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Tylenol (paracetamol) is also the leading cause of acute liver failure in the United States and Canada [1]. The toxic dose is very close to the active dose, far

• throwaway2048 5y ago
  if tylenol was a newly created drug, there is no chance it would have so few restrictions on its usage.
  • lostlogin 5y ago
    Imaging trying to get alcohol past regulators.
  • ekianjo 5y ago
    I would not be so sure. Regulatory agencies have recently approved AD treatment without any sort of evidence. In 2021.
    • np_tedious 5y ago
      True, but not quite relevant. That is a prescription drug which does/will therefore have quite a few more restrictions than over the counter Tylenol
      • ekianjo 5y ago
        It's relevant in the sense that you can't trust the FDA for anything scientific anymore. It's been hacked.
  • deleted 5y ago
    [deleted]
  • refurb 5y ago
    I disagree. Acetaminophen use is incredibly widespread yet few end up in liver failure. Without acetaminophen your only option for pain relief without going to much stronger drugs would be the NSAIDS like aspirin or ibuprofen. While not toxic to your liver, if you take them often enough you’ll end up with GI bleeding pretty reliably.
    • robbedpeter 5y ago
      There is little to no evidence that Tylenol works as a pain reliever - its analgesic effects are comparable to placebo. There's lots of evidence that it doesn't work, and there's no accepted or plausible mechanism of action. It doesn't work. It is the leading cause of liver failure in western societies. And yet the "common knowledge" of its utility surpasses those facts among doctors and pharmacists. They keep prescribing it and adding it to other medicines, but there's no good medical reasons to do so.
      • maccard 5y ago
        That's a lot of bold claims in one post. Have you uany studies to back up the claim that it doesn't work, it's the leadong cause of liver failure in western societies, or that there's no good reason to add it to other medicines?
      • satellite2 5y ago
        You might be mistaking it with other substances. There is a massive body of evidence showing that it's far more effective than placebo. There are even recent tentative evidence that show it increases risk taking behaviours and reduce emotional response to various stimulus.
    • robbedpeter 5y ago
      https://www.acsh.org/news/2017/09/18/tylenol-isnt-so-safe-least-it-works-right-11827 https://www.acsh.org/news/2017/09/18/tylenol-isnt-so-safe-le... You can find the studies with scihub. Tylenol doesn't seem to work for fever or anti inflammatory purposes either. It's great at hurting and killing people, though, in overdose and chronic use scenarios.
• onion2k 5y ago
  "It is the most common cause of liver injury.." That may well be true, but that doesn't mean it's especially dangerous. The number of people injured by a paracetamol overdose is tiny compared to the number of people who take it. Other drugs are significantly more dangerous when you consider per patient injuries. This is compounded by the fact that paracetamol overdose with alcohol is a common way for people to attempt suicide - all those who are discovered and rescued will end up with acute liver damage. Doctors (in the UK) usually recommend that people who have damaged their liver in this way avoid drinking alcohol for about a decade afterwards.
  • yosito 5y ago
    > avoid drinking alcohol for about a decade afterwards Really? I thought it was advised to not drink alcohol for life if you had liver damage. I thought the damage was permanent, no?
    • breput 5y ago
      Unless it is overwhelmingly damaged, the liver is the most resilient part of the human body and is the only organ that can regrow. It's that important.
      • yosito 5y ago
        If I recall correctly, liver damage is often because of the liver's ability to regrow. Small bits of damage to liver cells cause the liver to grow massive amounts of scar tissue which ultimately leads to failure of liver functions.
        • arghwhat 5y ago
          You're thinking of cirrhosis, which is usually the result of continuously injuring the liver over a long period of time. Saying the damage is caused by regrowth is silly as without it the liver would have failed at the first injury.
      • Angostura 5y ago
• masklinn 5y ago
  > The toxic dose is very close to the active dose Not “active dose”, recommended daily limit.
  • arcticbull 5y ago
    Both! You have to take way more times the active dose of Naproxen to die as compared to Tylenol.
