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FDA Considers Banning Acetaminophen-Based Pain Killers
Greg George writes "The FDA has determined that Tylenol enhancing pain killers are dangerous enough to potentially be pulled from the market. Drugs including Vicodin, Hydrocodone, Lortab, Maxidone, Norco, Zydone, Tylenol with codeine, Percocet, Endocet, and Darvocet may be permanently banned from the US market, even if the patient has a prescription from a doctor. The problem is the key ingredient — acetaminophen — can easily damage or destroy a patient's liver if more than 2000 mg are used per day. In many cases that means if you take a pain killer and then take two extra strength Tylenol, you may have gone over the maximum dosage per day."
As long as it doesn't cause Lupus...
I'm sure "SlashdotMedia" will improve on all the wonders that Dice Holdings blessed us all with
So does House still have a working liver at this point?
Before everyone screams bloody murder, the fact remains that you'll still be able to buy the stuff, separately. Percocet, for example, is actually a mix of oxycodone and acetaminophen. You can buy them separately as Oxycontin and Tylenol (or paracetamol in the UK).
It's the combination that causes problems; people wind up overdosing. Overdosing on the oxycodone portion is not all that dangerous (you could swallow 2 dozen of them at once though I would definitely not recommend it) compared to Tylenol, which can damage your liver. Thirty extra-strength tylenols at once can destroy your liver and you'll die within 72 hours. These medications have acetaminophen in them as an an anti-inflammatory to work with the painkiller, but they wind up being the deadlier part of the drug since people take too much. A few people think they can commit suicide by swallowing the whole prescription, but what happens is the codeine-based painkiller part wears off in hours and then the agonizing abdominal pain of liver failure begins until they're dead 3 days later.
You'll still be able to buy the separate ingredients, hydrocodone is Vicodin and Norco, oxycodone is Percocet, etc. There are other formulations; Percodan is nearly the same as Percocet except it uses aspirin in place of acetaminophen (Tylenol)
The problem is the key ingredient - acetaminophen - can easily damage or destroy a patient's liver if more than 2000 mg are used per day.
Disclaimer: Not a doctor or med student but my three sisters are nurses/researchers.
My older sister warned me when I started college that if I was going to drink I should avoid acetaminophen at all costs. Luckily, I don't get headaches or have had a need for a painkiller in a very long time and I think it's been about six years since I've taken them. If you are a heavy drinker, avoid acetaminophen as your liver's already dealing with the alcohol and crap in the American diet and doesn't appreciate it. My sister told me that people who use acetaminophen during hangovers may be putting themselves at a much higher risk for liver diseases. I'm a little concerned these have been out for this long when there's safer alternatives. I'm sure the companies that stand to profit have tons of tricks up their sleeves yet.
My work here is dung.
As someone who was prescribed Percocet after reconstructive surgery (my arm is full of plates and pins) the effect they might have on my liver was the furthest thing from my mind. Even had I known of this risk, I'd have not been at all hesitant about the drug.
Its also pretty hard to read that list and not assume the FDA is banning some of the more commonly abused pharmacuticals. Because, ya know, prohibition is totally what people want from their government.
A little inaccuracy sometimes saves tons of explanation.
Which is why my doctor tells me not to take any medication containing acetaminophen other than those prescribed, and the form I have to sign when I pick my prescriptions repeats that warning.
It seems to me that the majority of these pain killers are extensively used to treat pain. I took Percocet and Vicodin on occation after I was injured in the military.
What will replace these? I hope the FDA advisory panel which is recommending the FDA ban these has a backup plan to ease pain. The article says basically that doctors will have to explore other avenues of treatment, but wouldn't these acetaminophen based pills be the best already? So, then we have to go to a sub-standard method of pain relief? (maybe necessity will spur the development of safer pain killers?)
I for one, would rather risk damaging my liver over having incapacitating pain for weeks on end.
Would it not make more sense to educate the people taking the pills, instead of banning an effective pain reliever? Anyone taking a vicodin and then two Tylenol is either in serious pain that the hydrocodone is not treating, or is unaware of what is in vicodin. A little talk by the pharmacist or doctor can fix both. Lowering the dose of APAP in prescription pills makes sense too, I mean 650mg in Darvocets? Take that 4 times a day and you are already over the daily dose. All of that just to prevent some junkies from getting high?
