Changing acetaminophen guidelines

Acetaminophen needs review  (AP photo Paul Sakuma)

The most common cause of liver failure currently is over-use of acetaminophen (Tylenol). Today the FDA is considering restricting the distribution of acetaminophen and is recommending manufacturers lower doses of these products. Of particular interest is pain medications that are paired with acetaminophen to enhance pain relief.

Popular opioid pain relievers such as Percocet, Vicodin and others have acetaminophen in them to enhance pain relief.  Doctors sometimes recommend taking additional doses of acetaminophen even while on these opioids to help relieve pain. While acetaminophen provides pain relief it does not provide anti-inflammatory effects. Because it does not promote gastrointestinal bleeding, it is touted as a safer alternative to aspirin or ibuprofen for many people.

But like many things that are sold without a prescription, the perception is that acetaminophen is absolutely safe, free from any ill effects. But the ill effects on the liver have been known since the drug was first sold under Johnson and Johnson’ brand name of Tylenol. 48% of the overdoses are accidental because there is a narrow margin between benefit and overdose.  Relatively low doses taken over time tend to have a cumulative effect that can result in liver failure without an actual single overdose. One study showed that doses as low as 7.5 mg/day could result in liver failure when it is taken long term.

This study, set up in 1997 called “Acute Liver Failure Study Group”, began looking at the incidence of liver failure. They noted that the percentage of acute liver failure (ALF) due to acetaminophen has nearly doubled in 6 years. They have found the annual percentage of ALF related to acetaminophen has increased from 28% in 1998 to 51%by 2004, and continues to rise. These and other statistics, have alerted the FDA to the public health risk posed by the consumption of acetaminophen and the need for education, alteration of dosage and dosage guidelines and more careful monitoring of people taking these medications whether prescribed or not.

A particularly at-risk group includes those with chronic liver disease. Though most with chronic liver diseases know to avoid or limit use of acetaminophen, they may not know that even small amounts of acetaminophen can have devastating results when paired with coffee. A University of Washington team found that caffeine triples the amount of the toxic byproduct produced during the breakdown of acetaminophen which causes liver failure.

Before you take any over the counter products, including herbs and supplements, you must know that nothing is absolutely safe and that there are repercussions either for good or for ill when taking these things. Read the precautions; know the side effects especially as they relate to your particular health concerns. Your wellness depends on it.