7 ms·

The article kinda glossed over it, but one fact under-appreciated by the general public is just how dangerous acetaminophen overdoses can be. Scientists often

The article kinda glossed over it, but one fact under-appreciated by the general public is just how dangerous acetaminophen overdoses can be. Scientists often talk about the "therapeutic index" or "safety ratio" of a drug. It's the LD50 (dose at which 50% of recipients die) divided by the effective dose. Common hard drugs like heroin or methamphetamine have a safety ratio of about 6-10 [1]. "Soft" drugs like marijuana or LSD often have safety ratios of about 1000. The safety ratio of acetaminophen is under 4. A typical dosing schedule for an adult is 4-6 500mg tablets within a 24 hour period [2], for a total of no more than 3g. 7g of acetaminophen can kill you, and 12g is likely to [3]. Acetaminophen is the leading cause of liver failure in the U.S, causing 50% of cases and 20% of transplants. When they tell you "don't exceed 6 doses daily", they really mean it, and it's across all acetaminophen-containing products. The margin for error is narrower than heroin. [1] http://politicsofsin.50megs.com/risk/Toxicity.Comparison_Addiction.99,p686_2004.html http://politicsofsin.50megs.com/risk/Toxicity.Comparison_Add... [2] https://pmc.ncbi.nlm.nih.gov/articles/PMC3585765/ https://pmc.ncbi.nlm.nih.gov/articles/PMC3585765/ [3] https://www.ncbi.nlm.nih.gov/books/NBK441917/ https://www.ncbi.nlm.nih.gov/books/NBK441917/

