Tylenol Warnings

[Guest guest]

I'm posting this one because I know a lot of us are on various types of pain

medications and some of us aren't getting effective pain control from what the

doctors give will us. It's worth a look...

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November 29, 2005

The Consumer

Poisonings From a Popular Pain Reliever Are Rising

By DEBORAH FRANKLIN

Despite more than a decade's worth of research showing that taking too much of

a popular pain reliever can ruin the liver, the number of severe, unintentional

poisonings from the drug is on the rise, a new study reports. The drug,

acetaminophen, is best known under the brand name Tylenol. But many consumers

don't realize that it is also found in widely varying doses in several hundred

common cold remedies and combination pain relievers. These compounds include

Excedrin, Midol Teen Formula, Theraflu, Alka-Seltzer Plus Cold Medicine, and

NyQuil Cold and Flu, as well as other over-the-counter drugs and many

prescription narcotics, like Vicodin and Percocet. The authors of the study,

which is appearing in the December issue of Hepatology, say the combination of

acetaminophen's quiet ubiquity in over-the-counter remedies and its pairing with

narcotics in potentially addictive drugs like Vicodin and Percocet can make it

too easy for some patients to swallow much more than the maximum

recommended dose inadvertently. " It's extremely frustrating to see people

come into the hospital who felt fine several days ago, but now need a new

liver, " said Dr. Tim Davern, one of the authors and a gastroenterologist with

the liver transplant program of the University of California at San Francisco.

" Most had no idea that what they were taking could have that sort of effect. "

The numbers of poisonings, however, are still tiny in comparison with the

millions of people who use over-the-counter and prescription drugs with

acetaminophen. Dr. Davern and a team of colleagues from other centers led by

Dr. Anne Larson at the University of Washington Medical Center in Seattle,

tracked the 662 consecutive patients who showed up with acute liver failure at

23 transplant centers across the United States from 1998 to 2003.

Acetaminophen poisoning was to blame in nearly half the patients, the scientists

found. The proportion of cases linked to the drug rose to 51 percent in 2003

from 28

percent in 1998. Not all the poisonings were accidental. An estimated 44

percent were suicide attempts by people who swallowed fistfuls of pills. " It's a

grisly way to die, " Dr. Davern said, adding that patients who survive sometimes

suffer profound brain damage. But in at least another 48 percent of the cases

studied, the liver failed after a smaller, unintentional assault by the drug

over several days. " I see some young women who have been suffering flulike

symptoms for the better part of a week, and not eating much, " Dr. Davern said.

" They start with Tylenol, and maybe add an over-the-counter flu medicine on top

of that, and pretty soon they've been taking maybe six grams of acetaminophen a

day for a number of days. In rare cases that can be enough to throw them into

liver failure. " Each Extra Strength Tylenol tablet contains half a gram, or

500 milligrams, of acetaminophen, and arthritis-strength versions of the pain

reliever contain 650 milligrams. One tablet of Midol Teen

formula contains 500 milligrams of acetaminophen, as does one adult dose of

NyQuil Cold and Flu. One dose of Tylenol Cold and Flu Severe contains 1,000

milligrams. The recommended maximum daily dose for adults is 4 grams, or 4,000

milligrams. " Part of the problem is that the labeling on many of these drugs

is still crummy, " said Dr. Lee, a liver specialist at the University of

Texas Southwestern Medical Center in Dallas, who for years has been lobbying the

Food and Drug Administration to make manufacturers put " acetaminophen " in large

letters on the front of any package that contains it, so that as they reach for

the bottle, patients will be more likely to pause and keep track of exactly how

much they are swallowing. Some companies have voluntarily added new warnings

about acetaminophen's risk to the liver, and they should be given credit for

that, said Dr. Ganley, director of the F.D.A.'s Office of

Nonprescription Products. " But labeling isn't where I would like

it to be, " Dr. Ganley added. McNeil Consumer & Specialty Pharmaceuticals, a

division of & , updated the labeling on all its Tylenol products

in 2002 to list all the active ingredients on the front of the bottle, increase

the type size of acetaminophen, and added a label on the front warning consumers

not to use the product with others that contain acetaminophen, said Kathy Fallon

a spokeswoman. " I urge consumers to read the label, " she said. " Anything more

than the recommended dose is an overdose. " Dr. Lee said he was disturbed by a

pattern: " that acetaminophen is always billed as the one to reach to for safety,

probably even more so now, with other pain relievers pulled from the market. "

