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I'm always surprised at the hostility to Acetaminophen on HN (or Paracetamol as we call it here in the UK). It's one of the most commonly used medicines in the

I'm always surprised at the hostility to Acetaminophen on HN (or Paracetamol as we call it here in the UK). It's one of the most commonly used medicines in the UK - and certainly the most popular painkiller. YouGov even did a survey confirming that - https://ygo-assets-websites-editorial-emea.yougov.net/documents/Results2012071820painkillers.pdf https://ygo-assets-websites-editorial-emea.yougov.net/docume... The safety aspects of it are not something that gets raised in the UK much - other than suicide attempts, which are going to happen no matter what medicine you use. Probably the biggest risk comes from people not realising that other medicines (e.g. for cold and flu) often include it, so they double up on a dose.

zwnow 1y ago
Its so popular people will take it for mild inconveniences, which is absolutely not what you should do.
- daveoc64 1y ago
  Why not?
  - zwnow 1y ago
    Stresses the liver, also if its used frequently for mild inconveniences you should maybe go to the doctor, as frequent headaches or stuff like that can hint to more severe stuff.
    - epcoa 1y ago
      It does not stress the liver at recommended doses. Plenty of people get frequent headaches and other aches that have no other severe stuff going on, or really anything that needs to be treated more than symptomatically. Scheduled tylenol is an effective element of a pain regimen for many people.
      - zwnow 1y ago
        [flagged]
        Gud 1y ago
        Although I rarely take any form of painkiller, I've had headaches so bad I could barely exist. In those cases, pain killers were an important relief.
        seattle_spring 1y ago
        Yup. Anyone that flippant about "just a headache" definitely doesn't experience actual bad headaches themselves, and lacks empathy for those who do.
        zwnow 1y ago
        [flagged]
        dang 1y ago
        Please don't do this here.
        zwnow 1y ago
        [flagged]
        dang 1y ago
        Please don't post snarky putdowns or sneer at others. It only makes things worse.
        AlexeyBelov 1y ago
        Look at their bio. Why do you want them on this website, dang?
    - happytoexplain 1y ago
      What makes you think people who take a painkiller for chronic pain generally don't report it to their doctor?
      - kayodelycaon 1y ago
        1. A lot of people won't go to a doctor in the united states 2. They may be so used to pain they don't think to mention it. 3. A lot of people lie to their doctors for one reason or another.
        cosmic_cheese 1y ago
        In the US there’s also deep religious influence that paints suffering as virtue that’s been exploited by capitalists to establish a norm of pushing through the pain and continuing to work instead of taking a break to figure out what the root cause is and address it. Some also just don’t have a choice, because taking time off means not getting paid which means losing a roof over their head.
        pessimizer 1y ago
        [flagged]
    - watwut 1y ago
      If you go to doctor with mild annoyance, they wont take you seriously.
binarymax 1y ago
It’s the most popular in the UK because that’s what NHS GPs tell you to take for absolutely everything.
UltraSane 1y ago
I've heard people claim that Acetaminophen wouldn't be approved as an OTC drug if introduced today as it is too liver toxic.
WalterBright 1y ago
A friend of mine, Eric Engstrom, died of liver failure after taking (too much) Tylenol. Tylenol use over time can sneak up on you in the form of cumulative liver damage. No, I'm not a doctor and this isn't medical advice. Personally, a works-most-of-the-time treatment for headaches is going out for a walk. I don't know why it works, but it does.
- delfinom 1y ago
  Headaches have various causes, and you have to look at where the pain is "originating" from to even try and figure out why. Going out of a walk could be due to a sinus getting irritated and going out for fresh air helps relax it. It can also just be a stress headache and going for a walk relaxes you.
  - WalterBright 1y ago
    Oh I fully agree that it working depends on the cause of the headache. But when one doesn't know the cause, it's well worth a try.
- kelnos 1y ago
  My understanding is that if taken in the recommended dose, and not taken for a longer period of time (consecutive doses, I mean) than the bottle says to, you don't end up with cumulative damage. The damage should only occur if you take more than the recommended dose, or continue using it longer than the recommended period. (Also not a doctor and this isn't medical advice.)
- sneak 1y ago