unparagoned 3mo ago
Therapeutic index of fentanyl is much higher than heroin or morphine, but I don’t think people really think that it makes it safer.
- Shog9 3mo ago
  The folks I know who've been prescribed fentanyl weren't particularly upset about it. It is very potent, and thus measuring the dose properly is very important, but it's not particularly fussy beyond that. The people you know may be obtaining it from less reliable apothecaries; that can be a real issue.
- ErroneousBosh 3mo ago
  Reminds me of a comment I saw on a drug chemist's blog decades ago where they were talking about ACE inhibitors for Parkinsons' Disease - by dicking around with nerve conductivity and acetylcholine reuptake you could "boost" the failing nerves a bit, presumably until they fail altogether. Anyway much of the discussion was on how hard it is to make suitable drugs, and someone said "We actually have some fairly inexpensive, reliable, and well-characterised ACE inhibitors with a nice long half-life and known efficacy, but the therapeutic window of nerve gas is pretty narrow..."
- cykros 3mo ago
  Fentanyl isn't all that unsafe, aside from the habituation potential. When your measurement is "that looks about right" when purity is entirely unknown, not much really is all that safe.
rsync 4mo ago
Thank you - this is correct and cannot be repeated enough, especially in the context of infant and child doses.
m_a_g 3mo ago
In most countries 4g is the upper limit and it is considered perfectly safe within that limit. So 8 500mg pills in 24 hours.
- nostrademons 3mo ago
  Yes. 4g is generally considered perfectly safe and is fairly commonplace dosing. 7g can kill you. Hence a therapeutic index of < 2. This is why you have to be very, very careful. If you're doing 8 500mg Tylenol pills and then you also do 6 doses of DayQuil or Mucinex without realizing it's also acetaminophen, you can end up needing a liver transplant.
  - Scroll_Swe 3mo ago
    I wonder why it is not a more commonplace useage for suicides. Females seem to enjoy overdoes more, and men seem to enjoy violent ways. But female sucicides often "fails", seems like eating a box of Tylenols (here they come in 20 packs) would solve the "being alive" issue quite quick, no? Better not tip people off... :) >end up needing a liver transplant You won't get one nor should you get one if the reason is this.
    - SubmarineClub 3mo ago
      Probably because most people realize that it’s a horribly unpleasant way to go about it?
    - nostrademons 3mo ago
      It's a pretty terrible way to go. Death doesn't come immediately; you seem fine at first, and then about 3 days later you suffer intense abdominal pain and vomiting. At about 4 days you realize your liver is irreversibly shot and you're a dead man walking unless you can get a liver transplant. Then you enter multi-organ failure as your body and brain shuts down. Acetaminophen poisoning actually featured on two episodes of House, and one of them had the suicide plotline. In S05E11, "Joy to the World" they suspected an overweight teen OD'd on acetaminophen trying to kill herself, but the actual diagnosis was eclampsia from an undisclosed pregnancy. In S06E10, "Wilson", a friend of Wilson's suffers acetaminophen poisoning while trying to manage his back pain. https://house.fandom.com/wiki/Joy_to_the_World https://house.fandom.com/wiki/Joy_to_the_World https://house.fandom.com/wiki/Wilson_(episode) https://house.fandom.com/wiki/Wilson_(episode)
viccis 3mo ago
Acetaminophen should be treated with more caution in general. So many people have reacted with shock and upset when I told them that taking Tylenol (or anything with acetaminophen in it like Dayquil/Nyquil) while drinking can cause immediate liver damage.
- ssl-3 3mo ago
  Indeed. I like beer quite a lot and have for a very long time, so acetaminophen is banned from my medicine cabinet.
  - eureka7 3mo ago
    Seems like the logical thing to ban from your stomach for the time periods you need acetaminophen is the beer, unless I'm missing something.
    - annzabelle 3mo ago
      For a lot of us, Ibuprofen works just as well or better than Acetaminophen, so banning Acetaminophen is not much of a problem. I am on a medication that's contraindicated with NSAIDs, but I made sure that a low dose of Ibuprofen was acceptable.
      - Scroll_Swe 3mo ago
        Ibuprofen is hard on the kidneys and stomach too. And bleeding/clotting issues. Sooo ya :) Better just stay off the beer hubby. Remember, beer makes you fat also.
        annzabelle 3mo ago
        Wow, that's a really weird tone for a hackernews comment.
        Scroll_Swe 3mo ago
Lich 3mo ago
I didn’t know this until recently either. I grew up on a family where if there was pain, you just take tylenol to deal with it. We always followed the dosage timing and never had issues. So recently when my wife had some chronic pain I suggested taking tylenol but even after two days the pain would not go away and she went to ER. They did a blood check to see if they could find anything. They didn’t find the cause, just suspected food poisoning, but they found her liver enzymes were near dangerous levels. This was even with timing the dosages absed on instructions. Now I am super careful wtih Tylenol.
- CodeWriter23 3mo ago
  Not to chastise you or your wife, there is an actual "Liver Warning" on Tylenol Product labels. They warn against 4000mg/day or with alcohol consumption. It's not an on/off switch, the damage occurs on a ramp that achieves a critical point after so much consumption. Saying this to encourage label reading and to refute those who might try to characterize your wife's experience as anecdotal. And for those who stop reading a page like this one, after the first paragraph that touts "no evidence": https://www.tylenolprofessional.com/safety-and-efficacy/safety https://www.tylenolprofessional.com/safety-and-efficacy/safe... when at the bottom it reveals the Liver Warning.
  - jambalaya8 3mo ago
    It appears his wife took under that threshold and only for a few days. 4000mg is roughly 8-10 otc painkillers in a day (depending on the brand). That said, everyone's physical ability to metabolise drugs is different. I might worry something else was wrong, or at least get a followup test done later, if her liver tox screen showed that, just to rule out another cause.
