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I've always had an (unreasonable?) dislike of Paracetamol/Tylenol ever since I found out it was the #1 cause of acute liver failure in the US. Liver failure is

by Terr_ 1y ago

I've always had an (unreasonable?) dislike of Paracetamol/Tylenol ever since I found out it was the #1 cause of acute liver failure in the US. Liver failure is scary. https://en.wikipedia.org/wiki/Paracetamol_poisoning https://en.wikipedia.org/wiki/Paracetamol_poisoning

jonkoops 1y ago
As with all things, the poison is in the dose. A tonne of incredibly useful medicine can kill you if dosed incorrectly.
- deleted 1y ago
  [deleted]
  - Terr_ 1y ago
    > Public awareness that Tylenol causes liver failure which will last weeks before death might dissuade some. I suspect it will: There's statistical evidence from how Britain migrated its cooking gas systems away from carbon-monoxide-heavy mixes [0] indicating overall suicide-rates are sensitive to convenience and involve short-term periods of vulnerability. As contrasted to "if they really want to they'll find a way no matter what." [1] __________ [0] https://www.npr.org/2008/07/08/92319314/in-suicide-prevention-its-method-not-madness https://www.npr.org/2008/07/08/92319314/in-suicide-preventio... [1] That said, I wouldn't be surprised if there's a bimodal distribution lurking in there, between "depressed but otherwise healthy" versus "terminal diagnosis and chronic pain." The latter-group might not be deterred by inconvenience.
- pjerem 1y ago
  Sure but it’s pretty easy overdose on paracetamol. Since it’s a mild and really common painkiller, sometimes seen as not dangerous, someone uneducated about it who is really suffering could easily take 3 or 4 times the dose. Unlike a lot of drugs, you are not going to have a lot of immediate side effects if you overdose on paracetamol. You’ll just horribly die some days after,
  - deleted 1y ago
    [deleted]
  - littlestymaar 1y ago
    > someone uneducated about it who is really suffering could easily take 3 or 4 times the dose. And the solution is simple: educate people about that. And it's not something hard to do, just have pharmacists say “respect the dose as it will kill you if you don't” every time they sell things and it'll work.
    - thayne 1y ago
      But Tylenol/acetaminophen/paracetamol is an over the counter drug, so there is no pharmacist involved in most sales. And I certainly wouldn't count on everyone reading the tiny text on the bottle.
      - littlestymaar 1y ago
        That's entirely a sales (de)regulation problem though. It's funny that in a country where you can win massive sums of money on stupid trials a drug like paracetamol is sold without supervision.
  - basisword 1y ago
    How can you reach adulthood and think it's ok to take 3 or 4x the specific dose of any medication? If you're in that much pain you go to a doctor. Which makes me think maybe the issue is the private health system and not the drug.
    - zdragnar 1y ago
      Conversely, my grandmother's Alzheimer's became apparent when she was overdosing on either ibuprofen or aspirin, I forget which. She would take a dose for a headache, ten minutes later she'd forgotten so she'd take another dose, ten minutes later, she had forgotten, take another dose, rinse and repeat until it's time for a trip to the hospital. Maybe it wasn't ten minutes between, probably fewer given how much she'd ended up taking. This happened thirty or so years ago.
lr4444lr 1y ago
It's not just that it causes liver failure: it's that the difference between the therapeutic dosing range for pain relief it's prescribed for is dangerously close to the toxicity level. Other drugs like theophylline have ceased to be prescribed for a similar reason alternatives were available, but due to drug marketing, acetaminophen is touted as the "safe" pain reliever.
- littlestymaar 1y ago
  > but due to drug marketing, acetaminophen is touted as the "safe" pain reliever. Paracetamol's patents have expired long ago and there's not much profit to be made out of it (nowadays it's mostly not being made in the West, but imported from China, unlike profitable medicine). The reason why it's still used it's that it's much better than the alternatives, despite the risks (it's only risky if you don't respect the doses by the way).
skybrian 1y ago
It is scary, but I assume caution improves your chances of avoiding an overdose considerably.
a3w 1y ago
Most, if not all, medication would carry a poisonous symbol, if it were not taken out of regulation for that. Mostly, you kill organs by any overdose. Roughly: - Paracetamol overdose can cause severe liver damage and may be fatal. - Ibuprofen in high doses can lead to kidney injury and stomach bleeding. - Aspirin overdose may result in salicylate poisoning, causing ringing in the ears, confusion, and metabolic acidosis.
- Terr_ 1y ago
  "Any medicine can be poison" is kinda missing the point. There is a rich and varied multidimensional field of danger, from aspects like the safety-margin between regular/dangerous dose levels, the chronology of how it can spike or accumulate, whether there's feedback in advance of damage, etc. Yeah, I can poison myself drinking clean water, but it's hard.
  - baxtr 1y ago
    Thank you for this comment
- kuschku 1y ago
  That's why it's recommended to combine a half dose of ibuprofen and a half dose of paracetamol at the same time. (Plus some vitamin C) Together they have higher pain killung effects than each alone, and the side effects are reduced as they affect different body parts. And the vitamin C reduces the damage to the stomach lining.
  - bryanlarsen 1y ago
    Or if you need stronger painkilling you can take a full dose of paracetomol and either ibuprofen or aspirin. OTOH aspirin and ibuprofen use the same pathways so combining a full dose of ibuprofen and aspirin is not recommended.
    - dark-star 1y ago
      Interesting, then why does Aspirin do almost nothing when I have a headache, while Ibuprofen works very well and very quickly?
deleted 1y ago
[deleted]
whazor 1y ago
This send me into a whole rabbit hole. Mostly children get paracetamol overdose. Then I learned that in US/UK kids get paracetamol in liquid form with all kinds of flavours. Which is much harder to dose correctly when the kid spits or drools it out. Total culture shock for me, as in Europe the default for children is rectal ingestion (which is probably a culture shock as well for Americans). Any how, with pills it is much easier to avoid overdose.