  You have to take a lot at one time, or chronic overdoses, to damage your liver. Taking the maximum daily recommended dose (4g per day, thereabouts, in 1g doses) every day for months on end is fine and won’t do any damage. I’m sorry about your friend but his experience is unrelated to the fact that using the medication as recommended, even long term, is not harmful in the least.
  - 1y ago
tialaramex 1y ago
If Paracetamol was invented today it would likely never receive an OTC (over the counter sale, meaning you can just buy it from a retail outlet the way you'd buy cough medicine or toothpaste) license in the UK. Yes, it's safe (and for a bunch of people including me, effective) at the licensed dose, but it's useless at about half that dose, and it's toxic, leading to very nasty deaths in some cases, at just about 3-4 times that effective dose. That's a very narrow efficacy window. There are modern drugs with a narrow efficacy window but they have pharmacy only licenses or require prescription, which both mean somebody who knows what the hell they're doing sold you the drug, not the automated checkout at a supermarket. That's a vital opportunity to spot that e.g. you're taking this every single day (so it's ongoing pain, probably needs a different intervention, paracetamol is contrandicated) or you have an obvious wound, which needs medical attention not painkillers. Or sometimes very dumb things, like, hey, the actual symptoms you have described mean you're likely pregnant did you even realise that? Would you like a pregnancy test instead ?
- piker 1y ago
  Always surprises me as an American in the UK how hostile the UK is to paracetamol. You buy it in like 300-pill packages in the US, and I've literally never heard of anyone having a single accidental over-dose. I'm not sure I've ever heard of anyone intentionally overdosing on it, but I guess I can't rule that out since I'm aware of who 1-2 people personally have taken "a handful of pills". The efficacy window of driving cars is pretty narrow, and represents existential risk to third parties. But as with cars, sometimes the balance favors wide availability.
  - philjohn 1y ago
    The problem becomes, 8 tablets a day, minimum of 4 hours between doses is fine for a week or so, but do that for months and the liver toxicity creeps up on you.
    - jjk166 1y ago
      If you feel the need for 8 tablets a day for months, go see a doctor. Your liver is probably the least of your concerns.
pessimizer 1y ago
It's weird that you're surprised, it's one of the most dangerous otc drugs, and is the leading cause of liver failure on the planet. I'm always surprised that British people treat it like aspirin, because an overdose can easily kill you. I'm serious. Over 50% of all liver failure is due to acetaminophen, and 20% of liver transplants. https://pmc.ncbi.nlm.nih.gov/articles/PMC4913076/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4913076/
- ProjectArcturis 1y ago
  Well, c'mon, let's be fair. Your source says overdose-related liver failure. And reading further, most of the overdoses are either intentional (suicide attempts) or a result of addiction and opiate/acetaminophen combination drugs.
- Aloisius 1y ago
  > I'm serious. Over 50% of all liver failure is due to acetaminophen, and 20% of liver transplants. That's not what that study says. It says it is responsible for 50% of the overdose-related acute liver failures. Acute liver failure is rare, especially compared to chronic liver failure.
kelnos 1y ago
> or Paracetamol as we call it here in the UK Mildly amusing anecdote: years ago I visited my then-company's office in London (I'm from the US), and fell sick during my time there. One of my London-local colleagues recommended I get "Night Nurse", and told me of the magical virtues of paracetamol. I'd never heard of it (either the brand name or the drug name), and assumed it was some great drug that for some silly reason the US FDA decided not to approve. It worked perfectly well, but frankly no better than what I'd take at home. Much later I looked up "paracetamol" and discovered it's the same thing as acetaminophen... "oh, Night Nurse is just the UK version of NyQuil", I realized, somewhat disappointed, the magic lost. > I'm always surprised at the hostility to Acetaminophen I wouldn't say I'm hostile toward it, but the number one cause of headaches for me is alcohol consumption, and I was taught that alcohol plus acetaminophen is a strict no-no. Ibuprofen -- in the recommended dose -- is generally fine with alcohol. (I don't binge drink anymore, but as I get older, even 3 or 4 cocktails over the span of 4-6 hours can give me a headache later.) But when I come down with a cold, it's (the cheaper, generic version of) NyQuil for me. A bonus is that NyQuil also contains dextromethorphan (cough suppressant) and doxylamine succinate (antihistamine) (or phenylephrine in the non-drowsy DayQuil variant), which IIRC Night Nurse/Day Nurse did not include. (Looks like it does contain dextromethorphan and promethazine now; not sure if it didn't back then, or if I'm just misremembering.)