    - looptylou 3mo ago
      You're right: metabolisms vary. This is why I don't dance with the 4 gram limit, even though (insanely) post-op instructions regularly advise you to.
timothyisonline 3mo ago
Ibuprofen isn’t much better, unfortunately.
- GlickWick 3mo ago
  The index for ibuprofen is waaaaay better than DayQuil
- jack09268 3mo ago
  Would appreciate it if you could elaborate. Someone close to me takes a lot of ibuprofen.
  - lll-o-lll 3mo ago
    Not a doctor, this is how it was explained to me by my doctor. Paracetamol/acetaminophen has a therapeutic dose that is uncomfortably close to the fatal dose, but is otherwise as safe as any drug can possibly be. So long as you don’t take too much. Ibuprofen is also relatively safe, but it has a number of ways that it can do damage even at the therapeutic dose, if you are taking it all the time. The main one is that it depletes your mucus lining in your stomach, which can lead to bleeding and death (used to be a big problem here in Aus when codeine combined pills were available without prescription). It’s also harder on your kidneys and liver. Completely fine at therapeutic doses taken as per instructions and not mixed with alcohol. But having it every day is going to be much worse for you than the paracetamol and almost certainly lead to health problems.
  - agonz253 3mo ago
    https://asteriskmag.com/issues/14/the-mystery-in-the-medicine-cabinet https://asteriskmag.com/issues/14/the-mystery-in-the-medicin...
- deleted 3mo ago
  [deleted]
- nostrademons 3mo ago
  The therapeutic index for ibuprofen is considerably better: it's around 10, fairly similar to alcohol. Accidental overdoses of ibuprofen are rare. The main issue with ibuprofen is that it can have fairly annoying (but non-life-threatening) side effects like stomach upset and GI bleeds even with normal dosing.
lobf 3mo ago
I simply do not take acetaminophen because of this risk.
- Forgeties79 3mo ago
  Ibuprofen isn't easy on the kidneys either so I'd keep an eye on that if you don't
basch 3mo ago
>4-6 500mg tablets within a 24 hour period On top of that daily use brings it down to 3-5, preferably 4 or less of those a day. And they last less than 6 hours. The 8h extended release is 650mg a tablet, and you can have 3-4 a day daily. And if you have any experience taking them you can feel the first half of the extended dose wear off before the extended one kicks in, which leads to basically NEEDING 4 a day, and staggered start times.
hn_user82179 3mo ago
I'm grateful for you mentioning this. I grew up with ibuprofen as my default painkiller without really thinking of it too much but am about to do PRP which requires no NSAIDs for a week prior and 3 months after - but they do allow/recommend Tylenol as an alternative, especially for the post-procedure pain. I just would've assumed it was a sufficiently good substitute that I could treat them equivalently but now i know to be very careful about tracking how many I'm taking each day
- galangalalgol 3mo ago
  Nsaids are dangerous in all sorts of other ways, kidney, gut lining. Pain medications that work and are safe seem to all be highly addictive.
ButlerianJihad 3mo ago
I was in the hospital on Thanksgiving Day last year. I received 8 diagnoses at that time, including "Diabetic Hypertension" and "Metabolic Acidosis" and E. coli infection, and Hyponatremia. They treated me with an antibiotic, a potassium-rich saline drip and acetaminophen. Yeah that's all they put in my orders. The thing that pissed me off so much, firstly they insisted on calling it "Tylenol" when it was not, in fact, brand-name Tylenol but generic acetaminophen (even if they could charge $$$ per pill on it) and also that they basically refused to administer it at a rate that would keep my exquisite headache pain at bay. I was literally screaming and moaning through the entire night and day. (Actually, I was wearing one of those radio-transmitting heart monitors, and mostly the screams happened when I moved suddenly, and the electrodes tore at my chest hair...) But my head was also constantly throbbing, and that's how I knew to go to the hospital in the first place. The nurses could tell me how long to wait between doses, but they couldn't explain to me how to know that interval, given no clocks and no written-down time of dosing. So basically I had to keep guessing throughout my sleepless nights. And they didn't really inform me of a way to just put it on automatic dosing like a normal hospital would have a schedule for. I really didn't want acetaminophen at all; I don't like it much, and it really hasn't ever relieved any pain I've ever taken it for. My parents chomped so much of it, made me sick just watching them. I lived through the cyanide adulteration episodes and though unsolved, that guy wasn't wrong. When I finally got to visit a sane PCP after all this madness, I told him I was taking big doses of Bayer Aspirin, and he said that's fine; just follow instructions and heed warnings, and he also warned me: for Heaven's sake don't ever take any acetaminophen, because it would seriously harm my liver!!!
chrisweekly 3mo ago
[flagged]
- saagarjha 3mo ago
  Dude, chill out. Everything has a fatal dose, you can literally look up the LD50 and find that it’s a big number. Nobody is coming for your weed.
  - mikey_p 3mo ago
    I think the thing is that there is no official accepted value of LD50 for THC since there has never been a recorded death from THC: > The median lethal dose (LD50) of THC has been determined in various animal species through oral administration and ranges from 800 to 9000 mg/kg. In humans, there have been no recorded instances of fatal overdoses resulting from acute THC use. However, estimates for a potentially lethal human dose range from 4 to 15 g. https://www.ncbi.nlm.nih.gov/books/NBK563174/ https://www.ncbi.nlm.nih.gov/books/NBK563174/
    - nostrademons 3mo ago
