6 ms·

Not a particularly useful comment, but, wow: melatonin is a prescription in Australia? I mean, there are potential complications to melatonin…but I think it’s

Not a particularly useful comment, but, wow: melatonin is a prescription in Australia? I mean, there are potential complications to melatonin…but I think it’s hard to argue that it’s less safe than paracetamol or aspirin.

skissane 6y ago
Paracetamol is a lot more dangerous than melatonin. Take a big paracetamol overdose, get acute liver failure, significant chance of either death or urgent need for liver transplant–even if you are getting the best possible medical care. Take a massive melatonin overdose, nothing anywhere near as serious happens. You may become unconscious for 12 hours. There are reports of other negative side effects – tachycardia, hypotension, hypothermia, etc [1][2] – medically risky, but still your odds of survival without serious long-term consequences are pretty high, especially if you get proper medical care. Animal studies have failed to determine an LD50 for melatonin, even giving massive overdoses to animals they survive–it isn't clear if it is even possible for a healthy human to die by massive melatonin overdose, I think if it were to ever happen it would require a complete lack of medical attention combined with a very big dose of bad luck. By contrast, fatal paracetamol overdoses (mostly intentional, sometimes accidental) occur with some regularity. [1] https://journals.sagepub.com/doi/pdf/10.1177/102490790100800305 https://journals.sagepub.com/doi/pdf/10.1177/102490790100800... [2] https://pubmed.ncbi.nlm.nih.gov/31553200/ https://pubmed.ncbi.nlm.nih.gov/31553200/
- e1g 6y ago
  I think OP made that comparison because in Australia even a kid can get a pack of paracetamol for $1 over the counter at most grocery shops.
  - TheSpiceIsLife 6y ago
    20 x 500mg tables $0.70 at Coles. Two packs will end the average teen, formanent liver failure takes about 5 days though, quite uncomfortable I'm told. The antidote is n-acytel-cysteine, available from most sport supplement type places, I always keep 100g or so around cos early / immediate oral treatment can make the difference until medical intervention arrives, where they give the n-acytel-cysteine intravenously.
    - laurent92 6y ago
      Hi, It may be better not to publish exactly the dosage that is dangerous. For example, I tried not to read this part, because I know I’m tempted, and sometimes ignorance is bliss. I know you seek to share excellent knowledge, I’m myself passionate about air crashes and causes which is a topic a lot of people don’t like to hear about ;) It’s just, it’s very interesting to know for a public health perspective that lethal doses are possible to get at the local supermarket, perhaps the exact quantity is one detail too much. Cheers.
      - TheSpiceIsLife 6y ago
        Don't do it! This is a good point and something I consider every time I bring it up. I don't have a perfect response though sorry. I try to put people of this particular method by noting it's painful and takes a long time. Do you have someone(s) you can talk to? Support people?
        laurent92 6y ago
        Yes, don’t worry too much for me, I have a psychologist and we got several things rolling recently, so I’ll be fine for a couple of months already. Thank you for your concern ;)
      - gambiting 6y ago
        That's such a weird perspective to take. No information, including the exact dosage that will kill you, should be hidden "just in case". It's like security by obscurity of medical world. In fact I'd advocate that every paracetamol packet should say, in big letters in the back "TAKING X OF TABLETS WILL KILL YOU WITH NO KNOWN TREATMENT, AND IT WILL HURT ALL THE TIME AS YOU'RE DYING". There's so many people who don't realize how easily taking too much paracetamol can kill it's crazy.