In fact, the drug, when given in precise, appropriate doses is safer for

children and teenagers than aspirin, which can interact with a viral infection

to bring on rare but serious damage to the brain, liver and other organs in a

constellation of symptoms known as Reye's

syndrome. And among adults, low doses of acetaminophen are less likely than

aspirin, ibuprofen or naproxen to eat away at the stomach, aggravate bleeding or

harm the kidneys. Even patients with chronic liver disease are justly advised

to take acetaminophen for the occasional fever, or for the pain of

osteoarthritis, a back injury or other malady, if they keep the total daily dose

under about two grams, Dr. Lee said. Experts agree that a vast majority of

people can safely take the four-gram daily maximum that labels recommend for

adults - the equivalent of eight Extra Strength Tylenol spread across 24 hours -

and some people swallow much more without harm. But by eight grams in a single

day, a significant number of people whose livers have been stressed by a virus,

medication, alcohol or other factors would run into serious trouble, Dr. Lee

said. Without intervention, about half the people who swallowed a single dose of

12 to 15 grams could die. How much alcohol over what

time period is problematic? Recent research suggests the answer isn't simple.

The package labels now warn anyone who drinks three or more drinks every day to

consult a doctor before taking acetaminophen, but Dr. Lee thinks that people who

are sober during the week but binge on weekends may be vulnerable, too. The

few days of fasting that can accompany a bad stomach bug also seem to increase

the liver's vulnerability to acetaminophen. And though safe levels of the drug

for large men may, in general, be higher than those for small women, obese

people aren't protected; extra fat in the liver seems to prime the organ for

further damage. Nearly two-thirds of the people in the transplant center study

who unintentionally poisoned themselves were taking one or another of the

roughly 200 prescription drugs that contain acetaminophen plus an opiate. Among

the most popularly prescribed drugs in this group include hydroconebitartrate

plus acetaminophen, which is commonly sold as Vicodin,

and oxycodone hydrochloride plus acetaminophen, better known as Percocet.

While these acetaminophen/opiate combination drugs can be very effective in

curbing pain after surgery or injury, some patients who take the drugs

chronically soon find they need increasing amounts to achieve the same level of

pain relief. Because the narcotic part of the compound can be addictive, its

accompanying doses of acetaminophen climb sky high in lock step. The liver may

keep pace with gradual increases of the drug initially, only to suddenly crash

months later. It is the acetaminophen that kills the liver. Lynne Gong of San

, Calif., watched her 28-year-old daughter, Leah, nearly die last summer

after that sort of crash. What had started out as a treatment for the pain of a

dislocated shoulder and subsequent surgery had escalated over two years to a

full-blown addiction. After her daughter was hospitalized, Ms. Gong said she

found herself warning friends, neighbors " and anyone else who

would listen " that they needed to closely monitor their own intake of

acetaminophen and that of their children. Some dangers lurk in surprising

corners. One day, after Lynne Gong told the women in her prayer group about

Leah's experience, a member went home and, after a little investigating of her

own, discovered that her 12-year-old son and his friends had started nipping

NyQuil on Friday nights for the alcohol content, in hopes of getting drunk.

There are 9.8 grams of acetaminophen in a 10-ounce bottle of NyQuil, Ms. Gong

said. " Everyone really needs to be more aware. "

Serena

There is no such thing as an anomaly. Recheck your original premise.

...Ayn Rand,

paraphrased

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