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Re: RLS/Tylenol Products

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Dear Phil, Deborah and all

The use of Tylenol in the presence of liver disease makes me very

uneasy. The active ingredient in Tylenol is acetaminophen (US),

paracetamol (outside of US). The one serious side effect of this drug is

liver toxicity. Liver toxicity appears with daily doses in excess of

10 grams or in the presence of alcohol. There are ways of treating this

liver toxicity, but the liver damage can be life-threatening. Tylenol,

by itself, should not aggravate RLS.

Tylenol is marketed in many combinations. Two of the combined

ingredients are pseudo-ephedrine and antihistamines (either Benadryl

(diphenhydramine) or ChlorTrimeton (chlorpheniramine)). There are other

drugs added for relief of various symptoms. While I never dispute

anyone's claim that any drug either helped or aggravated their RLS, I

have not been impressed with the incidence of aggravation of RLS by

pseudo-ephedrine or any other nasal decongestant. On the other hand, the

aggravation of RLS by antihistamines, in some people, is well known.

Others can take antihistamines with no problem.

Pseudo-ephedrine should not be taken by people who are also taking

MAO-inhibitors such as Parnate, Nardil, Marplan, some tricyclic

antidepressants and others. These people should also not eat large

amounts of certain cheeses because of their tyramine content. The result

is elevated blood pressure and agitation. Because some of the drugs used

in treating Parkinson's disease are of the MAO-inhibitor type, a warning

appears in the PDR about Parkinson's Disease and pseudo-ephedrine. This

warning only applies to people taking MAO-inhibitors to treat their PD.

The usual drugs taken for RLS are not MAO-inhibitors, though some of the

antidepressants that may be used do belong to this class of drugs.

Like with any drug or drug combination, you have to know what you are

taking and what side effects can occur. Tylenol is a good drug in the

right setting. So is pseudo-ephedrine. In the wrong setting, both can be

dangerous.

Dr. Levin

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