        dkersten 6y ago
        Yeah, exact dosage is irrelevant. If you're going to kill yourself, you just take a few packs. As you say and has been said elsewhere in here, the dosage difference between therapeutic and fatal is really small, so if you take multiple times the normal dosage, well... you don't need exact dosage for that.
- nucleardog 6y ago
  It's been oft repeated that acetaminophen would not be OTC if it were discovered today. The difference between a therapeutic and a toxic dose are waaaaay too small. It's setting the bar _really_ low to compare to acetaminophen. There's a good chance if it weren't basically the only safe painkiller for pregnant and breastfeeding women it would simply not exist anymore.
  - kortex 6y ago
    > basically the only safe painkiller for pregnant and breastfeeding women Huh, is that why they keep it around? I thought it was mostly cruft/momentum. But it looks like NSAIDs are risky in the 3rd trimester. https://www.aafp.org/afp/2003/0615/p2517.html https://www.aafp.org/afp/2003/0615/p2517.html
- jl2718 6y ago
  And doctors will tell you to pound paracetamol all day just to stop bothering them with a problem that is ‘just in your head’. Why would we ever assume that another person, totally unrelated and unconnected, would ever prioritize our needs ahead of their benefit? This is the assumption of so many institutions where authority over ourselves is forcefully delegated to chosen others. This goes predictably wrong just about every time. We shouldn’t even be upset about it.
caf 6y ago
I suspect if paracetamol was newly brought to market today it would in fact be prescription. On the other hand diclofenac is over-the-counter in Australia.
- bouncycastle 6y ago
  come on guys, really? You can even overdose with water https://en.wikipedia.org/wiki/Water_intoxication https://en.wikipedia.org/wiki/Water_intoxication
  - BoiledCabbage 6y ago
    Are you not familiar with paracetamol? To post this and compare it to water overdose seem to be the only reason I can think of.
    - bouncycastle 6y ago
      I've mentioned water because it is something that you wouldn't expect. Probably alcohol would be another item that's easily available, and not many consider as dangerously lethal when overdosed. On the other hand, I think there's still a lot of common sense left with paracetamol and other medicine.
  - rsynnott 6y ago
    Paracetamol has the nasty feature that the therapeutic dose is quite close to the lethal dose; water does not.
- kortex 6y ago
  100%. With a drawn-out phase 3 and oodles of black-box warnings to boot. And why is there so much credulity in this thread? In fact why isn't paracetamol's toxicity more well known? My mom is a nurse and I have an undergrad in chemistry and it wasn't till college senior year in a pharmacochem elective that I learned how narrow the therapeutic range is, and how alcohol shrinks it further to the point where accidentally nerfing your liver with booze and dayquil is plausible.
dageshi 6y ago
From what I recall it's illegal to buy without a prescription in the UK as well because it's a hormone and all hormones need prescriptions. But it's not illegal to possess without a prescription, so you can just order it from abroad and essentially nobody cares, the same is true incidentally for steroids in the uk as well.
- rsynnott 6y ago
  > and all hormones need prescriptions. I don't think that's quite right; vitamin D is non-prescription in the UK AFAIK.