Not that I will argue too much, since I can't take Aspirin or ibuprofen, it will be much easier to get a script for pure codeine.
I'm borderline stage 3 and 4, and currently the only OTC pain killer I can use is Tylenol. If I receive my kidney, I would be receiving pain killers in the listed group for pain management. All the other pain killers I know of metabolize in the kidneys, so what exactly do they propose for people in this situation? Opiates that attack the liver and the kidneys perhaps?
Ah hell, I've got to read the article now. Damn it, I don't want to give up the AC cred. :)
The problem is with the idiots that take 1000mg and then cant wait for it to work so they take another 2-4 in an hour or so.
The people that are stupid and dont read the bottle that says" DO NOT TAKE MORE THAN XXX in a 24 hour period." It's clear as day on the fricking bottle.
So we ban something because the average person is too stupid to read the bottle?
Can we ban water as well? if you drink 6 gallons in an hour it will kill you!
Do not look at laser with remaining good eye.
Do not welcome our nannystate overlords.
Seriously why do we have to keep legislating everything.
Soon after Government run healthcare they are going to tell you want you can and can't eat.
Hope you Enjoy cardboard for the rest of your life
Elections have Consequences.
The FDA made the drug companies put acetaminophen into the narcotic painkillers to keep people from recreationally overdosing on them (same as they "denature" ethyl alcohol that you can buy at the hardware store by poisoning it with methyl alcohol), and then when druggies take large doses anyway and cause liver damage and death, the FDA is *surprised*?
If this is an issue with miss use, then pulling it from the shelf seems ok; however not letting a doctor prescribe it is just stupid.
The Kruger Dunning explains most post on
What is being proposed is not a wholesale ban on acetaminophen but a ban on *some* drug combinations that include it and a reduction in the maximum OTC dosage. The drug will still be available and you'll still be able to mix drugs yourself to get the old effect.
I am becoming gerund, destroyer of verbs.
... good.
My prescription is 7.5mg hydrocodone, 500mg acetaminophen (standard - though there are a few variations on the amount of hydrocodone). The FDA has enforced that amount of acetaminophen, for two reasons. Hydrocodone is relatively addictive, and acetaminophen often induces a huge amount of nausea. This acts as a deterrent for anyone trying to "get high" off of the hydrocodone. Second, acetaminophen is a pretty decent pain killer, which hey, if you're taking lortab, that is the whole point.
My problem is the raw nausea induced. It's not uncommon for me to need to take one, and then develop a severe stomach, erm, 'problem' to the point where I can't do anything until a couple minutes after I've emptied my stomach into the nearby toilet. That is solely a side effect of the acetaminophen.
The "hey my liver is going to live" is a bonus effect from the removal of acetaminophen as far as I'm concerned.
The problem of course - is what they'd replace the acetaminophen with, should they want to continue shipping lortab (and friends). I somehow doubt it'd be any better in terms of side effects.
But I can hope.
Well, the same can be said for alcohol, let's ban that. Wait, we tried? And failed? Damn.
We should probably ban water, too, then. After all, if you're holding your wee for a Wii, too much water has proven deadly.
Truth be told, in moderation, most things are fine. If you're too stupid to follow the directions given by your doctor/pharmacy, you deserve a little bit of liver damage. Since the liver is your only organ that regenerates, you probably won't even die.
But then I realized the cable was blue, so I only gave it one star. I hate blue.
Also, if you take any of these pills and then drive your car into a telephone pole or across the median of a highway you could die. Also, if you don't take any of these pills and then drive your car into a telephone pole or across the median of a highway you could die. I think this is a classic case of "don't do that, stupid"
Hydrocodone has 0 requirements to be "cut" with acetaminophen. Neither does oxycodone. It's just done as a way of limiting a patient's intake of the various painkillers that are mixed with acetaminophen. Look at the dosing for Vicodin for instance (I had neck surgery a while ago for a herniated neck disc & did a bit of research);
- 5mg hydrocodone for 500mg acetaminophen
- 7.5 for 750
etc
Similar ratios with oxycodone.
