5 ms·
The question is what is the level of risk you are trying to prevent. For me a far more underappreciated risk is the level of liver toxicity in acetaminophen (Ty
by skmurphy 4y ago
The question is what is the level of risk you are trying to prevent. For me a far more underappreciated risk is the level of liver toxicity in acetaminophen (Tylenol) especially with even moderate amounts of alcohol--taking Tylenol for a hangover is a very bad idea.
You can be in liver failure (See https://www.mayoclinic.org/diseases-conditions/acute-liver-failure/symptoms-causes/syc-20352863 https://www.mayoclinic.org/diseases-conditions/acute-liver-f... ) after one very large dose of acetaminophen, or after higher than recommended doses every day for several days.
From https://www.ucihealth.org/blog/2018/03/acetaminophen-liver-failure https://www.ucihealth.org/blog/2018/03/acetaminophen-liver-f...
About 1,600 U.S. cases of acute liver failure occur each year due to acetaminophen overuse. And some 500 people die each year from overdosing on the drug.
- sokoloff 4y agoEstimates are that half of those deaths are suicide. (That doesn’t mean the drug’s side-effect-free, but does mean labeling likely wouldn’t be effective.)
- skmurphy 4y agoIf labeling efforts cut the death rate in half that's 249 more people a year who are saved vs. "grapefruit deaths." The trick is to aim for improvement not perfection. We could limit deaths more by banning Tylenol but that would lead to other problems that might be equally serious (e.g. more opioid use for pain relief).
- sokoloff 4y agoWhat level of additional labeling will eliminate non-intentional ODs? There’s clear dosage instructions already, including “do not exceed” levels.
- skmurphy 4y agoI used acetaminophen as an example of drug that is killing many more people than grapefruit juice. It's possible we could take a more holistic look and see where else we could minimize unintentional overdoses and dangerous interactions. The question is what additional measures would reduce--for example, cut in half--the current level of unintentional overdoses and drug interactions that cause liver failure. What the doctors call polypharmacy and regular people call "grandma has a big bag of pills to take each day" is a serious problem for folks over 65 to pick a different aspect of the same challenge. In my experience you will get nowhere if you will only explore interventions that "eliminate problems." Reduction in harm for effort and money invested is a better standard.