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Acetaminophen: Painkiller or Pain Producer?

October 7, 2009

By Lindsay Grace Weber

On June 30th, 2009, a health advisory panel urged the U.S. Food and Drug Administration to lower the maximum dosage of acetaminophen in over-the-counter medications. A popular ingredient in both prescription and non-prescription painkillers—including Tylenol, Excedrin, Nyquil, and many generic brands of pain and fever reducers—acetaminophen has been linked potentially serious liver damage and death. The FDA panel also recommended reducing the maximum daily dose of acetaminophen, which is currently 4,000 milligrams, equal to 8 pills of Extra Strength Tylenol. [1]

High doses of acetaminophen are a leading cause of liver damage in the U.S., and even recommended dosages cause serious liver damage, especially in individuals with pre-existing liver disease or damage, and alcohol and/or narcotic dependency. Acetaminophen should never be taken with alcohol or other illegal narcotics, and individuals recovering from recent alcohol intoxication should avoid painkillers containing acetaminophen when experiencing hangover symptoms. Reach for the aspirin or ibuprofen (Advil or Motrin), eggs, fruit and/or water instead.

The FDA advisory panel additionally recommended a ban on Percocet and Vicodin, two of the most widely used prescription painkillers in the world, which combine the narcotics oxycodone (in Percocet) and hydrocodone (in Vicodin) with acetaminophen. Because they contain addictive narcotic ingredients, both Percocet and Vicodin also have a great potential for abuse; mixing these medications with alcohol is especially risky, leading to stomach bleeding as well as serious liver damage. While many individuals use over-the-counter and prescription painkillers containing acetaminophen without experiencing such harmful side effects, every year in the U.S. 42,000 people are hospitalized, and more than 400 people die from overdoses of medications containing acetaminophen. [2, 3]

Other Risks
More recent research has shown that women who used acetaminophen long-term experienced a decline in kidney function; current recommendation advises that unless directed by a doctor, individuals should not use acetaminophen-containing medications for more than 10 consecutive days. [4, 5] Research has also shown that women who use higher daily doses of acetaminophen (500 milligrams or more) increased their risk for hypertension. [6] For women with diabetes, hypertension significantly increases the risk of vascular complications (including stroke), chronic kidney disease, and coronary heart disease. Pregnant women with both diabetes and hypertension are also at a higher risk for pre-eclampsia, though acetaminophen has been shown to be safe during pregnancy and nursing when used sparingly and in consultation with a doctor. [7] Women with diabetes should seek alternative pain medications to reduce their risk of serious complications.

Heart disease, diabetes complications (including kidney disease), stroke, cirrhosis and chronic liver disease are among the leading causes of death amongst Indigenous women in the U.S. [8] As acetaminophen increases the risk for many of these diseases, and increases potentially harmful (and fatal) complications, Indigenous women should be particularly vigilant when using medications containing acetaminophen, especially if already diagnosed with any of the above-mentioned health conditions.

Side Effect Signs and Symptoms
If you experience any of the following symptoms during or after acetaminophen consumption, consult your doctor immediately: easy bruising or bleeding, persistent sore throat or other signs of infection. Signs of liver damage include severe nausea, yellowing eyes or skin, dark urine, stomach pain, and extreme fatigue. Symptoms of a serious allergic reaction to acetaminophen include rash, itching, swelling, severe dizziness, and trouble breathing. [9]

Protecting Yourself
Some plants and herbs have shown to be helpful in the prevention and treatment of liver damage, including that caused by acetaminophen consumption. Fresh garlic extract, turmeric extract, milk thistle, green tea, kutkin, and licorice root extract can have a positive impact on liver toxicity and regeneration, though they should not be maintained as the single course of treatment without consulting a medical professional or experienced healer. [10, 11, 12] Additionally, following the suggestions below will help to minimize unwanted effects of both prescription and over-the-counter painkillers:

  • Take painkillers with a full glass of milk or water. It will speed entry into the digestive system and minimize the possibility of an upset stomach.
  • Remember that all drugs have side effects. Find out early what to expect by asking the pharmacist for the drug package insert or asking your physician.
  • Take only the weakest form and the smallest dosage that will provide effective pain relief.
  • Don't wait until the pain is too severe to begin your medication. Delay makes it more difficult for the painkiller to be effective, and you may need a stronger dose.
  • If pain keeps you from sleeping, never take a sleeping pill along with painkillers. Use analgesics only for the pain itself.
  • If you are a cigarette smoker, painkillers may be metabolized at a different rate so tell your doctor if you smoke.
  • Before considering switching painkillers because of side effects, ask your doctor if she can reduce your dosage.
  • If you are taking a narcotic type of painkiller, check with your physician about alternating it with aspirin or an acetaminophen analgesic. This will help reduce the possibility of developing a tolerance and/or narcotic abuse.
  • Don't think of painkillers as your only weapon against pain. There are other techniques—such as relaxation training or cold compresses—that your physician can help you with.
  • Check the ingredients of your medications before consuming them. Overdoses are often caused by the mixing of two or more medications containing acetaminophen. [13]
Some Medications Containing Acetaminophen
Non-Prescription: Acephen, Aceta, Actamin, Actimin, Anacin-3, Apacet, Atasol, Captin, Crocin, Dapa, Datril, DayQuil, Depon, Disprol, Doliprane, Dolo, Dymadon, Efferalgan, Fensum, Feverall, Few Drops, Fibi, Genapap, Genebs, Hedex, Lekadol, Liquiprin, Lupocet, Mexalen, Napa, Neopap, Nofedol, Ny-Quil, Oraphen-PD, Panadol, Panadeine, Paracetamol, Paralen, Pediapirin, Perfalgan, Phenaphen, Plicet, Q-Pap, Redutemp, Snaplets-FR, Solpadeine, Syooaom, Tactinal, Tamen, Tapanol, Tempra, Tylenol, Tylex, Uniserts, Valorin, Vitapap, Xcel.

Prescription: Anexsia, Darvocet, Endocet, Fioricet, Lorcet, Lortab, Norco, Percocet, Roxicet, Talacen, Tylox, Ultracet, Vicodin, Zydone.

Sources:
[1] Reinberg, Steve. “FDA Advisers Urge Smaller Doses of Acetaminophen.” (June 30, 2009). U.S. News and World Report Online. Retrieved from http://health.usnews.com/articles/health/healthday/2009/06/30/fda-advisers-urge-smaller-doses-of-acetaminophen.html
[2] Harris, Gardiner. “Ban is Advised on 2 Top Pills for Pain Relief.” (July 1, 2009). The New York Times Online. Retrieved from http://www.nytimes.com/2009/07/01/health/01fda.html
[3] Ogbru, Omudhome and Jay W. Marks. “Acetaminophen.” (September 21, 2007). MedicineNet.com. Retrieved from http://www.medicinenet.com/acetaminophen/article.htm
[4] Adams, Mike. “Long-term use of Tylenol (acetaminophen) found to cause kidney damage, says new study.” (July 27, 2004). NaturalNews.com. Retrieved from http://www.naturalnews.com/001523.html
[5] Ogbru., Marks. (2007).
[6] Forman, John P. “Diabetes In Control: Non-Narcotic Analgesic Dose and Risk of Incident Hypertension in US Women.” (September 2005). Hypertension 46(500). Retrieved from http://www.defeatdiabetes.org/Articles/hypertension_risk051031.htm
[7] Lago, Rodrigo M., Premaranjan P. Singh, and Richard W. Nesto. “Diabetes and Hypertension.” (2007). Nature Clinical Practice Endocrinology & Metabolism 3 (667). Retrieved from http://www.nature.com/nrendo/journal/v3/n10/full/ncpendmet0638.html
[8] Making the Grade on Women's Health: A National and State-by-State Report Card. National Women's Law Center. (August 2000). Retrieved from http://www.womancando.org/womancando/nativeamerican.htm
[9] Ogbru., Marks. (2007).
[10] C. Levy., L. Seef., K. Lindor. “Use of herbal supplements for chronic liver disease.” (2004). Clinical Gastroenterology and Hepatology 2(11):947-956.
[11] S. Luper. “A review of plants used in the treatment of liver disease: part two.” (June 1999). Alternative Medicine Review 4(3):178-88.
[12] C. C. Ezeala, I. N. Nweke, P. C. Unekwe, I. A. El-Safty & E. Nwaegerue. “Fresh Garlic Extract Protects The Liver Against Acetaminophen-Induced Toxicity.” (2009). The Internet Journal of Nutrition and Wellness 7(1). Retrieved from http://www.ispub.com/journal/the_internet_journal_of_nutrition_and_wellness/volume_7_number_1_21/article/fresh_garlic_extract_protects_the_liver_against_acetaminophen_induced_toxicity.html
[13] Powell, Don R. “How To Take Painkillers Safely.” (1992). HealthWorld Online. Retrieved from http://www.healthy.net/scr/healthHint.asp?Id=351

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