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The judgement from my pharmacology instructor was that paracetamol, when used within the recommended doses and durations, is a very safe drug with very little s

by etiam 6y ago

The judgement from my pharmacology instructor was that paracetamol, when used within the recommended doses and durations, is a very safe drug with very little side effects. Whereas acetylsalicylic acid ("Aspirin") was the example of heirloom drugs still in prescription free use only for historical reasons. 'If you came requesting approval for ASA today they'd laugh in your face. "With that side effect profile!"'

arcticbull 6y ago
The other big issue with Tylenol is that the active dose is very close to its lethal dose -- far closer than other common over-the-counter drugs. People assume that since it's available without approval it must be pretty safe, so people take more than recommended. The maximum safe dose for Tylenol is 4g per day. The low end of the toxicity range is a daily dose of 7.5g-10g for an adult, ~2.5X the maximum recommended dose - or just 12 grams spread over 2 days. The effects are exacerbated by alcohol use. And worst of all, people take it for hangovers. [1] So, the toxic dose of Tylenol is only 2.5X the active dose, whereas for ASA it's 8X, for ibuprofen it's roughly 10X, and naproxen is about the same. Tylenol is much more dangerous than Aspirin. Tylenol leads to 50,000 ER visits per year and 25,000 hospitalizations. It would lead to way more deaths if left untreated. [1] https://www.uspharmacist.com/article/acetaminophen-toxicity-what-pharmacists-need-to-know https://www.uspharmacist.com/article/acetaminophen-toxicity-...
- lol768 6y ago
  > So, the toxic dose of Tylenol is only 2.5X the active dose The effective dose starts at 500mg. Most people are likely going to be taking 1 or 2x 500mg tablets for acute issues - and I'd argue that's often enough for most cases where you want short-term analgesia. Both 500mg and 1000mg will improve SPRID6 scores (dental; https://www.cadth.ca/sites/default/files/pdf/htis/june-2016/RC0786%20Acetaminophen%20Dose%20Final.pdf https://www.cadth.ca/sites/default/files/pdf/htis/june-2016/...). Where I've complained of medium term pain (expected duration: weeks to months) my GP has suggested NSAIDs instead. They're not without their own problems but I think I'd personally prefer their safety profile to long-term Paracetamol.
  - arcticbull 6y ago
    All Tylenol figures are in daily totals, and Tylenol lasts 4 hours. 500-1000mg taken 4x daily is 2-4g. That makes the therapeutic index 1.875-2.5 as I mentioned. 12g over 2 days is 1.5X. Again that’s without alcohol which folks do not seem to appreciate. People can and do exceed these numbers hence the 50,000 ER visits per year. It is the leading cause of acute liver failure in the United States. The bar shouldn’t be “often enough for most cases” when 1.5X the dose for 2 days can kill you. Either the safety margin is too low or the warnings aren’t nearly big enough, but the numbers don’t lie, the status quo is bad. Especially when the alternatives require way less diligence on your part and are sold as equivalent adjacent products.
  - apple4ever 6y ago
    That's exactly why I take NSAIDs over Tylenol if I can.

by etiam 6y ago

arcticbull 6y ago

The other big issue with Tylenol is that the active dose is very close to its lethal dose -- far closer than other common over-the-counter drugs. People assume that since it's available without approval it must be pretty safe, so people take more than recommended. The maximum safe dose for Tylenol is 4g per day. The low end of the toxicity range is a daily dose of 7.5g-10g for an adult, ~2.5X the maximum recommended dose - or just 12 grams spread over 2 days. The effects are exacerbated by alcohol use. And worst of all, people take it for hangovers. [1] So, the toxic dose of Tylenol is only 2.5X the active dose, whereas for ASA it's 8X, for ibuprofen it's roughly 10X, and naproxen is about the same. Tylenol is much more dangerous than Aspirin. Tylenol leads to 50,000 ER visits per year and 25,000 hospitalizations. It would lead to way more deaths if left untreated. [1] https://www.uspharmacist.com/article/acetaminophen-toxicity-what-pharmacists-need-to-know https://www.uspharmacist.com/article/acetaminophen-toxicity-...

lol768 6y ago
> So, the toxic dose of Tylenol is only 2.5X the active dose The effective dose starts at 500mg. Most people are likely going to be taking 1 or 2x 500mg tablets for acute issues - and I'd argue that's often enough for most cases where you want short-term analgesia. Both 500mg and 1000mg will improve SPRID6 scores (dental; https://www.cadth.ca/sites/default/files/pdf/htis/june-2016/RC0786%20Acetaminophen%20Dose%20Final.pdf https://www.cadth.ca/sites/default/files/pdf/htis/june-2016/...). Where I've complained of medium term pain (expected duration: weeks to months) my GP has suggested NSAIDs instead. They're not without their own problems but I think I'd personally prefer their safety profile to long-term Paracetamol.
- arcticbull 6y ago
  All Tylenol figures are in daily totals, and Tylenol lasts 4 hours. 500-1000mg taken 4x daily is 2-4g. That makes the therapeutic index 1.875-2.5 as I mentioned. 12g over 2 days is 1.5X. Again that’s without alcohol which folks do not seem to appreciate. People can and do exceed these numbers hence the 50,000 ER visits per year. It is the leading cause of acute liver failure in the United States. The bar shouldn’t be “often enough for most cases” when 1.5X the dose for 2 days can kill you. Either the safety margin is too low or the warnings aren’t nearly big enough, but the numbers don’t lie, the status quo is bad. Especially when the alternatives require way less diligence on your part and are sold as equivalent adjacent products.
- apple4ever 6y ago
  That's exactly why I take NSAIDs over Tylenol if I can.