So you really end up being limited by the amount of (unecessary) acetaminophen which has _nothing_ to do with the RX painkillers in question. The fact that liver damage etc is so prevalent with acetaminophen simply means they need to remove that component of it, and people consume that as as seperate pill.
Such silliness. Don't force people to take acetaminophen if they don't need it - damage from that is a very real problem with these painkillers. It makes no sense - "let's prevent people from overdosing on the painkiller by adding in something that will cause liver failure if they take too much of it!" "omgz grate idea I just happen to have a great deal worked out with this acetaminophen provider. We'll all get rich!"
For some fresh drama on an aging "House, MD"
slashdot: where everyone yells sarcastic metaphors to themselves to understand the issue
-Pointy sticks
-Firearms
-Automobiles
-Anything harder than nerf
'Cos you know, you could kill yourself if you used those things improperly.
So when will the FDA ban alcohol for destroying people's livers?
Seriously here. Why not make sure that there are STRONG WARNINGS on these drugs and require that they also place the warnings on TV Ads (not just in the small print, but actually required spoken warning about exceeding the 2000mg limit, and mention that other drugs like prescription pain killers may also contain this substance and to check with your doctor). I mean, if people know that over-dosing on this WILL seriously damage and potentially kill your liver, they will pay a little more attention to how much they are taking...
As it currently is, with the current ads and warnings, more people think that something like Tylenol with Codeine is pretty safe to take. I mean, its Tylenol, safe for your stomach (too bad just not necessarily safe for your liver).
We were all warned a long time ago that MS products sucked, remember the Magic 8 Ball said, "Outlook not so good"
Seems like a lot of people having problems overdosing on this stuff.
They are considering banning them from being put in the same pill as other drugs. You will still be able to take them as separate pills.
This is actually seems to be a good thing.
"...prohibition is totally what people want from their government."
Some people do. I mean not what THEY enjoy, just what others seems to. F'n neo-cons.
The Kruger Dunning explains most post on
JMO, but...
I think people who want to use a hair dryer in the bathtub should be encouraged to.
If you're old enough to read and you want to eat those little silica gel packets marked "Do Not Eat" the government shouldn't stand in your way.
And last, I think "hold my beer and watch this" events should be televised.
In short, the gummint is pissing in my gene pool.
we see things not as as they are, but as we are.
-- anais nin
I guess I had better stock up on some of this shit
I have a bottle of 1000 acetaminophen sitting right here... Maybe it's time to stock up as I love the black market in my nanny state of America.
If you can't be bothered with the fact that taking more of a drug than perscribed can hurt you than one of the following is true.
1. You are in such pain that you don't give a fuck (your doctor should have gave you better drugs but the DEA would kill him)
2. You really are just taking the shit to get high and are dumb and thus should die.
3. ???
4. Profit!
I just got a bottle of Vicodin for a root canal last week. My girlfriend has an even bigger bottle of Valium for back problems she's having. Luckily neither of us are in as much pain as was anticipated so we're not using it up very much. I guess we'll have to milk them both for as long as we can.
Even though I was concerned about taking the maximum daily limit of vicodin and then percocet, my doctors dismissed my concerns as all they really care about is treating my spine/nerve damage. Well now that my pre-surgery tests show that my enzyme levels were high, you would think that my neurologist and neurosurgen would care. Nope.
After switching doctors, my new neurologist has the same careless attitude towards how many percocet that I take daily. My he proscribes up to 6-500 mg per day. According to this recommendation I feel bitter about towards the highly uneducated pimps that call themselves doctors. So not only was my spine surgery not successful I know have to deal with liver damage.
Maybe taking 2000 mg in a day long-term could be dangerous (you could probably extend that theory to many drugs both prescription and non-prescription) but what about for the occasional headache or body ache? You know, what most people use these drugs for? Yet another example of the government legislating something away because a small percentage of people will or could abuse it.
My mom always said, "Jim, you're 1 in a million." Given the current population, there are 7000 of me. God help us all!
One problem with the substance is that the doses in which it's effective are so close to the doses in which it's toxic, as mentioned.
The other problem is that you can take a fatal overdose, and you'll be fine for three days. Then you die very horribly indeed.
