Hepatology, a medical journal devoted to liver diseases, featured a lengthy discussion a few years ago about acetaminophen, the main ingredient in Tylenol and many other medicines.
Acetaminophen is sold both over-the-counter and by doctor’s prescription, and more than 600 products now contain it. The conclusions of this article are definitely worth sharing with you.
Although Tylenol-type products are extremely safe in approved doses–no more than 4 grams per day–people frequently exceed that amount unintentionally and can run into serious trouble.
Researchers reviewed the records of 662 consecutive patients who needed an emergency liver transplant for total liver failure and were shocked to discover that in nearly half the cases, acetaminophen had been responsible.
Some of the cases were suicide attempts (with people swallowing handfuls of tablets), but the majority were accidental poisonings by people who took acetaminophen tablets for the flu and then added another form of the drug (like Alka Seltzer Plus, NyQuil Cold and Flu) on top of a third form, like Vicodin (used for chronic pain).
Understand, the total number of liver failures when compared to the tens of millions of doses of acetaminophen people take is very very small. For this reason, it’s not sensible to abandon the drug altogether. Tylenol does remain safer than either aspirin or the ibuprofen family of painkillers. The real issue is a failure of the FDA (Food and Drug Administration) to require better labeling of acetaminophen products, with a stern warning to you, the consumer, not to take two or more such products at the same time.
Acetaminophen and free radicals
As a side note, acetaminophen creates an increased amount of free radicals, those altered oxygen molecules associated with all sorts of chronic degenerative diseases. The only research done in this area showed that acetaminophen caused cataracts to develop in lab animals. This cataract-causing effect was prevented when the animals were given a potent antioxidant called n-acetyl cysteine (NAC), long available in health food stores and regularly used by nutritionally oriented doctors. In fact, the intravenous form of NAC is the only known treatment for acetaminophen poisoning.
Now, at this point, you might be saying to yourself, “Why not combine the two, acetaminophen and NAC, into one tablet and offer your body at least some protection?” Good idea, but the two are not available as a combination.
NAC is available in 500-mg capsules. The usual dose is one capsule three times a day. Click here to order NAC.
Most important: never exceed 4 grams a day of acetaminophen.
Be well,
David Edelberg, MD
I recently heard that ibuprofen usage has been linked to hearing loss. What are your thoughts on this?
Michelle Swank
One of the major risk factors towards acetaminophen toxicity is being in a “fasted” state at the time it is taken, which lowers serum glucose, and through a complex mechanism, alters the way acetaminophen is metabolized in the liver.. Now, most people who take a normal dose of Tylenol occasionally for a headache probably don’t have to worry about this one. But taking it during an illness in which normal eating habits can’t be maintained might be asking for trouble, especially in higher dosages or product combinations. Unfortunately, those are the times when physicians tend to prescribe it as a fever reducer or for pain (e.g., during a bad bout of the “flu” or post-surgery). There might be some question how safe it is for people who, for either disease process or “no known cause” reasons, tend to run low serum glucose on a frequent basis. While most doctors know about the risk of combining habitual alcohol use and acetaminophen consumption, dangerously few know about the “fasting state” risk associated with acetaminophen toxicity. Those of you who like reading this stuff can start with the article “Association of acetaminophen hepatotoxicity with fasting and ethanol use” (Whitcomb and Block, JAMA, 1994). Also, Google the terms “acetaminophen glucuronidation” with “fasting” to see all the research done on this topic using animal models.
Margo
Dr E, Thank you for a very informative article about acetophinomen. Would Ibuprofen have the same results? What is your position on Milk Thistle to protect the liver?
Patrice Gallagher