- XorNot 1y ago
  Liquid Panadol flavors were totally useless with my son. He would spit it out or upset himself so much he'd throw it up. We ended up crushing and diluting tablets in milk, which he would drink (you waste a lot of milk to hit the right factor).
- verbify 1y ago
  Recently had a prescription error with my two month old baby. The doctor prescribed 7 times as much iron supplement as they intended (confusing labelling - so while I'm annoyed, I can see how it happened). This went on for a month until we uncovered the error. We had blood test done (on the doctor's recommendation), and luckily there is no sign of any damage, but prescription errors do happen (even if they are rare) and it's much easier with liquids (you probably wouldn't give 8 pills to a baby, but 8ml doesn't seem so bad).
  - whazor 1y ago
    Paracetamol pills are labelled by age (and weight), available over the counter. So quite often we tend to under dose our child as children grow fast.
    - verbify 1y ago
      Calpol is paracetamol as a liquid - that's what we were prescribed after the vaccinations.
- littlestymaar 1y ago
  > as in Europe the default There's no “as in Europe”, every European country is different. In France the default is also liquid form, but the pipette is graduated is kilograms of baby weight, which limit the errors you can make (you know your kid doesn't weight 15kg when his weight is around 8).
tobias3 1y ago
Also extra damage if the liver is already busy with alcohol. So not good to take for a hangover. This is why Ibuprofen is perhaps the better default painkiller.
mullingitover 1y ago
The UK started requiring that Tylenol always be sold in blister packs instead of convenient-to-kill-yourself-with whole bottles of pills. Results: "Suicidal deaths from paracetamol and salicylates were reduced by 22% (95% confidence interval 11% to 32%) in the year after the change in legislation on 16 September 1998, and this reduction persisted in the next two years. Liver unit admissions and liver transplants for paracetamol induced hepatotoxicity were reduced by around 30% in the four years after the legislation. Numbers of paracetamol and salicylate tablets in non-fatal overdoses were reduced in the three years after the legislation. Large overdoses were reduced by 20% (9% to 29%) for paracetamol and by 39% (14% to 57%) for salicylates in the second and third years after the legislation. Ibuprofen overdoses increased after the legislation, but with little or no effect on deaths."[1] [1] https://pmc.ncbi.nlm.nih.gov/articles/PMC526120/ https://pmc.ncbi.nlm.nih.gov/articles/PMC526120/
- akk0 1y ago
  I am familiar enough with the numbers that I am not necessarily surprised, but I still find it emotionally hard to grok that more than one in five would-be paracetamol suicide victims would be dissuaded by having to pop the pills out of a blister pack first.
  - Dave3of5 1y ago
    Actually nowadays it's less that it's a problem to pop the pills out the booster pack and more that you are limited to the number you can buy. So if you're going to off yourself you'd have to stock pile or roam around shops picking up. There is a not insignificant number of suicides where people just say fck it I'll just kill myself but they don't want to go out to any real bother to do it i.e. they don't pre-plan it it's just spur of the moment. A bottle of kill yo self pills is pretty easy. Cupboard, swallow, drink down some water, die. But having to go out and buy a bunch over a few days or like drive around in your car just buying as many as you can. Like you'd have to look it up to check you're going to buy enough. Back when that law came in when they didn't reduce the total amount you could buy at one time so if you went in and bought like 10 packs at the supermarket then the person at the till would be like ok this person's going to kill themselves so again that would require a bit of balls from the would be kill yo selfer. I think you can buy a bottle of like 100 x 500mg for like $20 in the USA. That's like over 2 weeks swigging at the max amount. Like you don't need that many, 3-4 days is enough shouldn't be taking that much of the stuff.
basisword 1y ago
I'm finding all the 'liver failure' comments on this post fascinating. The dose is on the back on the packet, as is the time interval between doses and the maximum number of pills per day. To overdose you need to ignore that. Given all the mention of 'Tylenol' I'm assuming most of the commenters are American - is this a thing in the US where you just take a random number of pills and ignore the labelling or treat it as a guide? Is it a consequence of the fact you can buy these in bottles by the hundred?
- amenhotep 1y ago
  I choose to believe that all of the movies and TV shows showing Americans pouring a handful of pills out of a bottle into their hands and throwing them in their mouths (then chewing them!!!) are 100% accurate to life rather than cinematic shorthand
- thayne 1y ago
  I think there are a few possible factors: - different packages of the same medication have different doses per pill. So you might read one package that says to take two pills, then later you buy a different package of the same painkiller that says one pill, but you're lazy, and don't read the label for this, and assume it is the same as last time, so you end up doubling the dose. - For ibuprofen, the label often says if one dose isn't sufficient, then you can take another pill (with a maximum number in 24 hours). People may assume this is the case for Tylenol as well, but I don't think it is. - people may read the size of the dose, but skip over the warning about the maximum you can take in a 24 hour period. - The directions are in small hard to read text, which makes all of the above points worse. Not that any of those are a good excuse not to read the label, but, well, people make bad decisions all the time.
laughing_man 1y ago
Tylenol is unusual among OTC medications in that you can get liver damage from as little as double the recommended dosage. It doesn't play well with alcohol, either. I wonder how many of those liver failures are the result of people drinking and taking too much of the drug either because the alcohol causes them to lose track, or from the alcohol interaction itself.