skissane 6y ago

Paracetamol is a lot more dangerous than melatonin. Take a big paracetamol overdose, get acute liver failure, significant chance of either death or urgent need for liver transplant–even if you are getting the best possible medical care. Take a massive melatonin overdose, nothing anywhere near as serious happens. You may become unconscious for 12 hours. There are reports of other negative side effects – tachycardia, hypotension, hypothermia, etc [1][2] – medically risky, but still your odds of survival without serious long-term consequences are pretty high, especially if you get proper medical care. Animal studies have failed to determine an LD50 for melatonin, even giving massive overdoses to animals they survive–it isn't clear if it is even possible for a healthy human to die by massive melatonin overdose, I think if it were to ever happen it would require a complete lack of medical attention combined with a very big dose of bad luck. By contrast, fatal paracetamol overdoses (mostly intentional, sometimes accidental) occur with some regularity. [1] https://journals.sagepub.com/doi/pdf/10.1177/102490790100800305 https://journals.sagepub.com/doi/pdf/10.1177/102490790100800... [2] https://pubmed.ncbi.nlm.nih.gov/31553200/ https://pubmed.ncbi.nlm.nih.gov/31553200/

e1g 6y ago
I think OP made that comparison because in Australia even a kid can get a pack of paracetamol for $1 over the counter at most grocery shops.
- TheSpiceIsLife 6y ago
  20 x 500mg tables $0.70 at Coles. Two packs will end the average teen, formanent liver failure takes about 5 days though, quite uncomfortable I'm told. The antidote is n-acytel-cysteine, available from most sport supplement type places, I always keep 100g or so around cos early / immediate oral treatment can make the difference until medical intervention arrives, where they give the n-acytel-cysteine intravenously.
  - laurent92 6y ago
    Hi, It may be better not to publish exactly the dosage that is dangerous. For example, I tried not to read this part, because I know I’m tempted, and sometimes ignorance is bliss. I know you seek to share excellent knowledge, I’m myself passionate about air crashes and causes which is a topic a lot of people don’t like to hear about ;) It’s just, it’s very interesting to know for a public health perspective that lethal doses are possible to get at the local supermarket, perhaps the exact quantity is one detail too much. Cheers.
    - TheSpiceIsLife 6y ago
      Don't do it! This is a good point and something I consider every time I bring it up. I don't have a perfect response though sorry. I try to put people of this particular method by noting it's painful and takes a long time. Do you have someone(s) you can talk to? Support people?
      - laurent92 6y ago
        Yes, don’t worry too much for me, I have a psychologist and we got several things rolling recently, so I’ll be fine for a couple of months already. Thank you for your concern ;)
    - gambiting 6y ago
      That's such a weird perspective to take. No information, including the exact dosage that will kill you, should be hidden "just in case". It's like security by obscurity of medical world. In fact I'd advocate that every paracetamol packet should say, in big letters in the back "TAKING X OF TABLETS WILL KILL YOU WITH NO KNOWN TREATMENT, AND IT WILL HURT ALL THE TIME AS YOU'RE DYING". There's so many people who don't realize how easily taking too much paracetamol can kill it's crazy.
      - dkersten 6y ago
        Yeah, exact dosage is irrelevant. If you're going to kill yourself, you just take a few packs. As you say and has been said elsewhere in here, the dosage difference between therapeutic and fatal is really small, so if you take multiple times the normal dosage, well... you don't need exact dosage for that.
nucleardog 6y ago
It's been oft repeated that acetaminophen would not be OTC if it were discovered today. The difference between a therapeutic and a toxic dose are waaaaay too small. It's setting the bar _really_ low to compare to acetaminophen. There's a good chance if it weren't basically the only safe painkiller for pregnant and breastfeeding women it would simply not exist anymore.
- kortex 6y ago
  > basically the only safe painkiller for pregnant and breastfeeding women Huh, is that why they keep it around? I thought it was mostly cruft/momentum. But it looks like NSAIDs are risky in the 3rd trimester. https://www.aafp.org/afp/2003/0615/p2517.html https://www.aafp.org/afp/2003/0615/p2517.html
jl2718 6y ago
And doctors will tell you to pound paracetamol all day just to stop bothering them with a problem that is ‘just in your head’. Why would we ever assume that another person, totally unrelated and unconnected, would ever prioritize our needs ahead of their benefit? This is the assumption of so many institutions where authority over ourselves is forcefully delegated to chosen others. This goes predictably wrong just about every time. We shouldn’t even be upset about it.

caf 6y ago

I suspect if paracetamol was newly brought to market today it would in fact be prescription. On the other hand diclofenac is over-the-counter in Australia.

bouncycastle 6y ago
come on guys, really? You can even overdose with water https://en.wikipedia.org/wiki/Water_intoxication https://en.wikipedia.org/wiki/Water_intoxication
- BoiledCabbage 6y ago
  Are you not familiar with paracetamol? To post this and compare it to water overdose seem to be the only reason I can think of.
  - bouncycastle 6y ago
    I've mentioned water because it is something that you wouldn't expect. Probably alcohol would be another item that's easily available, and not many consider as dangerously lethal when overdosed. On the other hand, I think there's still a lot of common sense left with paracetamol and other medicine.
- rsynnott 6y ago
  Paracetamol has the nasty feature that the therapeutic dose is quite close to the lethal dose; water does not.
kortex 6y ago
100%. With a drawn-out phase 3 and oodles of black-box warnings to boot. And why is there so much credulity in this thread? In fact why isn't paracetamol's toxicity more well known? My mom is a nurse and I have an undergrad in chemistry and it wasn't till college senior year in a pharmacochem elective that I learned how narrow the therapeutic range is, and how alcohol shrinks it further to the point where accidentally nerfing your liver with booze and dayquil is plausible.

dageshi 6y ago

From what I recall it's illegal to buy without a prescription in the UK as well because it's a hormone and all hormones need prescriptions. But it's not illegal to possess without a prescription, so you can just order it from abroad and essentially nobody cares, the same is true incidentally for steroids in the uk as well.

rsynnott 6y ago
> and all hormones need prescriptions. I don't think that's quite right; vitamin D is non-prescription in the UK AFAIK.