4 ms·

Just for the sake of honest balance, with minimal commentary and no opinions: Acetaminophen and dementia correlation: https://pmc.ncbi.nlm.nih.gov/articles/PM

by eth0up 3mo ago

Just for the sake of honest balance, with minimal commentary and no opinions: Acetaminophen and dementia correlation: https://pmc.ncbi.nlm.nih.gov/articles/PMC2877629/ https://pmc.ncbi.nlm.nih.gov/articles/PMC2877629/ https://www.sciencedirect.com/science/article/abs/pii/S0163834323001317 https://www.sciencedirect.com/science/article/abs/pii/S01638... Note that it's also hard on the liver. A lot fatalities due to taking after hangovers, etc: https://www.medicalnewstoday.com/articles/322813 https://www.medicalnewstoday.com/articles/322813 So if you insist, maybe take some NAC. But apparently, Ibuprofen helps counter the dementia risk: https://www.aan.com/PressRoom/home/PressRelease/624 https://www.aan.com/PressRoom/home/PressRelease/624 I am not not asserting any clever marketing here. I am merely citing public information. Noting all the above, I am confident it's perfectly safe for children and fetuses, and if posing any risk at all, applies strictly to full grown adults. No doubts about child safety have been expressed here.

estearum 3mo ago
The first paper shows no evidence of any effect from Tylenol...? But yeah seems like lots of support for the ibuprofen protective effect, interestingly.
- eth0up 3mo ago
  If you do start munching on advil; note there are rumors, by medical researchers, case reports, and more, that if you dig beneath the shiny surface to find, do show a lot of compelling data for GI damage, heart risk and other serious side-effects. And depending on how fair one wants to be with 'evidence' -- almost all wording describing NSAIDs as "protective", uses easy-to-miss but distinct qualifiers such as "potential" and other such vague 'maybe'-equivalents that alone have been used to suppress and dismiss many other...potential medicines. Sometimes, conclusive just means inspired. And sometimes ambiguity means certainty, depending on levels of inspiration involved. Of course, one might pause for a moment to consider just how potential the alluded benefits really are with ibuprofen, and ask why doctors aren't recommending it for mental health, or as a general health product. But that might point to the peculiar fact that there is substantially more evidence suggesting risk over health benefits, and the benefits really depend on what one wants to see. There is a reason it's not marketed as a health product, but with the way it's framed, it should be, nu? I mean, potential benefits sells a lot of snake oil and lowfat yogurt. Why not advil and acetaminophen? And by similar logic used to dismiss acetaminophen here as a health risk, eg because there's no link with autism/ADHD it's safe; why not apply the same logic to opiates? We could just say opiates do not directly cause, eg , parkinsons, or AIDS, therefore it's safe for babies. Myself, I never correlated acetaminophen with autism/ADHD, but I know it has more side-effects than listen on the bottle.
  - estearum 3mo ago
    Yeah I work in clinical trials so I'm very comfortable with all the caveats the need to be applied to correlative studies like these. Which also answers your other question of why doctors don't recommend it: we don't actually know that it does this. As for the rest of the ramble, you (or I) definitely don't know hardly anything that hasn't been established in clinical trials. Certainly can't just vibes-based assess a label and its completeness. It's really, really hard to know things. The precise wording as far as safety is: "we have no substantive or high-quality evidence that the drug is unsafe."
    - eth0up 3mo ago
      Because we couldn't possibly modify "we have no substantive or high-quality evidence that the drug is unsafe." - (damn all the research showing it is) --to "we have no substantive or high-quality evidence that the drug is safe." - (damn all the research suggesting it isn't) Well, that's as good a green light for an ad campaign as one could ask for. "we don't actually know that it does this." ain't never stopped a motivated pharmaceutical rep before. You have my official endorsement for feeding advil and acetaminophen to all. And protection from dementia is just what America needs. !Win / !Win Maybe restless leg and depression too! And don't tell me fetuses don't get depressed there in that dark womb. We know damn well they get restless.
      - estearum 3mo ago
        Drugs are approved for the specific uses based on extremely high-quality evidence. That evidence balances the benefits against the detectable downsides/costs/side-effects. Those downsides are also on the label. That's almost entirely generated by the highest quality evidence generation system we could possibly have, which is RCTs. And no, pharma reps actually aren't allowed to encourage (or even talk about) off-label uses of drugs. I get the sense that you don't know much about this space.
        qsera 3mo ago
        >highest quality evidence generation system we could possibly have, which is RCTs. The "best we have" does not mean it is good enough for the task at hand. Just saying. Basically what I am saying is that qualifying something by saying "best we have", does not justify its using on its own..
greggsy 3mo ago
The liver toxicity is well known, and overdose is not uncommon.
- lokar 3mo ago
  A better policy fix would be to remove it from multi-drug products. Require it always be the only active ingredient.
- mmooss 3mo ago
  > overdose is not uncommon Anecdotally, I hear about it far more in Internet comments like the parent than elsewhere. How common is it?