A lot of the time a suicide attempt is the proverbial "cry for help". Someone overdosing on acetaminophen might take their overdose and fall asleep in a tearful puddle, feel emotionally purged and a lot better in the morning. And then discover a few days later that they are the walking dead.
Most other drugs have the virtue of making you feel ill enough to seek (or attract) medical attention. Some of them you can just literally "sleep off", with enough support.
That said, it's an excellent drug. Safe, when taken as prescribed, very few side effects, and effective, as evidenced by the enormous number of combination preparations containing it - it reduces the overall dose of opiates that need to be taken and that's a good thing.
The downside of this profligate mixing with other drugs of course, is that if you're not 100% clued up on which preparations you are taking, you might take an overdose.
I'm an ex-doctor. I had no idea that Vicodin contained it until I read TFS. I've never prescribed the stuff though. If I was living in blissful ignorance every time Greg House popped a little blue pill, imagine what the general level of knowledge is amongst Joe Public.
The tinfoil-hatted part of me thinks that they only mix acetaminophen with opiates to stop junkies abusing them anyway. Who'd be stupid enough to take a fatal overdose of something that doesn't even get you high ... oh , wait, the general public, after we spent so much time and effort dumbing them down...
In many cases that means if you take a pain killer and then take two extra strength Tylenol, you may have gone over the maximum dosage per day.
This is only a problem if that initial pain killer also contains acetaminophen. Alternating Tylenol with an NSAID (e.g. ibuprofen, aspirin) is a commonly recommended way to deal with short-term acute pain.
The basic problem, which has been known for decades, is that the level of acetaminophen required to effectively treat pain is unfortunately fairly close to the level that does harm.
#DeleteChrome
Acetaminophen is quite toxic, and some individuals are particularly susceptible. Matters are made far worse by the fact that usually by the time toxic symptoms are recognized, it's too late to save the patient.
hold the presses - late braking news: over-dosing on a drug could cause harm? Seriously - do we need to ban everything where taking too much could result in harm?
People don't understand that drugs are dangerous.
If the doctor prescribed it, it must be safe right? And they intentionally recommend lower doses than would be lethal, so you have a little room, right? I mean, I'm not like the other people who die taking it, I'm only taking a little more than recommended. If it didn't work, I must have missed some. I took it with food, that slows down alcohol absorption, so I can take more because I ate and it will be slowly absorbed and it will be fine.
All of these thoughts make sense by themselves... but you take that extra bit and it suddenly goes from completely safe to dangerous.
I think the point here is people should be scared of drugs - but they are so common these days that fear is completely lost. If a few people die, the drugs get taken off the market. I'm currently taking something that killed 6 people - now the paperwork around taking it is incredible. It takes so much documentation and checking to make sure that I'm still supposed to be taking it - every month. Over 6 people, it was taken off the market and reevaluated and additional paperwork and process created.
So there are two sides to this. One, people see that drugs are carefully followed and should be safe. Two, people SHOULD see that drugs are scary and powerful and need to be respected, but all they see is the safe side, because of the logical fallacy that you won't be the one. Sure seat belts save lives, but I don't get in accidents. Sure cars get hot, but I can leave my dog or kid in it - I'll just be a FEW minutes, not like those people whose kids or pets died. Or sure other people need to pay attention when they drive, but I've got it under control.
People don't get it, and you can't make them get it. so you either have to accept that people will die, or make it impossible for them to die. In my old age, I'm inclined to agree with this. Take it with another pain killer and die, take it with alcohol and die, so people can't be trusted. Personally I'm all for Darwinian self de-selection for the gene pool, but as an enlightened society we have no choice but to make it difficult for people to kill themselves accidentally.
As those who prescribe narcotics already know, opioids when combined with acetaminophen are considered Schedule III where as those without (like oxycodone, oxycontin, morphine, dilaudid, etc.) are considered Schedule II. Many physicians are uncomfortable with prescribing Schedule II medications. Schedule II medications, as per the Controlled Substances Act are considered to have a higher abuse potential. Prescriptions are limited to a 30 day supply and any refill (given 1 month at a time) requires a doctor's appointment. Schedule III drugs such as Norco and Vicodin may be refilled up to five times within a six month period.
