9 ms·

Acetaminophen in particular is somewhat scary. Just 2.5x the recommended maximal daily dose of 4g can lead to complete liver failure. With alcohol, other medica

Acetaminophen in particular is somewhat scary. Just 2.5x the recommended maximal daily dose of 4g can lead to complete liver failure. With alcohol, other medication, or existing damage, much less could be enough.

nostromo 10y ago
A friend of mine swears that the reason acetaminophen is added to opioids (like hydrocodone) is so that you cant abuse the opioid without being poisoned by the acetaminophen. If true, it's alarming that the way to "prevent abuse" is to poison the patient.
- snerbles 10y ago
  A more extreme example of this concept is denatured alcohol, which is ethanol adulterated to deter consumption. https://en.wikipedia.org/wiki/Denatured_alcohol https://en.wikipedia.org/wiki/Denatured_alcohol
- jaggederest 10y ago
  That is completely correct. It also has synergistic effects as a pain reliever, but it's mainly there to deter abuse. Of course, addicts have found ways to extract the opiates from the adulterants, so it's not even effective.
  - joshgel 10y ago
    Source? Adding it for synergism makes sense and is what I was taught in medical school. I doubt they add it to deter abusers, but I could be wrong...
    - icantdrive55 10y ago
      I think what you were taught in med school was correct. I was told by an emergency room nurse that Vicodin is not killing patients/abusers; it the liver damage that results from the acetaminophen. A few years ago, I heard they were talking about removing it, but lost track of the outcome.
    - jaggederest 10y ago
      Just look at the simple fact that they were schedule 3 instead of schedule 2 until 2014, even though the base hydrocodone was schedule 2 without adulterants. Here's an interesting discussion from 2010, before they were rescheduled https://painmedicine.oxfordjournals.org/content/11/3/379.full.pdf https://painmedicine.oxfordjournals.org/content/11/3/379.ful...
- maccard 10y ago
  You can buy codeine over the counter in the UK, in doses of 8mg with 500mg acetaminophen(paracetamol to us). If you get a prescription, they happily bump it to 30/500
- matt4077 10y ago
  Isn't their anything that is uncomfortable in higher doses, but not deadly? Or have I misunderstood what I read about acetaminophen and/or liver failure–i. e. is there a meaningful dosage range where it's uncomfortable without causing irreparable harm?
ghaff 10y ago
It's arguable that Acetaminophen shouldn't be an OTC drug. And that, had its liver toxicity been fully understood, it probably wouldn't be. At the time, it apparently seemed a good alternative to aspirin which does cause some number of people to have stomach problems. (As well as having a particularly extensive repertoire of only somewhat understood physiological effects, for better or worse.)
- nommm-nommm 10y ago
  And aspirin should never be used in children because its use in children is associated with Reye syndrome.

nostromo 10y ago

A friend of mine swears that the reason acetaminophen is added to opioids (like hydrocodone) is so that you cant abuse the opioid without being poisoned by the acetaminophen. If true, it's alarming that the way to "prevent abuse" is to poison the patient.

snerbles 10y ago
A more extreme example of this concept is denatured alcohol, which is ethanol adulterated to deter consumption. https://en.wikipedia.org/wiki/Denatured_alcohol https://en.wikipedia.org/wiki/Denatured_alcohol
jaggederest 10y ago
That is completely correct. It also has synergistic effects as a pain reliever, but it's mainly there to deter abuse. Of course, addicts have found ways to extract the opiates from the adulterants, so it's not even effective.
- joshgel 10y ago
  Source? Adding it for synergism makes sense and is what I was taught in medical school. I doubt they add it to deter abusers, but I could be wrong...
  - icantdrive55 10y ago
    I think what you were taught in med school was correct. I was told by an emergency room nurse that Vicodin is not killing patients/abusers; it the liver damage that results from the acetaminophen. A few years ago, I heard they were talking about removing it, but lost track of the outcome.
  - jaggederest 10y ago
    Just look at the simple fact that they were schedule 3 instead of schedule 2 until 2014, even though the base hydrocodone was schedule 2 without adulterants. Here's an interesting discussion from 2010, before they were rescheduled https://painmedicine.oxfordjournals.org/content/11/3/379.full.pdf https://painmedicine.oxfordjournals.org/content/11/3/379.ful...
maccard 10y ago
You can buy codeine over the counter in the UK, in doses of 8mg with 500mg acetaminophen(paracetamol to us). If you get a prescription, they happily bump it to 30/500
matt4077 10y ago
Isn't their anything that is uncomfortable in higher doses, but not deadly? Or have I misunderstood what I read about acetaminophen and/or liver failure–i. e. is there a meaningful dosage range where it's uncomfortable without causing irreparable harm?

ghaff 10y ago

It's arguable that Acetaminophen shouldn't be an OTC drug. And that, had its liver toxicity been fully understood, it probably wouldn't be. At the time, it apparently seemed a good alternative to aspirin which does cause some number of people to have stomach problems. (As well as having a particularly extensive repertoire of only somewhat understood physiological effects, for better or worse.)

nommm-nommm 10y ago
And aspirin should never be used in children because its use in children is associated with Reye syndrome.