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"Therapeutic index" is a strange number to worry about. Those index scores are the balance between efficacy and toxicity. Acetaminophen is an effective analges

"Therapeutic index" is a strange number to worry about. Those index scores are the balance between efficacy and toxicity. Acetaminophen is an effective analgesic, just toxic in large doses. It's perfect for lower intensity pain. It's non-addictive, doesn't have long term issues like NSAIDs. It's popular for a reason.

Jolter 1y ago
It’s cheap, too.
raffraffraff 1y ago
My family always had boxes of it around the place when I was growing up. Never really had much use for pain killers. But when I was in my early 20s, no money, not looking at myself, I cracked a tooth in half and it took a few days to see the dentist. It was excruciating. First thing I did, take paracetamol (our name for acetaminophen). It did absolutely nothing. The pain was like a lightning bolt from tooth to brain. After another 30 minutes, I couldn't handle it any more, went to the pharmacy and got aspirin. That worked within 20 minutes. I have never taken acetaminophen since then. If it's a low intensity pain, then I can handle it myself. If I need actual pain relief I'll use an NSAID. Finding out later that paracetamol dosage is super close to overdose, and how it actually kills you... That put the tin hat on it.
- Jolter 1y ago
  Super close may be an exaggeration but could certainly be voted “most likely analgesic to let you take an intentional overdose”.
- oliwarner 1y ago
  Neuropathic pain (which dental pain mostly is) is poorly handled. I agree, paracetamol isn't perfect for every type of pain. NSAIDs help relieve pressure and can help, and opioids can waffle-stomp most pain but only for a little while and with dire risks of dependency, but for-purpose drugs like gabapentin are usually a lot more effective at blocking even high intensity neuropathic pain. Unlike NSAIDs, you can take them long term without needing a cocktail of PPIs to keep your stomach from imploding, and they're non-addictive.
tialaramex 1y ago
The effectiveness varies a lot. For me it works great, several other people I know get no effects at all from taking safe doses and of course excess doses are potentially extremely dangerous, extremely fast - about 2.5x the usual maximum dose causes liver failure in some people, that's barely more than "Oops, I already took that and I forgot" from a nasty death. If it was discovered tomorrow rather than last century, it would never get OTC approval, because while for some people (like me) it's useful, the dangers are too high, so they'd definitely make it prescription-only. I'd probably still come back from any surgery with a bag of paracetamol because it's cheap and the surgeons can prescribe it to somebody it works on without worrying (it's not like an opioid, nobody is going to get unnecessary surgery so as to secure more paracetamol) but it would not be in cold & flu meds if they hadn't found it last century when they were more lax about safety. [Edited to insert crucial omitted "not"]

Jolter 1y ago

It’s cheap, too.

raffraffraff 1y ago

My family always had boxes of it around the place when I was growing up. Never really had much use for pain killers. But when I was in my early 20s, no money, not looking at myself, I cracked a tooth in half and it took a few days to see the dentist. It was excruciating. First thing I did, take paracetamol (our name for acetaminophen). It did absolutely nothing. The pain was like a lightning bolt from tooth to brain. After another 30 minutes, I couldn't handle it any more, went to the pharmacy and got aspirin. That worked within 20 minutes. I have never taken acetaminophen since then. If it's a low intensity pain, then I can handle it myself. If I need actual pain relief I'll use an NSAID. Finding out later that paracetamol dosage is super close to overdose, and how it actually kills you... That put the tin hat on it.

Jolter 1y ago
Super close may be an exaggeration but could certainly be voted “most likely analgesic to let you take an intentional overdose”.
oliwarner 1y ago
Neuropathic pain (which dental pain mostly is) is poorly handled. I agree, paracetamol isn't perfect for every type of pain. NSAIDs help relieve pressure and can help, and opioids can waffle-stomp most pain but only for a little while and with dire risks of dependency, but for-purpose drugs like gabapentin are usually a lot more effective at blocking even high intensity neuropathic pain. Unlike NSAIDs, you can take them long term without needing a cocktail of PPIs to keep your stomach from imploding, and they're non-addictive.

tialaramex 1y ago

The effectiveness varies a lot. For me it works great, several other people I know get no effects at all from taking safe doses and of course excess doses are potentially extremely dangerous, extremely fast - about 2.5x the usual maximum dose causes liver failure in some people, that's barely more than "Oops, I already took that and I forgot" from a nasty death. If it was discovered tomorrow rather than last century, it would never get OTC approval, because while for some people (like me) it's useful, the dangers are too high, so they'd definitely make it prescription-only. I'd probably still come back from any surgery with a bag of paracetamol because it's cheap and the surgeons can prescribe it to somebody it works on without worrying (it's not like an opioid, nobody is going to get unnecessary surgery so as to secure more paracetamol) but it would not be in cold & flu meds if they hadn't found it last century when they were more lax about safety. [Edited to insert crucial omitted "not"]