Does God treat us as servants or friends? Check my homepage.
As a nurse, I know that the current FDA limit is no more than 6,000 mg per day for up to ten days. Where is this new number from?
Paracetamol's problem (acetaminophen) is that it's effective dose is quite close to its toxic dose. I have often wondered why the tablets aren't sold with the antidote, acetylcysteine, mixed together and usually concluded it was down to the additional costs involved - which of course invites a comparison of those costs against those of treating overdose patients.
As someone that is allergic and/or hypersensitive to everything except Tylenol, I guess I'm screwed if I need one of those types of drugs then, huh?
Wonder how long it will take them to ban Tylenol itself.
Thanks a lot for treating me like an idiot.
These FDA morons are going to get a letter from me. Not that it'll do any good, since modern government doesn't listen to the people anymore. Not really.
This is a sig. Deal with it.
You can also drown in just three inches of water.
OH MY GOD, BAN WATER!
Who could take two grams of acetaminophen?!? My god, that is a lot of stuff! While we're at it, let's ban water, because if you drink like 1/4 gallon or more at one time, you could die!
I think nearly any any drug is dangerous when taken in such large amounts.
Yet we still allow cigarettes to be legal even though we know for sure that they cause lung cancer.
I heard doctors discussing this on NPR this morning state toxicity was 6 grams for a single dose (or narrow window), and 4 grams daily over a longer period.
It must have been something you assimilated. . . .
I've always been under the impression that acetaminophen is added to narcotics mainly for the purpose of making it so one cannot take large quantities of said narcotic without getting sick. So, I'm not really sure what the problem is here... they shouldn't have been mixed in from the get go imo. The only good thing that comes of including it is that it's able to regulated less strictly that way. (I'm side stepping my opinion on regulation here.)
I'm a Type II diabetic. One of the medications I take for it is glypizide, which increases my insulin production, lowering my blood glucose level. If I took too many, my bg would get so low I'd pass out and possibly die. Does that mean it should be banned? No, of course not; it means that I'm given instructions on how much to take and when, and I follow those instructions. Give patients using these drugs instructions that include not taking other, non-prescription pain killers with them (or listing which ones are safe, and in what dose) and trust them to do as they're told. Most people will follow that type of doctor's orders, especially if it's explained why and it's not just an arbitrary order. And don't point out that some people aren't smart enough to understand, either, because it's the people who are smart enough to "know better" that are the problem. The "left side of the bell curve" is more likely to do what they're told because they understand that they don't know better.
Good, inexpensive web hosting
think that maybe, just maybe if you are too stupid to READ THE FUCKING LABEL on the medicine you are taking, we ought to weed you out of the gene pool anyways...
I'm one of those people that can't even acknowledge the "won't happen to me" fallacy, even if I am shown proof.
I think its mostly related to the feeling that I'd rather be dead than scared of something killing me all the time
This actually happened to me. A few years back I had open heart surgery. After spending a week in hospital, I was released with a big fat percocet prescription (having your sternum in 2 halves is remarkably painful). I was told to "try" to get by on Tylenol, but to take the percocet if the pain was too much. Funny thing about narcotics...it's pretty easy to forget how many and exactly WHEN you last took the medication. In 3 days, I managed to completely shut down my liver by taking two percocets every 4-6 hours. Back into hospital I went and it took about a week for my liver to "wake up." It could have just as easily failed permanently and resulted in my eventual death.
The doctors and nurses who were responsible for prescribing the medication did a lot of finger pointing about WHO should have let me know about the risk of hepatic failure, but the end result was "you should have known better." I'm a programmer, not a doctor...for fook sake.
Also, as someone else mentioned, it is remarkably easy to destroy your liver when you consume alcohol along with acetaminophen. That should be a big bold warning on the label, not fine print.
Best,
Anyone taking medicine should know they have to check for drug interactions and overdoses. The medical industry has been harping about it for years. If the product they offer is safe when following the directions, then it's not their problem if people do stupid things with it.
Childproof caps piss me off too. *I* have to push down when I turn them, just because YOU can't control your kid. Kids have gotten stupider since we've gotten childproof caps. The ones who don't read anything on the bottle like drug interactions / overdoses / cap removal instructions are still living long enough to reproduce.