zwnow 1y ago

Its so popular people will take it for mild inconveniences, which is absolutely not what you should do.

daveoc64 1y ago
Why not?
- zwnow 1y ago
  Stresses the liver, also if its used frequently for mild inconveniences you should maybe go to the doctor, as frequent headaches or stuff like that can hint to more severe stuff.
  - epcoa 1y ago
    It does not stress the liver at recommended doses. Plenty of people get frequent headaches and other aches that have no other severe stuff going on, or really anything that needs to be treated more than symptomatically. Scheduled tylenol is an effective element of a pain regimen for many people.
    - zwnow 1y ago
      [flagged]
      - Gud 1y ago
        Although I rarely take any form of painkiller, I've had headaches so bad I could barely exist. In those cases, pain killers were an important relief.
        seattle_spring 1y ago
        Yup. Anyone that flippant about "just a headache" definitely doesn't experience actual bad headaches themselves, and lacks empathy for those who do.
        zwnow 1y ago
        [flagged]
      - dang 1y ago
        Please don't do this here.
        zwnow 1y ago
        [flagged]
        dang 1y ago
        Please don't post snarky putdowns or sneer at others. It only makes things worse.
        AlexeyBelov 1y ago
        Look at their bio. Why do you want them on this website, dang?
  - happytoexplain 1y ago
    What makes you think people who take a painkiller for chronic pain generally don't report it to their doctor?
    - kayodelycaon 1y ago
      1. A lot of people won't go to a doctor in the united states 2. They may be so used to pain they don't think to mention it. 3. A lot of people lie to their doctors for one reason or another.
      - cosmic_cheese 1y ago
        In the US there’s also deep religious influence that paints suffering as virtue that’s been exploited by capitalists to establish a norm of pushing through the pain and continuing to work instead of taking a break to figure out what the root cause is and address it. Some also just don’t have a choice, because taking time off means not getting paid which means losing a roof over their head.
        pessimizer 1y ago
        [flagged]
  - watwut 1y ago
    If you go to doctor with mild annoyance, they wont take you seriously.

binarymax 1y ago

It’s the most popular in the UK because that’s what NHS GPs tell you to take for absolutely everything.

UltraSane 1y ago

I've heard people claim that Acetaminophen wouldn't be approved as an OTC drug if introduced today as it is too liver toxic.

WalterBright 1y ago

A friend of mine, Eric Engstrom, died of liver failure after taking (too much) Tylenol. Tylenol use over time can sneak up on you in the form of cumulative liver damage. No, I'm not a doctor and this isn't medical advice. Personally, a works-most-of-the-time treatment for headaches is going out for a walk. I don't know why it works, but it does.

delfinom 1y ago
Headaches have various causes, and you have to look at where the pain is "originating" from to even try and figure out why. Going out of a walk could be due to a sinus getting irritated and going out for fresh air helps relax it. It can also just be a stress headache and going for a walk relaxes you.
- WalterBright 1y ago
  Oh I fully agree that it working depends on the cause of the headache. But when one doesn't know the cause, it's well worth a try.
kelnos 1y ago
My understanding is that if taken in the recommended dose, and not taken for a longer period of time (consecutive doses, I mean) than the bottle says to, you don't end up with cumulative damage. The damage should only occur if you take more than the recommended dose, or continue using it longer than the recommended period. (Also not a doctor and this isn't medical advice.)
sneak 1y ago
You have to take a lot at one time, or chronic overdoses, to damage your liver. Taking the maximum daily recommended dose (4g per day, thereabouts, in 1g doses) every day for months on end is fine and won’t do any damage. I’m sorry about your friend but his experience is unrelated to the fact that using the medication as recommended, even long term, is not harmful in the least.
- 1y ago

