Why acetaminophen is the 'most common cause of liver injury' in Canada

[etherealtruth]

Source: CBC News

Health Canada's new labelling rules for acetaminophen are not strict enough, and the extra-strength products should be removed from store shelves, some doctors say.

Acetaminophen is one of the most widely used pain and fever relievers in Canada and worldwide. It is safe if used properly, but too much can be dangerous, particularly over time.

"It is the most common cause of liver injury. Period. Full stop," said Dr. Michael Rieder, a pediatric clinical pharmacologist at Western University in London, Ont.


Read more: http://www.cbc.ca/news/health/acetaminophen-toxicity-health-canada-1.3764672

[maxsolomon]

1. in America, the most common cause

is being shot in the Liver.

[etherealtruth]

2. Yeah, fortunately for Canada they only have to worry about hepatotoxicity

.... and actually address identified problems

[LeftyMom]

3. It's hepatitis c.

[maxsolomon]

4. it was a joke

sorry if you thought I was serious. 538 has me feeling cynical today.

[Stuckinthebush]

15. I laughed

Good one!

[Sen. Walter Sobchak]

5. You would have to take a metric fuck tonne for that to happen

[Dorian Gray]

6. That's true

I think a lot of the problems come bc it's used in prescription meds that combine it with an opiod. People who build up tolerance to the opioids take more and more, and then it can damage livers.

[etherealtruth]

7. Research has clearly identified liver damage associated with the administration of therapeutic doses

.... however, the greatest risk is with inadvertent overdose associated with the use of multiple products that may be acetaminophen containing (refer to article).

It appears most damage is associated with inadvertent overdose ... but not associated with ingesting a "shit ton" (unless a shit ton is the equivalent of 1-2 "extra" doses)

[Sen. Walter Sobchak]

8. It was meant to be a Canada metric system joke...

[etherealtruth]

9. Sorry ... it turns out I am an idiot sometimes

Again, sorry for being obtuse

[Yo_Mama]

19. Not true. Without monitoring, people are poisoning themselves with OTC pills in the US

http://emedicine.medscape.com/article/820200-overview

Acetaminophen is one of the most commonly used oral analgesics and antipyretics. It has an excellent safety profile when administered in proper therapeutic doses, but hepatotoxicity can occur after overdose or when misused in at-risk populations. In the United States, acetaminophen toxicity has replaced viral hepatitis as the most common cause of acute hepatic failure and is the second most common cause of liver failure requiring transplantation.

There's a whole bunch of risk factors here:
http://emedicine.medscape.com/article/820200-overview#a4

Chronic acetaminophen toxicity has been recognized in pediatric patients. This condition occurs in young, febrile children with reduced oral intake who are treated with repeated high doses of acetaminophen to relieve their symptoms. As a reference, the 24-hour dosage of acetaminophen for children should not exceed 75 mg/kg/d.

In chronic acetaminophen toxicity, the role of fasting, reduced glutathione stores, and enhanced metabolism remains unclear. Risk factors for chronic acetaminophen toxicity include the following[18] :

Repeated administration of high doses
Repeated administration of proper doses at shortened time intervals
Fever
Poor oral intake
Young age (as due to caregiver mismanagement)

In adults, sometimes someone is ill and takes cold medicine containing the compound, drinks, and then takes the compound. In susceptible individuals, that can be enough.

Individuals with reduced liver function and certain viruses (which can affect liver function) can poison themselves with surprisingly small doses combined with some alcohol intake.

For example, mono or Epstein-Barr. You can still find medical sites recommending Tylenol for the pain and fever (such as this one http://www.uptodate.com/contents/infectious-mononucleosis-mono-in-adults-and-adolescents-beyond-the-basics), but in severe cases acetaminophen is utterly contraindicated. People don't realize that their liver is temporarily shot to hell, and then they take Tylenol at recommended doses and shut it right down.

I think it is a lethal drug that should be off the market, or sold only with very strong warnings and a usage limit recommendation of only a few days.

[Sen. Walter Sobchak]

20. Canada. Metric System. Profanity. Joke

[Yo_Mama]

21. I'm stupid. This is happening in the US too. n/t

[demigoddess]

30. In Canada with a single payer system they would have an incentive to find

problems like this. In the US, the problems with medicines just get covered up.

[Egnever]

31. The idea of drinking while sick

Seems very foreign to me. I recognize there are a lot of folks out there that drink no matter what. I just can't imagine doing it personally. Last thing I would ever think of doing while sick.

[Yo_Mama]

33. Hot toddies actually do work in the onset of some viral illnesses.

I had a doctor recommend it to me once when I went to a clinic with an acute viremia. The tea/whiskey/lemon/honey combo actually does work:
http://vinepair.com/wine-blog/drunk-aunt-right-hot-toddy-cure-common-cold/

It tends to disrupt viral replication in the bloodstream. But only one, and you don't combine it with other cold remedies. Then you wrap up well and sweat it out. Really works.

Combining alcohol and tylenol is a very, very bad idea. Back when these cures were commonly used, people weren't combining them with all the OTC cold/flu remedies available now. The combination can be lethal. I wouldn't do a hot toddy with ibuprofen or anything except aspirin on the same day!