      It's not true that there has never been a recorded death from THC. A quick literature search turned up: B. Hartung, S. Kauferstein, S. Ritz-Timme, T. Daldrup, Sudden unexpected death under acute influence of cannabis, Forensic Science International (2014), http://dx.doi.org/10.1016/j.forsciint.2014.02.001 http://dx.doi.org/10.1016/j.forsciint.2014.02.001. Case report of two otherwise-healthy 20-something men who died of cardiac arrhythmia's following large marijuana doses. https://3402974.fs1.hubspotusercontent-na1.net/hubfs/3402974/MGC%20Website%20PDFs/Sudden-unexpected-death-under-acute-influence-of-cannabis.pdf https://3402974.fs1.hubspotusercontent-na1.net/hubfs/3402974... Noble, M. J., Hedberg, K., & Hendrickson, R. G. (2019). Acute cannabis toxicity. Clinical Toxicology, 57(8), 735–742. https://doi.org/10.1080/15563650.2018.1548708 https://doi.org/10.1080/15563650.2018.1548708. Clinical review of 253 Poison Center cases involving acute cannabis poisoning; 8 patients were admitted to the ICU, 3 were intubated, and 1 died. https://pubmed.ncbi.nlm.nih.gov/30676820/ https://pubmed.ncbi.nlm.nih.gov/30676820/ There's also a Heyndrickx 1969 paper that everybody cites (including my original reference on hazard ratios), but I can't find an abstract or full text anywhere on the web. Cases of cannabis poisoning fatalities are extremely rare, but they do exist. Your citation was apparently unaware of (or possibly published before) the other cases.
padjo 3mo ago
It's not under appreciated in the UK and Ireland where you can only buy tiny quantities of it at a time. Cash registers will literally refuse to process a sale if there is more than one pack of acetaminophen in your groceries. On the plus side you can still buy psuedo OTC.
- sieabahlpark 3mo ago
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Scroll_Swe 3mo ago
It's a good darwin effect clearer/cleaner I think. Can't read or follow simple instructions? Well maybe modern society is not for you anymore.
blks 3mo ago
Safety ratio as you present it is a bit misleading, numbers for hard/soft drugs are usually for a single dose.
fmajid 3mo ago
Replacing Aspirin with Acetaminophen/Paracetamol was absurd. Reyes’s syndrome was nowhere as prevalent as acetaminophen overdoses, which are a horrible way to go.
dreamcompiler 3mo ago
There is an antidote available for acetaminophen overdose, but it's only available in the hospital. So if you think you took too much, get to a hospital quickly before your liver suffers permanent damage. Untreated acetaminophen overdose is an extremely unpleasant way to die.
- SoMomentary 3mo ago
  Huh, looked this up as Acetaminophen is one of the only OTC painkillers I can take. I thought NAC (N-Acetyl Cysteine) sounded familiar and low and behold I already have some I've purchased as a supplement. Anyone can buy this stuff, no need to make it sound like it's some controlled substance. I will say if I take to much Acetaminophen I'll just head to the hospital instead of winging it!
  - dreamcompiler 3mo ago
    I was trying to keep it simple. Yes you can buy n-acetylcysteine but OTC versions can vary in purity and dosage and it's not the only treatment you might need. With an acetaminophen OD you really want to be in a hospital.
AnodicElegy 3mo ago
The safety ratios listed in reference [1] are exaggerated, as can be determined by the following qualification: "The majority of published reports of acute lethal toxicity indicate that the decedent used a co-intoxicant (most often alcohol)." The vast majority of so-called drug overdoses are due to polydrug intoxication. It's much harder to die by consuming a single substance. This is clear from the statistics of the few jurisdictions that report all substances in the blood in coroner's reports. See, for example, the Scottish data from 2020 (https://www.drugsandalcohol.ie/34642/7/ndrdd_report.pdf https://www.drugsandalcohol.ie/34642/7/ndrdd_report.pdf ): "In 2020, almost all (96%) [drug-related deaths] occurred after the consumption of multiple substances."
- no-name-here 3mo ago
  I imagine painkillers are fairly commonly used for hangover headaches, and it’s surprisingly difficult to get guidance on how long after drinking it’s ok to take painkillers (presumably as it’s complicated) - perhaps instructions should be updated to not just say don’t take with alcohol, but don’t take within a day of alcohol?
NotAFurry2 3mo ago
Liver failure is the worst way to go, it's slow and painful. if someone accidentally takes too much you can give them activated charcoal before you get them to the ER to give them a better chance of not going through liver failure
nullc 3mo ago
Perhaps it's useful to know that NAC is the treatment for acetaminophen toxicity, should you happen to find yourself in the middle of a zombie apocalypse with a Tylenol ODed friend and a supplements isle handy but no readily available medical support. :D There has been some suggestions that acetaminophen products should contain NAC to offset some of the toxic effects, but I dunno where they've gone-- there probably isn't any money in it to study it formally. I try to make an effort to know what the treatment/antidote is for any hazardous substance in my home... things you hope you never need to know but are glad if you do.
- cykros 3mo ago
  Add yet another benefit to NAC. Also works wonders for COVID spike protein detox.
rsynnott 3mo ago
The thing about it is, _if taken as directed_ it's extremely safe, moreso than just about any other painkiller. In some countries it's the only one available in supermarkets.
Hugsbox 3mo ago
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n8henrie 3mo ago
> 7g of acetaminophen can kill you, and 12g is likely to [3] I agree that people should be cautious, but I think you are significantly misunderstanding [3]. "Toxicity" != death -- toxicity is merely "some evidence of a toxic effect" -- possibly as simple as a transiently abnormal blood test with no symptoms or sequelae, ever. Single (accidental) doses of up to 200 mg / kg are routinely recommended to be managed at home [0], i.e. "you don't really need to go to the emergency department for this." For me, a fairly average 79kg male, this would be about 16g. Please consult with your local poison control if you have concerns or questions! [0]: https://pubmed.ncbi.nlm.nih.gov/16496488/ https://pubmed.ncbi.nlm.nih.gov/16496488/