by Terr_ 1y ago

jonkoops 1y ago

As with all things, the poison is in the dose. A tonne of incredibly useful medicine can kill you if dosed incorrectly.

deleted 1y ago
[deleted]
- Terr_ 1y ago
  > Public awareness that Tylenol causes liver failure which will last weeks before death might dissuade some. I suspect it will: There's statistical evidence from how Britain migrated its cooking gas systems away from carbon-monoxide-heavy mixes [0] indicating overall suicide-rates are sensitive to convenience and involve short-term periods of vulnerability. As contrasted to "if they really want to they'll find a way no matter what." [1] __________ [0] https://www.npr.org/2008/07/08/92319314/in-suicide-prevention-its-method-not-madness https://www.npr.org/2008/07/08/92319314/in-suicide-preventio... [1] That said, I wouldn't be surprised if there's a bimodal distribution lurking in there, between "depressed but otherwise healthy" versus "terminal diagnosis and chronic pain." The latter-group might not be deterred by inconvenience.
pjerem 1y ago
Sure but it’s pretty easy overdose on paracetamol. Since it’s a mild and really common painkiller, sometimes seen as not dangerous, someone uneducated about it who is really suffering could easily take 3 or 4 times the dose. Unlike a lot of drugs, you are not going to have a lot of immediate side effects if you overdose on paracetamol. You’ll just horribly die some days after,
- deleted 1y ago
  [deleted]
- littlestymaar 1y ago
  > someone uneducated about it who is really suffering could easily take 3 or 4 times the dose. And the solution is simple: educate people about that. And it's not something hard to do, just have pharmacists say “respect the dose as it will kill you if you don't” every time they sell things and it'll work.
  - thayne 1y ago
    But Tylenol/acetaminophen/paracetamol is an over the counter drug, so there is no pharmacist involved in most sales. And I certainly wouldn't count on everyone reading the tiny text on the bottle.
    - littlestymaar 1y ago
      That's entirely a sales (de)regulation problem though. It's funny that in a country where you can win massive sums of money on stupid trials a drug like paracetamol is sold without supervision.
- basisword 1y ago
  How can you reach adulthood and think it's ok to take 3 or 4x the specific dose of any medication? If you're in that much pain you go to a doctor. Which makes me think maybe the issue is the private health system and not the drug.
  - zdragnar 1y ago
    Conversely, my grandmother's Alzheimer's became apparent when she was overdosing on either ibuprofen or aspirin, I forget which. She would take a dose for a headache, ten minutes later she'd forgotten so she'd take another dose, ten minutes later, she had forgotten, take another dose, rinse and repeat until it's time for a trip to the hospital. Maybe it wasn't ten minutes between, probably fewer given how much she'd ended up taking. This happened thirty or so years ago.

