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Pills & Ills: ; Pay Close Attention When Taking Acetaminophen

Posted on: Wednesday, 28 December 2005, 00:00 CST

By Richard Harkness

Q: I was taking Vioxx for pain relief until it was taken off the market due to the increased risk of heart attacks. In its place, I have been taking acetaminophen. Is this drug safe?

A: Acetaminophen (Tylenol and other brands) is very safe when used properly. The Vioxx you took is a COX-2 NSAID (others are Bextra and Celebrex). These and traditional NSAIDs (e.g., ibuprofen, naproxen, ketoprofen) have been mainstays for pain and arthritis.

In regard to cardiovascular risk, the noose has tightened around both types of NSAIDs.

This increased risk is fairly small (much less compared with smoking, for instance), and appears to escalate with longer-term use, higher doses and advancing age.

Because more people may be turning to acetaminophen, let's take a closer look at this popular over-the-counter drug used for pain and fever. The key to safe use of acetaminophen is the daily dose. In excessive doses, acetaminophen is toxic to the liver. In fact, it's the most common cause of drug-induced liver failure.

Acetaminophen can damage the liver when you take more than the highest recommended daily dose (4,000 milligrams) at one time or when you take lower doses several times daily that exceed a total of 4,000 milligrams daily. Over-the-counter "extra-strength" acetaminophen pills contain 500 milligrams. As you can see, eight pills take you to the ceiling limit of 4,000 milligrams.

Be aware that many commonly used prescription narcotic pain- relievers also contain acetaminophen, including Darvocet N-100, Lortab, Lorcet and Vicodin. These products contain substantial amounts of acetaminophen - from 500 milligrams to 750 milligrams per pill. They are prescribed for moderate pain to be taken at intervals of four to six hours when needed.

Taking more than eight pills of the 500-milligram products or more than five pills of the 750-milligram products a day puts you in the danger zone. Chronic users of alcohol should stay well below the danger zone because alcohol puts an extra burden on the liver. Likewise for those with impaired liver function.

Acetaminophen use in children merits special attention. About 27,000 accidental overdoses of acetaminophen are reported annually in children. The key to avoiding problems is to recognize the difference between acetaminophen infants' drops and children's liquid.

Parents take heed: The infants' formulation is more than three times stronger than the children's product. The infants' product is designed to be given with the supplied dropper. Not realizing the strength difference, parents may use a teaspoon and give the infants' drops in the same amount they would give the children's liquid, resulting in an overdose.

This mistake may be particularly apt to occur in households with children of different ages. Caregivers also should be made aware of the potential danger.

Finally, keep in mind that over 200 OTC products contain acetaminophen, including remedies for pain, fever, and cold and cough. In adding up the total daily dose of acetaminophen, remember to check product labels and count amounts from all sources.

Richard Harkness is a consultant pharmacist, natural medicines specialist, and author of eight published books. Write him at 1224 King Henry Drive, Ocean Springs, MS 39564, or rharkn@aol.com. Selected questions will be used in the column.

Source: Sunday Gazette - Mail; Charleston, W.V.

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