others can challenge and correct the information provided, and cite references and resources. No, it's not perfect, but it's pretty good.

________________________________

Notes:

1. http://partners.nytimes.com/library/national/science/050399s...

2. http://en.wikipedia.org/wiki/F00f

Being polite: that's horrible advice. If paracetamol is taken correctly it is very safe and effective. There is some new evidence about correct but long term use being harmful, but more research is needed.

Paracetamol is probably the safest OTC analgesic outside of Colorado and Washington. NSAIDs -- aspirin, ibuprofen, and naproxen -- have significantly higher risks associated with their use, due to a particular side effect which is inhibition of COX-1 (---> stomach bleeding); serious side-effects in regular NSAID users occur to the tune of 1-2%! See:

https://www.lef.org/protocols/appendix/otc_toxicity_01.htm

This might be paracetamol is preferred over ibuprofen et al in combination analgesics like Vicodin; if they just wanted to kill junkies they could do better.

Is Paracetamol safer than weak opiates like codeine? Actually, I'd be surprised if it's a whole ton safer than hydrocodone. Max dose of APAP used to be 4g, and what, 3 or 4 times that can cause acute liver toxicity? Whereas an intolerant person will probably be knocked back pretty hard with 5mg of hydrocodone, yet 20mg wouldn't really hurt.

Hydrocodone is schedule II, unless mixed with APAP at which point it drops to S III. I'm not sure there's any way to view that except as anti-human. And ironically enough, restrictions on pharmaceutical grade opiates makes the prices so high people end up using impure heroin instead. It's unlikely this is an unknown effect to regulators.

Just adding my two cents to this discussion as someone who prescribes this stuff and has taken care of people with liver failure.

Agree that acetaminophen/tylenol/paracetamol is the safest OTC and non-OTC analgesic within the 'safe' dose limit <4000mg/24h (pills are typically 325/500/650mg)

Liver failure from tylenol toxicity that is not a suicide attempt is actually quite rare. People that intentionally overdose and die usually take large amounts, like 10-20gm AND don't come to the hospital until very late or when they are found by someone else. Smaller doses and arriving in hospital within a day can usually be treated quite successfully with N-acetylcysteine/NAC.

Tylenol + Alcohol = Lowers the dose needed for liver injury.

Alcohol causes orders of magnitude more damage to livers and to our society than tylenol does. More than half the liver transplants here are at least partially related to alcohol, and the rest are mostly hepatitis C, fatty liver, cancer, autoimmune, etc. People on the transplant list do tend to drink "a lot", such as 5-10 bottles of beer/day for 10-20 years

Tylenol is combined with opiates (eg. Tylenol#3, Percocet, Vicodin) because both work in the central nervous system (as opposed to NSAIDs that work peripherally), resulting in a synergistic effect.

Aspirin and other NSAIDs (ibuprofen/Advil, naproxen/Aleeve) are ok when used occasionally, but long-term chronic use has side effects as mentioned (eg. bleeding, kidney injury, can precipitate heart attacks in people with coronary disease, etc.)

Extremely helpful comment. Don't understand why someone voted it down.

It's worth adding that long-term observational studies with Aspirin intake have shown high colleration with the reduction of certain types of cancer (colorectal, esophageal, mainly), while the internal bleeding issue remains a potential concern:

http://www.ncbi.nlm.nih.gov/pubmed/22440112

The same is true of dextromethorphan (DXM), the main active ingredient in cough syrup.

For many naive teenagers, cough syrup is their introduction to recreational drug use because it's available OTC. Unfortunately, most teenagers are also impulsive and can't be bothered to do much research beforehand. Threads like this one below, titled "6,276 mg acetaminophen...am I gonna die?", are unfortunately very common.

http://www.bluelight.org/vb/archive/index.php/t-511125.html

This American Life did a fascinating episode on this issue.

http://www.thisamericanlife.org/radio-archives/episode/505/u...

There was a discussion on HN on this several months ago for those that are interested:

https://news.ycombinator.com/item?id=6428749

Paracetamol can also warp the way you think, which I think is pretty interesting / scary:

http://www.bencollier.info/content/suffering-existential-ang...

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