lr4444lr 1y ago

It's not just that it causes liver failure: it's that the difference between the therapeutic dosing range for pain relief it's prescribed for is dangerously close to the toxicity level. Other drugs like theophylline have ceased to be prescribed for a similar reason alternatives were available, but due to drug marketing, acetaminophen is touted as the "safe" pain reliever.

littlestymaar 1y ago
> but due to drug marketing, acetaminophen is touted as the "safe" pain reliever. Paracetamol's patents have expired long ago and there's not much profit to be made out of it (nowadays it's mostly not being made in the West, but imported from China, unlike profitable medicine). The reason why it's still used it's that it's much better than the alternatives, despite the risks (it's only risky if you don't respect the doses by the way).

skybrian 1y ago

It is scary, but I assume caution improves your chances of avoiding an overdose considerably.

a3w 1y ago

Most, if not all, medication would carry a poisonous symbol, if it were not taken out of regulation for that. Mostly, you kill organs by any overdose. Roughly: - Paracetamol overdose can cause severe liver damage and may be fatal. - Ibuprofen in high doses can lead to kidney injury and stomach bleeding. - Aspirin overdose may result in salicylate poisoning, causing ringing in the ears, confusion, and metabolic acidosis.

Terr_ 1y ago
"Any medicine can be poison" is kinda missing the point. There is a rich and varied multidimensional field of danger, from aspects like the safety-margin between regular/dangerous dose levels, the chronology of how it can spike or accumulate, whether there's feedback in advance of damage, etc. Yeah, I can poison myself drinking clean water, but it's hard.
- baxtr 1y ago
  Thank you for this comment
kuschku 1y ago
That's why it's recommended to combine a half dose of ibuprofen and a half dose of paracetamol at the same time. (Plus some vitamin C) Together they have higher pain killung effects than each alone, and the side effects are reduced as they affect different body parts. And the vitamin C reduces the damage to the stomach lining.
- bryanlarsen 1y ago
  Or if you need stronger painkilling you can take a full dose of paracetomol and either ibuprofen or aspirin. OTOH aspirin and ibuprofen use the same pathways so combining a full dose of ibuprofen and aspirin is not recommended.
  - dark-star 1y ago
    Interesting, then why does Aspirin do almost nothing when I have a headache, while Ibuprofen works very well and very quickly?

deleted 1y ago

[deleted]

whazor 1y ago

This send me into a whole rabbit hole. Mostly children get paracetamol overdose. Then I learned that in US/UK kids get paracetamol in liquid form with all kinds of flavours. Which is much harder to dose correctly when the kid spits or drools it out. Total culture shock for me, as in Europe the default for children is rectal ingestion (which is probably a culture shock as well for Americans). Any how, with pills it is much easier to avoid overdose.

XorNot 1y ago
Liquid Panadol flavors were totally useless with my son. He would spit it out or upset himself so much he'd throw it up. We ended up crushing and diluting tablets in milk, which he would drink (you waste a lot of milk to hit the right factor).
verbify 1y ago
Recently had a prescription error with my two month old baby. The doctor prescribed 7 times as much iron supplement as they intended (confusing labelling - so while I'm annoyed, I can see how it happened). This went on for a month until we uncovered the error. We had blood test done (on the doctor's recommendation), and luckily there is no sign of any damage, but prescription errors do happen (even if they are rare) and it's much easier with liquids (you probably wouldn't give 8 pills to a baby, but 8ml doesn't seem so bad).
- whazor 1y ago
  Paracetamol pills are labelled by age (and weight), available over the counter. So quite often we tend to under dose our child as children grow fast.
  - verbify 1y ago
    Calpol is paracetamol as a liquid - that's what we were prescribed after the vaccinations.
littlestymaar 1y ago
> as in Europe the default There's no “as in Europe”, every European country is different. In France the default is also liquid form, but the pipette is graduated is kilograms of baby weight, which limit the errors you can make (you know your kid doesn't weight 15kg when his weight is around 8).