unparagoned 3mo ago

Therapeutic index of fentanyl is much higher than heroin or morphine, but I don’t think people really think that it makes it safer.

Shog9 3mo ago
The folks I know who've been prescribed fentanyl weren't particularly upset about it. It is very potent, and thus measuring the dose properly is very important, but it's not particularly fussy beyond that. The people you know may be obtaining it from less reliable apothecaries; that can be a real issue.
ErroneousBosh 3mo ago
Reminds me of a comment I saw on a drug chemist's blog decades ago where they were talking about ACE inhibitors for Parkinsons' Disease - by dicking around with nerve conductivity and acetylcholine reuptake you could "boost" the failing nerves a bit, presumably until they fail altogether. Anyway much of the discussion was on how hard it is to make suitable drugs, and someone said "We actually have some fairly inexpensive, reliable, and well-characterised ACE inhibitors with a nice long half-life and known efficacy, but the therapeutic window of nerve gas is pretty narrow..."
cykros 3mo ago
Fentanyl isn't all that unsafe, aside from the habituation potential. When your measurement is "that looks about right" when purity is entirely unknown, not much really is all that safe.

rsync 4mo ago

Thank you - this is correct and cannot be repeated enough, especially in the context of infant and child doses.

m_a_g 3mo ago

In most countries 4g is the upper limit and it is considered perfectly safe within that limit. So 8 500mg pills in 24 hours.

nostrademons 3mo ago
Yes. 4g is generally considered perfectly safe and is fairly commonplace dosing. 7g can kill you. Hence a therapeutic index of < 2. This is why you have to be very, very careful. If you're doing 8 500mg Tylenol pills and then you also do 6 doses of DayQuil or Mucinex without realizing it's also acetaminophen, you can end up needing a liver transplant.
- Scroll_Swe 3mo ago
  I wonder why it is not a more commonplace useage for suicides. Females seem to enjoy overdoes more, and men seem to enjoy violent ways. But female sucicides often "fails", seems like eating a box of Tylenols (here they come in 20 packs) would solve the "being alive" issue quite quick, no? Better not tip people off... :) >end up needing a liver transplant You won't get one nor should you get one if the reason is this.
  - SubmarineClub 3mo ago
    Probably because most people realize that it’s a horribly unpleasant way to go about it?
  - nostrademons 3mo ago
    It's a pretty terrible way to go. Death doesn't come immediately; you seem fine at first, and then about 3 days later you suffer intense abdominal pain and vomiting. At about 4 days you realize your liver is irreversibly shot and you're a dead man walking unless you can get a liver transplant. Then you enter multi-organ failure as your body and brain shuts down. Acetaminophen poisoning actually featured on two episodes of House, and one of them had the suicide plotline. In S05E11, "Joy to the World" they suspected an overweight teen OD'd on acetaminophen trying to kill herself, but the actual diagnosis was eclampsia from an undisclosed pregnancy. In S06E10, "Wilson", a friend of Wilson's suffers acetaminophen poisoning while trying to manage his back pain. https://house.fandom.com/wiki/Joy_to_the_World https://house.fandom.com/wiki/Joy_to_the_World https://house.fandom.com/wiki/Wilson_(episode) https://house.fandom.com/wiki/Wilson_(episode)

viccis 3mo ago

Acetaminophen should be treated with more caution in general. So many people have reacted with shock and upset when I told them that taking Tylenol (or anything with acetaminophen in it like Dayquil/Nyquil) while drinking can cause immediate liver damage.