  - eth0up 3mo ago
    Poison center stats, annual, acetaminophen... https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808062 https://jamanetwork.com/journals/jamanetworkopen/fullarticle... Emergency department visits ~56,000 https://pubmed.ncbi.nlm.nih.gov/16294364/ https://pubmed.ncbi.nlm.nih.gov/16294364/ Hospitalizations ~26,000 https://pubmed.ncbi.nlm.nih.gov/16294364/ https://pubmed.ncbi.nlm.nih.gov/16294364/ Deaths ~500 deaths/year https://pubmed.ncbi.nlm.nih.gov/16294364/ https://pubmed.ncbi.nlm.nih.gov/16294364/ Also, direct from FDA, for those promoting its use with alcohol: "Be aware that severe liver damage may occur if you have three or more alcoholic drinks per day while using acetaminophen." One can infer that stressing the liver prior, then again with tylenol, might be unwise. But by all means, headaches suck. I understand. Also: https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/alcohol-medication-interactions-potentially-dangerous-mixes https://www.niaaa.nih.gov/health-professionals-communities/c... But do not worry. The FDA only specifies that to qualify as risk, requires 'daily' intake of 'three or more drinks'. That is 'daily'. Therefore, it is, if you manage to survive binge drinking several cases of beer and your drinking pattern is null for day1-6, but n amount on day7, perfectly safe to take acetaminophen at will. The documentation does not refute this, therefore it is safe. Only daily drinks, three or more. Binge ok. Only official documentation good true. Inference bad false. I stand corrected by ctoa! And to the noble clinical researcher in the house (estearum), I much respec your authorituh. No corruption or monetary influence has ever affected the medical or research field. This I do not dispute. As a chartered researcher, you are an impervious and pure and good person. And honest too. Pharmaceutical industry applies here as well; beyond reproach -- if you're in, you're pure. The notion that they have financial incentives is schizophrenic and despicably paranoid. Anyone who thinks otherwise can have a $200 epipen stuffed in their eye, for free. I also humbly rescind all my own experience and research. A single I "don't know much" sense from an illustrious professional medical champion was the evidence I needed to retire. Farewell and I shall never think nor speak again. All that cherry pickin really wore me out ;( And for all: ScienceDirect S0163834323001317 - A 2023 piece ("Association of regular use of ibuprofen and paracetamol, genetic susceptibility, and new-onset dementia in the older population") that found regular paracetamol use, but not ibuprofen, associated with higher risk of new-onset all-cause dementia, AD, and vascular dementia, independent of genetic risk. But ignore that. Acetaminophen is uncontested by good people. This = bad people https://www.sciencedirect.com/science/article/abs/pii/S0163834323001317 https://www.sciencedirect.com/science/article/abs/pii/S01638... *Mess due to comment throttling.
ctoa 3mo ago
"A lot fatalities due to taking after hangovers" no, that's not how acetaminophen fatalities happen. In fact, the article you cited specifically mentions "there is no scientific evidence that people with AUD (alcohol use disorder) who take the recommended dose of acetaminophen increase their risk of liver damage." Fatalities happen basically from: product stacking combination medicines people don't realize contain acetaminophen and/or multi-day accumulation exceeding max daily limit over multiple days. Chronic drinkers have impaired acetaminophen processing so they can't handle otherwise safe doses, but fatalities still typically occur in multi-day accumulation scenarios. Their safe daily max is ~half that of a non drinker. The effects of one round of acute drinking don't impair the liver in the same way. People are not dropping dead because they took a normal dose of acetaminophen for a hangover. Not that I'm recommending you start doing it, but it is a myth.
- redwall_hp 3mo ago
  > Fatalities happen basically from: product stacking combination medicines people don't realize contain acetaminophen and/or multi-day accumulation exceeding max daily limit over multiple days. I find it obnoxious that NyQuil has taken over as the default brand people grab for cough syrup, for that reason. It has acetaminophen, while Robitussin or such have the other active ingredients without that risk. The typical person doesn't read and understand active ingredients, and it's lucky if they even check dosage instructions.
  - ctoa 3mo ago
    I absolutely think we should ban acetaminophen in otc combo meds. There was a big drop in hospitalizations when they dropped the max allowed dose in prescription drugs like Vicodin, there's no reason these otc things like NyQuil need to exist at all.
    - terribleperson 3mo ago
      I think it's supposed to be an anti-abuse thing for commonly abused drugs. Maybe I'm crazy, but I don't think killing people is an improvement.
phendrenad2 3mo ago
This article is about "how early a child is born or a child’s weight at birth". I don't know why we're talking about other possible negatives of Acetaminophen. Seems off-topic to me.
- eth0up 3mo ago
  So a guy who beckons to "Keep HN weird." and has a history of non-strict adherence to subject titles with his/her own comments implies I must not challenge a title that claims "no adverse birth outcomes" from acetaminophen with closely related acetaminophen concerns and possible counter data? And that is some kind of special, golden? double standard? But truly, if I am the only rascal here on HN, deviating slightly from the subject title, I will gather the tinder. Let's burn me with haste!

