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Winnipeg Free Press - PRINT EDITION

Avoid perilous Tylenol trap

High acetaminophen level damages liver

By: W. Gifford-Jones MD.

17/04/2009 1:00 AM | Comments: 1

Why would I want people to suffer pain when in the past I've criticized doctors for inadequate pain control? For years I've argued it's inhuman to allow terminal-cancer patients to die in agony. How some get insufficient amounts of painkillers. Others are denied medication for fear of addiction even though they have only days or weeks to live. But suffering a little bit is the right prescription for millions of other people.

Today, many North Americans take acetaminophen, better known as Tylenol, to ease a variety of pains. It's been known for years that too much Tylenol can cause liver failure and death. Now, a new study shows that even taking the recommended daily dose may cause liver problems. This should be a wake-up call.

Dr. Neil Kaplowitz of the University of Southern California, cites a study of 145 healthy patients who took four grams of Tylenol a day, the maximum daily dose, for two weeks. Forty per cent of these volunteers showed an increase of aminotransferase, a liver enzyme that indicates possible liver damage. In fact, the elevation was three times the usual point for concern.

It's easy to overdose when using Tylenol. Extra-strength Tylenol contains 500 milligrams (mg) of acetaminophen. Two of these tablets four times a day equals 4,000 mgs., the maximum dose. And any increase above this dose is flirting with danger.

Today, acetaminophen causes more overdoses and overdose deaths than any other drug in the U.S. A study at the University of Texas and Washington showed that nearly half of all cases of liver failure in 662 patients from 22 liver transplant centres, over a six year period, were the result of acetaminophen poisoning.

It's equally worrying that in 1998, only 28 per cent of liver poisonings could be traced to this painkiller. Just five years later in 2003 this figure had escalated to 51 per cent.

The Federal Drug Administration in the U.S. estimates that 56,000 emergency visits a year are due to acetaminophen poisoning.

Some of these emergency visits were due to what researchers call "therapeutic misadventures." These occur for several reasons and often patients have no idea what's happening.

For instance, there is a North American tendency to overdo things. The reasoning is that if eight tablets of Tylenol a day help to ease pain symptoms, then 12 tablets a day would be even more helpful. This is a bad error.

Another unexpected Tylenol trap results in double dosing. While suffering from a backache you awaken one morning with a cold. Now you reach for a cold remedy that also contains acetaminophen.

Today, there are more than 150 non-prescription, over-the-counter medicines that contain acetaminophen. And who takes the time, when in pain, to read the label to learn whether this painkiller is present?

Parents should remember that children's versions of acetaminophen come in a variety of formulations. For instance, by substituting infant drops for syrup or elixir, an infant could receive three times the dose it should be.

Tylenol is a safe medication if used properly. The problem is there are too many unsafe people. The reasons why some people reach for Tylenol and other minor painkillers are also shocking. Some patients tell me, "It lifts me up" or "It helps to relax me" or "I have a slight headache." These patients have been brainwashed by TV ads assuring us that no one need ever suffer any pain, slight as it may be.

Painkillers are metabolized by the liver and excreted by the kidneys. Researchers say that safe doses do not injure these organs. Maybe they're right, but I can't believe that even low doses are good for these organs and the fewer drugs we take the better.

During the past few years reports have shown how many drugs other than Tylenol have caused either severe injury or death. Some patients were taking these medications for bona fide medical problems. And I have no problem with painkillers used to help ease the suffering of those riddled with arthritic and other disabling diseases.

But compared to our ancestors, who hacked their way into the primitive forest, we've become a nation of wimps who expect total freedom from the slightest pain. It's become a dangerous addiction.

Republished from the Winnipeg Free Press print edition April 17, 2009 A22

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