tialaramex 1y ago

If Paracetamol was invented today it would likely never receive an OTC (over the counter sale, meaning you can just buy it from a retail outlet the way you'd buy cough medicine or toothpaste) license in the UK. Yes, it's safe (and for a bunch of people including me, effective) at the licensed dose, but it's useless at about half that dose, and it's toxic, leading to very nasty deaths in some cases, at just about 3-4 times that effective dose. That's a very narrow efficacy window. There are modern drugs with a narrow efficacy window but they have pharmacy only licenses or require prescription, which both mean somebody who knows what the hell they're doing sold you the drug, not the automated checkout at a supermarket. That's a vital opportunity to spot that e.g. you're taking this every single day (so it's ongoing pain, probably needs a different intervention, paracetamol is contrandicated) or you have an obvious wound, which needs medical attention not painkillers. Or sometimes very dumb things, like, hey, the actual symptoms you have described mean you're likely pregnant did you even realise that? Would you like a pregnancy test instead ?

piker 1y ago
Always surprises me as an American in the UK how hostile the UK is to paracetamol. You buy it in like 300-pill packages in the US, and I've literally never heard of anyone having a single accidental over-dose. I'm not sure I've ever heard of anyone intentionally overdosing on it, but I guess I can't rule that out since I'm aware of who 1-2 people personally have taken "a handful of pills". The efficacy window of driving cars is pretty narrow, and represents existential risk to third parties. But as with cars, sometimes the balance favors wide availability.
- philjohn 1y ago
  The problem becomes, 8 tablets a day, minimum of 4 hours between doses is fine for a week or so, but do that for months and the liver toxicity creeps up on you.
  - jjk166 1y ago
    If you feel the need for 8 tablets a day for months, go see a doctor. Your liver is probably the least of your concerns.

pessimizer 1y ago

It's weird that you're surprised, it's one of the most dangerous otc drugs, and is the leading cause of liver failure on the planet. I'm always surprised that British people treat it like aspirin, because an overdose can easily kill you. I'm serious. Over 50% of all liver failure is due to acetaminophen, and 20% of liver transplants. https://pmc.ncbi.nlm.nih.gov/articles/PMC4913076/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4913076/

ProjectArcturis 1y ago
Well, c'mon, let's be fair. Your source says overdose-related liver failure. And reading further, most of the overdoses are either intentional (suicide attempts) or a result of addiction and opiate/acetaminophen combination drugs.
Aloisius 1y ago
> I'm serious. Over 50% of all liver failure is due to acetaminophen, and 20% of liver transplants. That's not what that study says. It says it is responsible for 50% of the overdose-related acute liver failures. Acute liver failure is rare, especially compared to chronic liver failure.

kelnos 1y ago

> or Paracetamol as we call it here in the UK Mildly amusing anecdote: years ago I visited my then-company's office in London (I'm from the US), and fell sick during my time there. One of my London-local colleagues recommended I get "Night Nurse", and told me of the magical virtues of paracetamol. I'd never heard of it (either the brand name or the drug name), and assumed it was some great drug that for some silly reason the US FDA decided not to approve. It worked perfectly well, but frankly no better than what I'd take at home. Much later I looked up "paracetamol" and discovered it's the same thing as acetaminophen... "oh, Night Nurse is just the UK version of NyQuil", I realized, somewhat disappointed, the magic lost. > I'm always surprised at the hostility to Acetaminophen I wouldn't say I'm hostile toward it, but the number one cause of headaches for me is alcohol consumption, and I was taught that alcohol plus acetaminophen is a strict no-no. Ibuprofen -- in the recommended dose -- is generally fine with alcohol. (I don't binge drink anymore, but as I get older, even 3 or 4 cocktails over the span of 4-6 hours can give me a headache later.) But when I come down with a cold, it's (the cheaper, generic version of) NyQuil for me. A bonus is that NyQuil also contains dextromethorphan (cough suppressant) and doxylamine succinate (antihistamine) (or phenylephrine in the non-drowsy DayQuil variant), which IIRC Night Nurse/Day Nurse did not include. (Looks like it does contain dextromethorphan and promethazine now; not sure if it didn't back then, or if I'm just misremembering.)