ssl-3 3mo ago
Indeed. I like beer quite a lot and have for a very long time, so acetaminophen is banned from my medicine cabinet.
- eureka7 3mo ago
  Seems like the logical thing to ban from your stomach for the time periods you need acetaminophen is the beer, unless I'm missing something.
  - annzabelle 3mo ago
    For a lot of us, Ibuprofen works just as well or better than Acetaminophen, so banning Acetaminophen is not much of a problem. I am on a medication that's contraindicated with NSAIDs, but I made sure that a low dose of Ibuprofen was acceptable.
    - Scroll_Swe 3mo ago
      Ibuprofen is hard on the kidneys and stomach too. And bleeding/clotting issues. Sooo ya :) Better just stay off the beer hubby. Remember, beer makes you fat also.
      - annzabelle 3mo ago
        Wow, that's a really weird tone for a hackernews comment.
        Scroll_Swe 3mo ago

Lich 3mo ago

I didn’t know this until recently either. I grew up on a family where if there was pain, you just take tylenol to deal with it. We always followed the dosage timing and never had issues. So recently when my wife had some chronic pain I suggested taking tylenol but even after two days the pain would not go away and she went to ER. They did a blood check to see if they could find anything. They didn’t find the cause, just suspected food poisoning, but they found her liver enzymes were near dangerous levels. This was even with timing the dosages absed on instructions. Now I am super careful wtih Tylenol.

CodeWriter23 3mo ago
Not to chastise you or your wife, there is an actual "Liver Warning" on Tylenol Product labels. They warn against 4000mg/day or with alcohol consumption. It's not an on/off switch, the damage occurs on a ramp that achieves a critical point after so much consumption. Saying this to encourage label reading and to refute those who might try to characterize your wife's experience as anecdotal. And for those who stop reading a page like this one, after the first paragraph that touts "no evidence": https://www.tylenolprofessional.com/safety-and-efficacy/safety https://www.tylenolprofessional.com/safety-and-efficacy/safe... when at the bottom it reveals the Liver Warning.
- jambalaya8 3mo ago
  It appears his wife took under that threshold and only for a few days. 4000mg is roughly 8-10 otc painkillers in a day (depending on the brand). That said, everyone's physical ability to metabolise drugs is different. I might worry something else was wrong, or at least get a followup test done later, if her liver tox screen showed that, just to rule out another cause.
  - looptylou 3mo ago
    You're right: metabolisms vary. This is why I don't dance with the 4 gram limit, even though (insanely) post-op instructions regularly advise you to.

timothyisonline 3mo ago

Ibuprofen isn’t much better, unfortunately.

GlickWick 3mo ago
The index for ibuprofen is waaaaay better than DayQuil
jack09268 3mo ago
Would appreciate it if you could elaborate. Someone close to me takes a lot of ibuprofen.
- lll-o-lll 3mo ago
  Not a doctor, this is how it was explained to me by my doctor. Paracetamol/acetaminophen has a therapeutic dose that is uncomfortably close to the fatal dose, but is otherwise as safe as any drug can possibly be. So long as you don’t take too much. Ibuprofen is also relatively safe, but it has a number of ways that it can do damage even at the therapeutic dose, if you are taking it all the time. The main one is that it depletes your mucus lining in your stomach, which can lead to bleeding and death (used to be a big problem here in Aus when codeine combined pills were available without prescription). It’s also harder on your kidneys and liver. Completely fine at therapeutic doses taken as per instructions and not mixed with alcohol. But having it every day is going to be much worse for you than the paracetamol and almost certainly lead to health problems.
- agonz253 3mo ago
  https://asteriskmag.com/issues/14/the-mystery-in-the-medicine-cabinet https://asteriskmag.com/issues/14/the-mystery-in-the-medicin...
deleted 3mo ago
[deleted]
nostrademons 3mo ago
The therapeutic index for ibuprofen is considerably better: it's around 10, fairly similar to alcohol. Accidental overdoses of ibuprofen are rare. The main issue with ibuprofen is that it can have fairly annoying (but non-life-threatening) side effects like stomach upset and GI bleeds even with normal dosing.

lobf 3mo ago

I simply do not take acetaminophen because of this risk.

Forgeties79 3mo ago
Ibuprofen isn't easy on the kidneys either so I'd keep an eye on that if you don't

basch 3mo ago

>4-6 500mg tablets within a 24 hour period On top of that daily use brings it down to 3-5, preferably 4 or less of those a day. And they last less than 6 hours. The 8h extended release is 650mg a tablet, and you can have 3-4 a day daily. And if you have any experience taking them you can feel the first half of the extended dose wear off before the extended one kicks in, which leads to basically NEEDING 4 a day, and staggered start times.

hn_user82179 3mo ago

I'm grateful for you mentioning this. I grew up with ibuprofen as my default painkiller without really thinking of it too much but am about to do PRP which requires no NSAIDs for a week prior and 3 months after - but they do allow/recommend Tylenol as an alternative, especially for the post-procedure pain. I just would've assumed it was a sufficiently good substitute that I could treat them equivalently but now i know to be very careful about tracking how many I'm taking each day

galangalalgol 3mo ago
Nsaids are dangerous in all sorts of other ways, kidney, gut lining. Pain medications that work and are safe seem to all be highly addictive.