And people who drink every day probably don't stop that when they get ill.

[rurallib]

10. Wonder if taking it and drinking enhances the problem?

And by reading the article I see it is yes:

"I'm on call to the liver transplant program for this province. I just got a phone call literally two days ago from another hospital of somebody who was a heavy consumer of alcohol and took Tylenol and now they're in severe liver injury and they were calling for a transplant or possible transplant assessment."

There's a good chance of recovery for that individual, Yoshida said, but the problem is a common one.

[ColemanMaskell]

11. Alcohol + Tylenol/Acetaminophen/Paracetamol is long known to be the main problem

The Republic of Ireland passed a law over a decade ago to restrict the sale of paracetamol somewhat -- So you could not buy big bottles of a thousand tablets, and so on. The stated reason at the time was that many people were in a habit of taking the headache tablets for alcohol-induced headaches.

What I wonder about is whether there are other common substances that interact with acetaminophen/paracetamol/Tylenol in the same way, but it hasn't been generally noticed yet.

If the amino acid methionine is taken together with the acetaminophen, then the toxicity is ameliorated. Cysteine (as NAC) is related to methionine and is supposed to work too. Wikipedia tells us that "Paradote was a tablet sold in the UK which combined 500 mg paracetamol with 100 mg methionine,"

[Ruby the Liberal]

25. That combination is incredibly toxic to the liver

Back in college, I knew someone who died from tylenol toxicity. She took 4 before going to bed one night after she had been drinking. Poor thing never woke up.

After that, they put out PSAs on campus about not mixing the two, and to take aspirin or advil if you had been drinking in the last 24 hours (or planned to).

I never forgot that.

[Spitfire of ATJ]

12. 'most common cause of liver injury'

Wow. I thought it was...

[unblock]

27. i would have gone with a pic of glenliver

but then again, the pic would probably have made clear it's actually glenlivet, so....

[Warpy]

13. It's all those damned combination drugs

for colds, sinus headache, flu, and others that contain it. People OD when they take several of them at once when they've got a nasty cold or flu with multiple symptoms they want to medicate. Then they take an extra strength Tylenol because they hurt and their liver starts to fry. It's not just that extra strength Tylenol, which would be fine by itself. It's all that other crap that contains Tylenol.

People just won't read labels, so the best idea is to get rid of the combination products. The one that will cause the most squawking by drug warriors is Sudafed since it can be used in meth production. Oh well, better to have a meth cooker visit 20 drug stores a day to get enough for a batch than kill a bunch of people with Tylenol OD. It's a really nasty way to go.

[etherealtruth]

14. I agree (and so do "they")

Although liver damage can be seen within the therapeutic doses .... its the inadvertent overdose through exactly what you state (in addition to use in combination with alcohol)

[Coventina]

16. I rarely take it. Tylenol does nothing for me.

I know docs love to recommend it, I cannot fathom why.

[etherealtruth]

17. I don't take it either ... I prefer ibuprofen, which is not without its own risks ....

.... but, if I am willingly taking a drug and knowledgeable about its risks ... I at least want it to work (be worth the risk)

[Doitnow]

28. Go to earthclinic.com where there is a wealth of health information.

It's full of natural health aids. Some work, some don't, but at least trying them won't be harmful. Lots of guesswork, maybe, but lots of doctors do just that and only rely on our fabulous pharmaceutical industry for information.

[hack89]

32. Natural does not mean harmless

Without actual scientific testing that could be a very dangerous assumption.

[TexasBushwhacker]

18. I think they primarily recommend it for children

because NSAIDS can cause Reyes Syndrome. Alone, Tylenol does nothing for me, but I was having a big problem with arthritis in my knee a few weeks ago. My doctor suggested Aleve + Tylenol. It did the trick. But I don't drink alcohol and I was only taking more than 3 a day.

[SCantiGOP]

22. For arthritis

There is a prescription drug called Vimovo that is a strong dose of generic Alleve with a coating to lessen the chance of stomach problems. My uncle takes it and he says he couldn't get out of bed some days without it. He takes two a day.
The reason it is prescription is that it exceeds the recommended dose of the OTC medicine, but that is a bonus because my uncle's insurance covers it without a co-pay.

[TexasBushwhacker]

23. My doc didn't even bring it up!

He did tell me I could double the OTC dose of ibruprofen, but Aleve has a better record with arthritis. I wonder if my insurance covers Vimovo.

[etherealtruth]

29. Aspirin is linked to Reyes Syndrome

http://www.mayoclinic.org/diseases-conditions/reyes-syndrome/basics/definition/con-20020083


I don't mean to be an ass correcting you but if anyone has young children and teen's , it important to know the risk aspirin carries risk

NSAIDS are COX-2 inhibitors and may have some serious cardiac risks: http://www.uphs.upenn.edu/news/news_releases/2012/05/risk/

[smirkymonkey]

24. It does nothing for me either - I use external pain patches most of the time.

Most of my pain is stress pain from being at a computer all day or low back pain and I have found that external pain patches (Salon Pas are the best) work much better than pills. I have never really felt any relief from acetaminophen. Sometimes I will use Ibuprofen, but that's about it.

[harun]

26. Depends on the person. Works really well for me for sharp pain type things

like toothaches or headaches.