3 ms·

Paracetamol is probably the safest OTC analgesic outside of Colorado and Washington. NSAIDs -- aspirin, ibuprofen, and naproxen -- have significantly higher ris

by scythe 13y ago

Paracetamol is probably the safest OTC analgesic outside of Colorado and Washington. NSAIDs -- aspirin, ibuprofen, and naproxen -- have significantly higher risks associated with their use, due to a particular side effect which is inhibition of COX-1 (---> stomach bleeding); serious side-effects in regular NSAID users occur to the tune of 1-2%! See: https://www.lef.org/protocols/appendix/otc_toxicity_01.htm https://www.lef.org/protocols/appendix/otc_toxicity_01.htm This might be paracetamol is preferred over ibuprofen et al in combination analgesics like Vicodin; if they just wanted to kill junkies they could do better.

MichaelGG 13y ago
Is Paracetamol safer than weak opiates like codeine? Actually, I'd be surprised if it's a whole ton safer than hydrocodone. Max dose of APAP used to be 4g, and what, 3 or 4 times that can cause acute liver toxicity? Whereas an intolerant person will probably be knocked back pretty hard with 5mg of hydrocodone, yet 20mg wouldn't really hurt. Hydrocodone is schedule II, unless mixed with APAP at which point it drops to S III. I'm not sure there's any way to view that except as anti-human. And ironically enough, restrictions on pharmaceutical grade opiates makes the prices so high people end up using impure heroin instead. It's unlikely this is an unknown effect to regulators.
sithu 13y ago
Just adding my two cents to this discussion as someone who prescribes this stuff and has taken care of people with liver failure. Agree that acetaminophen/tylenol/paracetamol is the safest OTC and non-OTC analgesic within the 'safe' dose limit <4000mg/24h (pills are typically 325/500/650mg) Liver failure from tylenol toxicity that is not a suicide attempt is actually quite rare. People that intentionally overdose and die usually take large amounts, like 10-20gm AND don't come to the hospital until very late or when they are found by someone else. Smaller doses and arriving in hospital within a day can usually be treated quite successfully with N-acetylcysteine/NAC. Tylenol + Alcohol = Lowers the dose needed for liver injury. Alcohol causes orders of magnitude more damage to livers and to our society than tylenol does. More than half the liver transplants here are at least partially related to alcohol, and the rest are mostly hepatitis C, fatty liver, cancer, autoimmune, etc. People on the transplant list do tend to drink "a lot", such as 5-10 bottles of beer/day for 10-20 years Tylenol is combined with opiates (eg. Tylenol#3, Percocet, Vicodin) because both work in the central nervous system (as opposed to NSAIDs that work peripherally), resulting in a synergistic effect. Aspirin and other NSAIDs (ibuprofen/Advil, naproxen/Aleeve) are ok when used occasionally, but long-term chronic use has side effects as mentioned (eg. bleeding, kidney injury, can precipitate heart attacks in people with coronary disease, etc.)
- chrisbennet 13y ago
  Extremely helpful comment. Don't understand why someone voted it down.
- ekianjo 13y ago
  It's worth adding that long-term observational studies with Aspirin intake have shown high colleration with the reduction of certain types of cancer (colorectal, esophageal, mainly), while the internal bleeding issue remains a potential concern: http://www.ncbi.nlm.nih.gov/pubmed/22440112 http://www.ncbi.nlm.nih.gov/pubmed/22440112

by scythe 13y ago

MichaelGG 13y ago

Is Paracetamol safer than weak opiates like codeine? Actually, I'd be surprised if it's a whole ton safer than hydrocodone. Max dose of APAP used to be 4g, and what, 3 or 4 times that can cause acute liver toxicity? Whereas an intolerant person will probably be knocked back pretty hard with 5mg of hydrocodone, yet 20mg wouldn't really hurt. Hydrocodone is schedule II, unless mixed with APAP at which point it drops to S III. I'm not sure there's any way to view that except as anti-human. And ironically enough, restrictions on pharmaceutical grade opiates makes the prices so high people end up using impure heroin instead. It's unlikely this is an unknown effect to regulators.

sithu 13y ago

Just adding my two cents to this discussion as someone who prescribes this stuff and has taken care of people with liver failure. Agree that acetaminophen/tylenol/paracetamol is the safest OTC and non-OTC analgesic within the 'safe' dose limit <4000mg/24h (pills are typically 325/500/650mg) Liver failure from tylenol toxicity that is not a suicide attempt is actually quite rare. People that intentionally overdose and die usually take large amounts, like 10-20gm AND don't come to the hospital until very late or when they are found by someone else. Smaller doses and arriving in hospital within a day can usually be treated quite successfully with N-acetylcysteine/NAC. Tylenol + Alcohol = Lowers the dose needed for liver injury. Alcohol causes orders of magnitude more damage to livers and to our society than tylenol does. More than half the liver transplants here are at least partially related to alcohol, and the rest are mostly hepatitis C, fatty liver, cancer, autoimmune, etc. People on the transplant list do tend to drink "a lot", such as 5-10 bottles of beer/day for 10-20 years Tylenol is combined with opiates (eg. Tylenol#3, Percocet, Vicodin) because both work in the central nervous system (as opposed to NSAIDs that work peripherally), resulting in a synergistic effect. Aspirin and other NSAIDs (ibuprofen/Advil, naproxen/Aleeve) are ok when used occasionally, but long-term chronic use has side effects as mentioned (eg. bleeding, kidney injury, can precipitate heart attacks in people with coronary disease, etc.)

chrisbennet 13y ago
Extremely helpful comment. Don't understand why someone voted it down.
ekianjo 13y ago
It's worth adding that long-term observational studies with Aspirin intake have shown high colleration with the reduction of certain types of cancer (colorectal, esophageal, mainly), while the internal bleeding issue remains a potential concern: http://www.ncbi.nlm.nih.gov/pubmed/22440112 http://www.ncbi.nlm.nih.gov/pubmed/22440112