Doctors back weaker pain pills
Acetaminophen limits endorsed
Local doctors and researchers who have seen the effects of so-called Tylenol poisoning on the liver said they support the Food and Drug Administration's proposed new restrictions on acetaminophen.
Though it could be a year before a decision is made, an advisory committee to the FDA recommended this week to lower the amount of acetaminophen in a dose of the pain reliever. The committee also wants the total maximum dose of the substance per day to be lowered from 4,000 milligrams to a little over 3,000 milligrams. Another priority is to eliminate prescription drugs that combine acetaminophen with narcotic painkillers.
Acetaminophen, the generic name for the pain reliever Tylenol, is also found in Vicodin, Percocet, Excedrin, and cold and flu medicines such as Nyquil.
Its potential toxicity can lead to acute liver failure and even death if overdose occurs, something many are unaware of, said Dr. Timothy Collins, a neurologist at Duke University Medical Center.
"A common thought by the average person is that Tylenol is pretty benign and harmless," Collins said. "Most of the people I have discussions with are not aware that it causes liver damage. In fact, most are under the perception that ibuprofen causes liver failure when it doesn't."
Problems often arise when patients combine over-the-counter remedies with prescription drugs that all contain acetaminophen, said Dr. Judy Kramer, associate professor of medicine at Duke.
"Many of them are legitimate pain patients, not drug abusers," Kramer said. "But over a number of years the amount of acetaminophen in any one tablet, either over-the-counter or in prescription drugs, has been creeping up."
According to Kramer, several hundred cases of acute liver failure occur every year in this country as a result of acetaminophen overdoses.
Patients often aren't aware that drugs such as Nyquil contain acetaminophen because it's not prominently displayed on the medication's label.
"When you turn the box over it's in very small print and not blatantly out there for patients to see," Collins said.
People can inadvertently take too much of the drug by combining Tylenol with Nyquil for a cold and Percocet for chronic pain.
"They don't realize they're getting Tylenol in all three products, and that's where the big problem comes from," Collins said.
Collins saw a patient this week who was taking 4,000 milligrams of Tylenol every day, the maximum dosage. He thinks the recommended dose of 1,000 milligrams every four to six hours should be lowered to 650 milligrams no more than three times a day. He said some references caution that as little as 7,000 milligrams in adults can be fatal.
"It's a really, really common problem," he said. "And damage can happen the first time they overdose."
The difficult aspect is knowing what to look for. Patients can feel fairly normal for the first six to eight hours after an overdose of acetaminophen. Symptoms usually don't kick in until 16 to 24 hours later, and by that time it could be too late.
"Symptoms come on very gradually," Kramer said. "And they aren't distinctive, so it could feel like the flu."
After 18 to 24 hours, an overdose patient may feel pain in the abdomen where the liver is located, below the ribs on the right side of the body. Vomiting may also occur, and after three days the patient may start experiencing confusion and could slip into a coma.
Collins said that if a person doesn't get medical attention within eight to 12 hours after an overdose, there's almost nothing doctors can do for acetaminophen poisoning.
July 5th, 2009 - 00:43
So it’s official. We are all too fucking stupid to read the directions on the bottle and need to be told what and how much to take.
Fuck.