• nindalf 5y ago
  I’m not sure if I agree with any of the claims in the article you linked. > Each year, about 4,500 hospitalizations in Canada occur due to acetaminophen overdose, and about 16 per cent of these are accidental, Health Canada says. So this affects only a tiny minority. It’s absurd that the tens of millions of people who use acetaminophen without an issue need to have their access to the drug restricted because of these 700 people. To be absolutely clear, the maximum recommended dose is 4000mg over 24 hours. That’s eight extra strength pills. According to your article, the people who still accidentally overdose apparently take two pills every 2-3 hours and then forget how many they took. No wonder the vast majority avoid this fate, we simply take one pill instead. It annoys me to no end when some folks trying to win the Darwin Award make medical professionals change guidelines in a misguided attempt to “protect” us. No, we don’t need that protection. Just keep it available while educating people about concerns around pregnancy and lower doses for younger children. Everyone involved with writing, editing or contributing to this nothing burger of an article should be ashamed of themselves.
  • slavik81 5y ago
    > To be absolutely clear, the maximum recommended dose is 4000mg over 24 hours. That’s eight extra strength pills. It's also included as a secondary ingredient in a lot of other medicines, which makes it easy to take more than you thought. Additionally, other common drugs (like alcohol) use the same metabolic pathways, so they can dramatically lower the safe limit for acetaminophen. When you look at the rate of death and serious injury due to overdose, acetaminophen comes out very badly. The only medicines that kill more are opioids.
  • touisteur 5y ago
    A more charitable interpretation of the overdose on acetaminophen is that people are bad at handling pain and we should help with that. And also when in a flu-like state, people (me included) have trouble keeping up with their dosage. One other thing is that many compound otc drugs (marketed as 'get through this' for ) also have acetaminophen... I'll also say that being pregnant is the medical wild card. You shouldn't do, eat, take, catch anything. It doesn't help discriminating between the level of risks you're taking when anything you do is forbidden. Having such a risky drug at hand mechanically increases the risk of overdose and we should strive to find better alternatives, I think. It doesn't have to be more control, since it won't help you at home and will just make suffering people more miserable, but tech could help here, with delivery or packaging for example. 700 dead people isn't nothing. And putting a 'Darwin Awards' tag on them feels the same as 'pilot blaming' in aviation: not likely to increase safety.
• raverbashing 5y ago
  Paracetamol was "hyped" as much as the others NSAIDs (and similars) are daemonized for rare and/or high-dosage side effects (I'm sure fear of litigation plays a part) The medical gate-keeping/lobbying for keeping anything effective prescription-only is strong. (Of course the other side is that people will not read the leaflet and take some stuff willy-nilly) As even the article says, having a fever is also dangerous in pregnancy.
  • maccard 5y ago
    > Of course the other side is that people will not read the leaflet and take some stuff willy-nilly) In the UK, for basically any medicine you buy OTC in a pharmacy/drug store, the store assistant will ask you if you're taking any other medication, and will tell you the dosage to take (by reading the packet). It's not fool proof by any means but it does mean that people get _some_ advice.
• phaedrus441 5y ago
  Just anecdotal data, but in both my roles as an academic hospitalist and community hospitalist in the US (inpatient internal medicine doc, ie the person that cares for people admitted with acetaminophen overdose if not sent directly to the ICU), I have only seen two cases of intentional acetaminophen overdose (both survived, amazingly) and have heard of an accidental overdose only once (my colleague admitted them; older man taking 8-9 grams/day for about a month because he thought he was doing the right thing by avoiding opiates for hip pain). Compare that to the three alcoholic cirrhotics I am currently caring for (which is a fairly common number where I work), and I personally don’t think acetaminophen is a very big deal for most people. Also, we (hospitalists in the US) certainly see far more bad outcomes from OTC NSAID use contributing to GI bleeds and heart trouble (I’d say I care for a couple/month on average).
• rscho 5y ago
  Therapeutic index for Tylenol is 2. That's already much better than NSAIDs, which are often already very toxic at usual dosage (400mg ibuprofen) in diabetics, senior citizens, children, etc. The big difference is that with acute liver damage you are feeling very sick and die quickly, while with kidney failure you feel normal and die very slowly. So, what's worse? Additionally, it's no wonder that it's a paediatrician speaking, because many Tylenol intoxications are actually intentional in children (suicide). It's one of the most common suicide plan in teenagers.