ButlerianJihad 3mo ago

I was in the hospital on Thanksgiving Day last year. I received 8 diagnoses at that time, including "Diabetic Hypertension" and "Metabolic Acidosis" and E. coli infection, and Hyponatremia. They treated me with an antibiotic, a potassium-rich saline drip and acetaminophen. Yeah that's all they put in my orders. The thing that pissed me off so much, firstly they insisted on calling it "Tylenol" when it was not, in fact, brand-name Tylenol but generic acetaminophen (even if they could charge $$$ per pill on it) and also that they basically refused to administer it at a rate that would keep my exquisite headache pain at bay. I was literally screaming and moaning through the entire night and day. (Actually, I was wearing one of those radio-transmitting heart monitors, and mostly the screams happened when I moved suddenly, and the electrodes tore at my chest hair...) But my head was also constantly throbbing, and that's how I knew to go to the hospital in the first place. The nurses could tell me how long to wait between doses, but they couldn't explain to me how to know that interval, given no clocks and no written-down time of dosing. So basically I had to keep guessing throughout my sleepless nights. And they didn't really inform me of a way to just put it on automatic dosing like a normal hospital would have a schedule for. I really didn't want acetaminophen at all; I don't like it much, and it really hasn't ever relieved any pain I've ever taken it for. My parents chomped so much of it, made me sick just watching them. I lived through the cyanide adulteration episodes and though unsolved, that guy wasn't wrong. When I finally got to visit a sane PCP after all this madness, I told him I was taking big doses of Bayer Aspirin, and he said that's fine; just follow instructions and heed warnings, and he also warned me: for Heaven's sake don't ever take any acetaminophen, because it would seriously harm my liver!!!

chrisweekly 3mo ago

[flagged]

saagarjha 3mo ago
Dude, chill out. Everything has a fatal dose, you can literally look up the LD50 and find that it’s a big number. Nobody is coming for your weed.
- mikey_p 3mo ago
  I think the thing is that there is no official accepted value of LD50 for THC since there has never been a recorded death from THC: > The median lethal dose (LD50) of THC has been determined in various animal species through oral administration and ranges from 800 to 9000 mg/kg. In humans, there have been no recorded instances of fatal overdoses resulting from acute THC use. However, estimates for a potentially lethal human dose range from 4 to 15 g. https://www.ncbi.nlm.nih.gov/books/NBK563174/ https://www.ncbi.nlm.nih.gov/books/NBK563174/
  - nostrademons 3mo ago
    It's not true that there has never been a recorded death from THC. A quick literature search turned up: B. Hartung, S. Kauferstein, S. Ritz-Timme, T. Daldrup, Sudden unexpected death under acute influence of cannabis, Forensic Science International (2014), http://dx.doi.org/10.1016/j.forsciint.2014.02.001 http://dx.doi.org/10.1016/j.forsciint.2014.02.001. Case report of two otherwise-healthy 20-something men who died of cardiac arrhythmia's following large marijuana doses. https://3402974.fs1.hubspotusercontent-na1.net/hubfs/3402974/MGC%20Website%20PDFs/Sudden-unexpected-death-under-acute-influence-of-cannabis.pdf https://3402974.fs1.hubspotusercontent-na1.net/hubfs/3402974... Noble, M. J., Hedberg, K., & Hendrickson, R. G. (2019). Acute cannabis toxicity. Clinical Toxicology, 57(8), 735–742. https://doi.org/10.1080/15563650.2018.1548708 https://doi.org/10.1080/15563650.2018.1548708. Clinical review of 253 Poison Center cases involving acute cannabis poisoning; 8 patients were admitted to the ICU, 3 were intubated, and 1 died. https://pubmed.ncbi.nlm.nih.gov/30676820/ https://pubmed.ncbi.nlm.nih.gov/30676820/ There's also a Heyndrickx 1969 paper that everybody cites (including my original reference on hazard ratios), but I can't find an abstract or full text anywhere on the web. Cases of cannabis poisoning fatalities are extremely rare, but they do exist. Your citation was apparently unaware of (or possibly published before) the other cases.