by eth0up 3mo ago

estearum 3mo ago

The first paper shows no evidence of any effect from Tylenol...? But yeah seems like lots of support for the ibuprofen protective effect, interestingly.

eth0up 3mo ago
If you do start munching on advil; note there are rumors, by medical researchers, case reports, and more, that if you dig beneath the shiny surface to find, do show a lot of compelling data for GI damage, heart risk and other serious side-effects. And depending on how fair one wants to be with 'evidence' -- almost all wording describing NSAIDs as "protective", uses easy-to-miss but distinct qualifiers such as "potential" and other such vague 'maybe'-equivalents that alone have been used to suppress and dismiss many other...potential medicines. Sometimes, conclusive just means inspired. And sometimes ambiguity means certainty, depending on levels of inspiration involved. Of course, one might pause for a moment to consider just how potential the alluded benefits really are with ibuprofen, and ask why doctors aren't recommending it for mental health, or as a general health product. But that might point to the peculiar fact that there is substantially more evidence suggesting risk over health benefits, and the benefits really depend on what one wants to see. There is a reason it's not marketed as a health product, but with the way it's framed, it should be, nu? I mean, potential benefits sells a lot of snake oil and lowfat yogurt. Why not advil and acetaminophen? And by similar logic used to dismiss acetaminophen here as a health risk, eg because there's no link with autism/ADHD it's safe; why not apply the same logic to opiates? We could just say opiates do not directly cause, eg , parkinsons, or AIDS, therefore it's safe for babies. Myself, I never correlated acetaminophen with autism/ADHD, but I know it has more side-effects than listen on the bottle.
- estearum 3mo ago
  Yeah I work in clinical trials so I'm very comfortable with all the caveats the need to be applied to correlative studies like these. Which also answers your other question of why doctors don't recommend it: we don't actually know that it does this. As for the rest of the ramble, you (or I) definitely don't know hardly anything that hasn't been established in clinical trials. Certainly can't just vibes-based assess a label and its completeness. It's really, really hard to know things. The precise wording as far as safety is: "we have no substantive or high-quality evidence that the drug is unsafe."
  - eth0up 3mo ago
    Because we couldn't possibly modify "we have no substantive or high-quality evidence that the drug is unsafe." - (damn all the research showing it is) --to "we have no substantive or high-quality evidence that the drug is safe." - (damn all the research suggesting it isn't) Well, that's as good a green light for an ad campaign as one could ask for. "we don't actually know that it does this." ain't never stopped a motivated pharmaceutical rep before. You have my official endorsement for feeding advil and acetaminophen to all. And protection from dementia is just what America needs. !Win / !Win Maybe restless leg and depression too! And don't tell me fetuses don't get depressed there in that dark womb. We know damn well they get restless.
    - estearum 3mo ago
      Drugs are approved for the specific uses based on extremely high-quality evidence. That evidence balances the benefits against the detectable downsides/costs/side-effects. Those downsides are also on the label. That's almost entirely generated by the highest quality evidence generation system we could possibly have, which is RCTs. And no, pharma reps actually aren't allowed to encourage (or even talk about) off-label uses of drugs. I get the sense that you don't know much about this space.
      - qsera 3mo ago
        >highest quality evidence generation system we could possibly have, which is RCTs. The "best we have" does not mean it is good enough for the task at hand. Just saying. Basically what I am saying is that qualifying something by saying "best we have", does not justify its using on its own..

greggsy 3mo ago

The liver toxicity is well known, and overdose is not uncommon.