tobias3 1y ago

Also extra damage if the liver is already busy with alcohol. So not good to take for a hangover. This is why Ibuprofen is perhaps the better default painkiller.

mullingitover 1y ago

The UK started requiring that Tylenol always be sold in blister packs instead of convenient-to-kill-yourself-with whole bottles of pills. Results: "Suicidal deaths from paracetamol and salicylates were reduced by 22% (95% confidence interval 11% to 32%) in the year after the change in legislation on 16 September 1998, and this reduction persisted in the next two years. Liver unit admissions and liver transplants for paracetamol induced hepatotoxicity were reduced by around 30% in the four years after the legislation. Numbers of paracetamol and salicylate tablets in non-fatal overdoses were reduced in the three years after the legislation. Large overdoses were reduced by 20% (9% to 29%) for paracetamol and by 39% (14% to 57%) for salicylates in the second and third years after the legislation. Ibuprofen overdoses increased after the legislation, but with little or no effect on deaths."[1] [1] https://pmc.ncbi.nlm.nih.gov/articles/PMC526120/ https://pmc.ncbi.nlm.nih.gov/articles/PMC526120/

akk0 1y ago
I am familiar enough with the numbers that I am not necessarily surprised, but I still find it emotionally hard to grok that more than one in five would-be paracetamol suicide victims would be dissuaded by having to pop the pills out of a blister pack first.
- Dave3of5 1y ago
  Actually nowadays it's less that it's a problem to pop the pills out the booster pack and more that you are limited to the number you can buy. So if you're going to off yourself you'd have to stock pile or roam around shops picking up. There is a not insignificant number of suicides where people just say fck it I'll just kill myself but they don't want to go out to any real bother to do it i.e. they don't pre-plan it it's just spur of the moment. A bottle of kill yo self pills is pretty easy. Cupboard, swallow, drink down some water, die. But having to go out and buy a bunch over a few days or like drive around in your car just buying as many as you can. Like you'd have to look it up to check you're going to buy enough. Back when that law came in when they didn't reduce the total amount you could buy at one time so if you went in and bought like 10 packs at the supermarket then the person at the till would be like ok this person's going to kill themselves so again that would require a bit of balls from the would be kill yo selfer. I think you can buy a bottle of like 100 x 500mg for like $20 in the USA. That's like over 2 weeks swigging at the max amount. Like you don't need that many, 3-4 days is enough shouldn't be taking that much of the stuff.

basisword 1y ago

I'm finding all the 'liver failure' comments on this post fascinating. The dose is on the back on the packet, as is the time interval between doses and the maximum number of pills per day. To overdose you need to ignore that. Given all the mention of 'Tylenol' I'm assuming most of the commenters are American - is this a thing in the US where you just take a random number of pills and ignore the labelling or treat it as a guide? Is it a consequence of the fact you can buy these in bottles by the hundred?

amenhotep 1y ago
I choose to believe that all of the movies and TV shows showing Americans pouring a handful of pills out of a bottle into their hands and throwing them in their mouths (then chewing them!!!) are 100% accurate to life rather than cinematic shorthand
thayne 1y ago
I think there are a few possible factors: - different packages of the same medication have different doses per pill. So you might read one package that says to take two pills, then later you buy a different package of the same painkiller that says one pill, but you're lazy, and don't read the label for this, and assume it is the same as last time, so you end up doubling the dose. - For ibuprofen, the label often says if one dose isn't sufficient, then you can take another pill (with a maximum number in 24 hours). People may assume this is the case for Tylenol as well, but I don't think it is. - people may read the size of the dose, but skip over the warning about the maximum you can take in a 24 hour period. - The directions are in small hard to read text, which makes all of the above points worse. Not that any of those are a good excuse not to read the label, but, well, people make bad decisions all the time.

laughing_man 1y ago

Tylenol is unusual among OTC medications in that you can get liver damage from as little as double the recommended dosage. It doesn't play well with alcohol, either. I wonder how many of those liver failures are the result of people drinking and taking too much of the drug either because the alcohol causes them to lose track, or from the alcohol interaction itself.