Q&A: What’s the problem with taking Tylenol?

Common questions answered about new acetaminophen advisories

By JoNel Aleccia

Health writer

updated 9:10 a.m. CT, Wed., July 1, 2009

Anyone who’s ever popped a painkiller to tackle a tough headache or an aching back had to pause at the federal Food and Drug Administration’s latest warnings this week.

First, an advisory panel recommended yanking off the market two popular prescription drugs, Vicodin and Percocet, which combine narcotics with a popular pain medication, acetaminophen. At the same time, another group took aim at acetaminophen on its own, seeking to lower the recommended daily dose of one of the most widely used over-the-counter drugs in the country.

The FDA’s chief worry is that too many people are suffering accidental liver damage associated with acetaminophen, the drug that fuels brands like extra-strength Tylenol and Excedrin. A study of 22 leading specialty medical centers in the U.S. showed that between 1998 and 2003, acetaminophen damage was the leading causing of acute liver failure, according to FDA data.

But where does that leave consumers who need a little something to ease arthritis or a sore shoulder?  Here are a few answers:

Q: How can taking a couple Tylenol be dangerous? Doesn’t everybody do it?

A: Yes, analgesics like acetaminophen and ibuprofen are the most frequently taken non-prescription drugs in the country, with between 16 percent and 20 percent of U.S. adults using them in a given week, according to a 2002 study in the Journal of the American Medical Association.

The problem is that people pay too little attention to the recommended dosage, previously listed at 4 grams of acetaminophen per day, which amounts to eight 500-milligram Extra Strength Tylenol tablets.

However, some people self-medicate, popping 10 or 12 pills — or more — in a 24-hour period.

“People think that if it’s a safe drug and I have this pain, it work better if I take more,” said Cesar Alaniz, a clinical associate professor at the University of Michigan College of Pharmacy.

Q: But don’t you have to take a lot of extra pills before it’s a problem?

A: The answer is definitely no, said Alaniz and other experts. One of the reasons the FDA wants to lower the recommended dose of over-the-counter acetaminophen is because taking just a small amount over the advised level can cause liver damage.

If the recommended level is 4 grams a day, the level at which damage occurred in cases tracked by the FDA’s drug warning system was between 5 and 7.5 grams a day. That’s only an additional 500-milligram pill or two extra every day.

And if that dosage continues for days or weeks, or if the acetaminophen is combined with alcohol, the results can be dangerous or — even deadly.

Q: Liver damage sounds serious. What are the warning signs?

A: Liver damage is serious, particularly because it can result in acute liver failure, the need for a liver transplant or death.

People who take high doses of acetaminophen for extended periods of time should look out for the following symptoms and seek immediate medical help if they detect them:

  • Low fever with nausea, stomach pain and loss of appetite
  • Dark-colored urine
  • Clay-colored stools
  • Jaundice (yellowing of the skin or eyes)

    One problem with liver damage is that the initial phase of illness can be followed by a period of apparent recovery. Some people continue to take acetaminophen during that period, which only makes the problem worse. By the time they reach the third phase of liver damage, the most serious phase, it can be too late for help.

    Doctors usually pump the stomach of people with acetaminophen overdoses and they’ll often give an antidote, acetylcysteine.

    Q: What’s the correct dose of acetaminophen to take? Is there a way to control my pain and not risk liver damage?

    A: FDA advisers have not yet determined a new maximum dosage of acetaminophen, but Alaniz said it could settle at 2 grams or 3 grams a day or between four and six 500-milligram pills. He advises people to reduce the strength of the pills they take. For instance, if the previous maximum was two 500-milligram pills four times a day, a consumer could substitute 325-milligram pills instead.

    Alaniz emphasized that tolerance for acetaminophen can vary with individual chemistry. He also urged people to remember that acetaminophen comes in many forms, from prescription drugs like Percocet and Vicodin to over-the-counter cough medicines such as NyQuil. It’s easy to overlook the cumulative dose of medication from all the sources.

    “All over-the-counter medications carry risks,” Alaniz said. “It’s important for the public to know.

    © 2009 msnbc.com Reprints

    URL: http://www.msnbc.msn.com/id/31672184/ns/health-more_health_news/

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