padjo 3mo ago

It's not under appreciated in the UK and Ireland where you can only buy tiny quantities of it at a time. Cash registers will literally refuse to process a sale if there is more than one pack of acetaminophen in your groceries. On the plus side you can still buy psuedo OTC.

sieabahlpark 3mo ago
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Scroll_Swe 3mo ago

It's a good darwin effect clearer/cleaner I think. Can't read or follow simple instructions? Well maybe modern society is not for you anymore.

blks 3mo ago

Safety ratio as you present it is a bit misleading, numbers for hard/soft drugs are usually for a single dose.

fmajid 3mo ago

Replacing Aspirin with Acetaminophen/Paracetamol was absurd. Reyes’s syndrome was nowhere as prevalent as acetaminophen overdoses, which are a horrible way to go.

dreamcompiler 3mo ago

There is an antidote available for acetaminophen overdose, but it's only available in the hospital. So if you think you took too much, get to a hospital quickly before your liver suffers permanent damage. Untreated acetaminophen overdose is an extremely unpleasant way to die.

SoMomentary 3mo ago
Huh, looked this up as Acetaminophen is one of the only OTC painkillers I can take. I thought NAC (N-Acetyl Cysteine) sounded familiar and low and behold I already have some I've purchased as a supplement. Anyone can buy this stuff, no need to make it sound like it's some controlled substance. I will say if I take to much Acetaminophen I'll just head to the hospital instead of winging it!
- dreamcompiler 3mo ago
  I was trying to keep it simple. Yes you can buy n-acetylcysteine but OTC versions can vary in purity and dosage and it's not the only treatment you might need. With an acetaminophen OD you really want to be in a hospital.

AnodicElegy 3mo ago

The safety ratios listed in reference [1] are exaggerated, as can be determined by the following qualification: "The majority of published reports of acute lethal toxicity indicate that the decedent used a co-intoxicant (most often alcohol)." The vast majority of so-called drug overdoses are due to polydrug intoxication. It's much harder to die by consuming a single substance. This is clear from the statistics of the few jurisdictions that report all substances in the blood in coroner's reports. See, for example, the Scottish data from 2020 (https://www.drugsandalcohol.ie/34642/7/ndrdd_report.pdf https://www.drugsandalcohol.ie/34642/7/ndrdd_report.pdf ): "In 2020, almost all (96%) [drug-related deaths] occurred after the consumption of multiple substances."

no-name-here 3mo ago
I imagine painkillers are fairly commonly used for hangover headaches, and it’s surprisingly difficult to get guidance on how long after drinking it’s ok to take painkillers (presumably as it’s complicated) - perhaps instructions should be updated to not just say don’t take with alcohol, but don’t take within a day of alcohol?

NotAFurry2 3mo ago

Liver failure is the worst way to go, it's slow and painful. if someone accidentally takes too much you can give them activated charcoal before you get them to the ER to give them a better chance of not going through liver failure

nullc 3mo ago

Perhaps it's useful to know that NAC is the treatment for acetaminophen toxicity, should you happen to find yourself in the middle of a zombie apocalypse with a Tylenol ODed friend and a supplements isle handy but no readily available medical support. :D There has been some suggestions that acetaminophen products should contain NAC to offset some of the toxic effects, but I dunno where they've gone-- there probably isn't any money in it to study it formally. I try to make an effort to know what the treatment/antidote is for any hazardous substance in my home... things you hope you never need to know but are glad if you do.

cykros 3mo ago
Add yet another benefit to NAC. Also works wonders for COVID spike protein detox.

rsynnott 3mo ago

The thing about it is, _if taken as directed_ it's extremely safe, moreso than just about any other painkiller. In some countries it's the only one available in supermarkets.

Hugsbox 3mo ago

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n8henrie 3mo ago

> 7g of acetaminophen can kill you, and 12g is likely to [3] I agree that people should be cautious, but I think you are significantly misunderstanding [3]. "Toxicity" != death -- toxicity is merely "some evidence of a toxic effect" -- possibly as simple as a transiently abnormal blood test with no symptoms or sequelae, ever. Single (accidental) doses of up to 200 mg / kg are routinely recommended to be managed at home [0], i.e. "you don't really need to go to the emergency department for this." For me, a fairly average 79kg male, this would be about 16g. Please consult with your local poison control if you have concerns or questions! [0]: https://pubmed.ncbi.nlm.nih.gov/16496488/ https://pubmed.ncbi.nlm.nih.gov/16496488/