lokar 3mo ago
A better policy fix would be to remove it from multi-drug products. Require it always be the only active ingredient.
mmooss 3mo ago
> overdose is not uncommon Anecdotally, I hear about it far more in Internet comments like the parent than elsewhere. How common is it?
- eth0up 3mo ago
  Poison center stats, annual, acetaminophen... https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808062 https://jamanetwork.com/journals/jamanetworkopen/fullarticle... Emergency department visits ~56,000 https://pubmed.ncbi.nlm.nih.gov/16294364/ https://pubmed.ncbi.nlm.nih.gov/16294364/ Hospitalizations ~26,000 https://pubmed.ncbi.nlm.nih.gov/16294364/ https://pubmed.ncbi.nlm.nih.gov/16294364/ Deaths ~500 deaths/year https://pubmed.ncbi.nlm.nih.gov/16294364/ https://pubmed.ncbi.nlm.nih.gov/16294364/ Also, direct from FDA, for those promoting its use with alcohol: "Be aware that severe liver damage may occur if you have three or more alcoholic drinks per day while using acetaminophen." One can infer that stressing the liver prior, then again with tylenol, might be unwise. But by all means, headaches suck. I understand. Also: https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/alcohol-medication-interactions-potentially-dangerous-mixes https://www.niaaa.nih.gov/health-professionals-communities/c... But do not worry. The FDA only specifies that to qualify as risk, requires 'daily' intake of 'three or more drinks'. That is 'daily'. Therefore, it is, if you manage to survive binge drinking several cases of beer and your drinking pattern is null for day1-6, but n amount on day7, perfectly safe to take acetaminophen at will. The documentation does not refute this, therefore it is safe. Only daily drinks, three or more. Binge ok. Only official documentation good true. Inference bad false. I stand corrected by ctoa! And to the noble clinical researcher in the house (estearum), I much respec your authorituh. No corruption or monetary influence has ever affected the medical or research field. This I do not dispute. As a chartered researcher, you are an impervious and pure and good person. And honest too. Pharmaceutical industry applies here as well; beyond reproach -- if you're in, you're pure. The notion that they have financial incentives is schizophrenic and despicably paranoid. Anyone who thinks otherwise can have a $200 epipen stuffed in their eye, for free. I also humbly rescind all my own experience and research. A single I "don't know much" sense from an illustrious professional medical champion was the evidence I needed to retire. Farewell and I shall never think nor speak again. All that cherry pickin really wore me out ;( And for all: ScienceDirect S0163834323001317 - A 2023 piece ("Association of regular use of ibuprofen and paracetamol, genetic susceptibility, and new-onset dementia in the older population") that found regular paracetamol use, but not ibuprofen, associated with higher risk of new-onset all-cause dementia, AD, and vascular dementia, independent of genetic risk. But ignore that. Acetaminophen is uncontested by good people. This = bad people https://www.sciencedirect.com/science/article/abs/pii/S0163834323001317 https://www.sciencedirect.com/science/article/abs/pii/S01638... *Mess due to comment throttling.

ctoa 3mo ago

"A lot fatalities due to taking after hangovers" no, that's not how acetaminophen fatalities happen. In fact, the article you cited specifically mentions "there is no scientific evidence that people with AUD (alcohol use disorder) who take the recommended dose of acetaminophen increase their risk of liver damage." Fatalities happen basically from: product stacking combination medicines people don't realize contain acetaminophen and/or multi-day accumulation exceeding max daily limit over multiple days. Chronic drinkers have impaired acetaminophen processing so they can't handle otherwise safe doses, but fatalities still typically occur in multi-day accumulation scenarios. Their safe daily max is ~half that of a non drinker. The effects of one round of acute drinking don't impair the liver in the same way. People are not dropping dead because they took a normal dose of acetaminophen for a hangover. Not that I'm recommending you start doing it, but it is a myth.

redwall_hp 3mo ago
> Fatalities happen basically from: product stacking combination medicines people don't realize contain acetaminophen and/or multi-day accumulation exceeding max daily limit over multiple days. I find it obnoxious that NyQuil has taken over as the default brand people grab for cough syrup, for that reason. It has acetaminophen, while Robitussin or such have the other active ingredients without that risk. The typical person doesn't read and understand active ingredients, and it's lucky if they even check dosage instructions.
- ctoa 3mo ago
  I absolutely think we should ban acetaminophen in otc combo meds. There was a big drop in hospitalizations when they dropped the max allowed dose in prescription drugs like Vicodin, there's no reason these otc things like NyQuil need to exist at all.
  - terribleperson 3mo ago
    I think it's supposed to be an anti-abuse thing for commonly abused drugs. Maybe I'm crazy, but I don't think killing people is an improvement.

phendrenad2 3mo ago

This article is about "how early a child is born or a child’s weight at birth". I don't know why we're talking about other possible negatives of Acetaminophen. Seems off-topic to me.

eth0up 3mo ago
So a guy who beckons to "Keep HN weird." and has a history of non-strict adherence to subject titles with his/her own comments implies I must not challenge a title that claims "no adverse birth outcomes" from acetaminophen with closely related acetaminophen concerns and possible counter data? And that is some kind of special, golden? double standard? But truly, if I am the only rascal here on HN, deviating slightly from the subject title, I will gather the tinder. Let's burn me with haste!