I'll be first to admit I do not have the worse back problem, and (thankfully) there is no pins, breaks, etc.. I have mild scoliosis
They cannot operate and my doctor knows very much how many tylenol I use and I've told him I'm worried about my liver and other health issues dealing with aceta... use but completely refuses to use anything else to eleviate my pain.. Which btw, I can't completely make someone without back problems understand but keep me in bed most of day is prolonged and with me 24/7. There are times where it feels like someone is popping my head of my neck like a dandelion and I can't think straight, drive or even walk because of the pain. Granted I'm in canada, but if this happens in usa I'm pucked if the ban comes here. I'd rather not be on pain killers at all, and definitely not on anything like oxy, morphene, etc.. but only thing that works is codeine so far, and even then my doctor refuses to up my dosage - even if I can't take more than my usual dose without being sick. I've tried physio, yoga, acupuncture, gym, and a bunch of other things without helping at all. + Advil and other meds such as anti-imflamatory, etc.. has been tried and totally failed. Even some replacements to codeine have me popping 8 or more tylenol during day.
I guess what I'm saying here is that nobody in pain wants to be in pain of course but they will take what they need to to be productive, get through work/sports like I do. Until they figure some new kind of miracle drug they should not remove one of the only solutions people have to help them manage pain. Alot of doctors are scared to put people on narcotics, and rightfully so in alot of cases... and what about regular people who have pain? and those who other solutions don't work (advil, etc..)
I dunno. I wanted to rant, because this is something I'm familiar with and just sorta ticks me off
Geo
"We put the KILL in pain-killers!"
If telephones are outlawed, then only outlaws will have telephones.
http://www.enotes.com/1930-medicine-health-american-decades/food-drug-cosmetic-act
The link describes "The Food, Drug, And Cosmetic Act Of 1938" amending the FDA's scope to include medicines. An antibiotic drug was mixed with the solvent diethylene glycol. Similar to acetaminophen, diethylene glycol is poisonous to the kidneys and liver in higher doses. Many people died from consuming too much of the drug. So, this exactly the role FDA has in protecting consumers, including patients.
2000mg is not the daily limit for acetaminophen; 4000mg is. 2000-3000 is the limit for "at risk" populations (e.g. existing liver disease). The linked article doesn't even mention a dosage limit. You can take your 2 Percocets and 2 extra strength Tylenol and still be under the dose limit; that's only 2300 mg even with the high-dose Percocets.
It's one thing to be concerned about an overdose and set a dose limit; it's a completely different thing to arbitrarily lop the max dose in half to cause hysteria.
my wife sees it all the time - dead livers. The concern isn't for people taking this on prescription. They can get a different preparation if necessary. Good riddance. Better yet, get rid of the whole prescription regime. Many doctors are sick of being the narcotic gate keeper. On one side is the DEA looking to pull your license and prosecute, on the other a patient who may or may no be in pain. It's the doctors responsibility to correctly identify drug seekers. Chronic pain rarely kills. What would you do if your livelihood could be taken away for prescribing narcotics to a patient who you believed to be in pain, but was a very clever junkie? I have a feeling there are a lot of chronic pain sufferers that aren't having their pain managed correctly because their physician fears being accused of over prescribing narcotics. More senseless shit brought to you by the War on Drugs. As the late but not so great Bill Hicks said - it's not a war on drugs, it's a war on personal freedom.
46 & 2
You'd be surprised how many college kids don't know this, drink while they have a headache (or worse yet, a hangover AND drinking) and they die from liver failure.
Last year when I came across the story the number of deaths from "Non-Steroidal NSAIDS" (including Tylenol) was 8,000 in a year. (!)
--- For a good time mail uce@ftc.gov
Any time I see a "new & improved" version of a drug or an FDA ban, the first thing I think is that a patent is running out on the old version and something has to be done to keep generics from competing.
I think the most recent I remember is Lamictal. The "new and improved" version did everything the old one did plus DISOLVE ON THE TONGUE or something silly like that (also, it's patent is not expired so anyone who wants the "better" version doesn't get a generic option)
As the article points out, more pills = more errors. This is a stupid idea.
All of the above painkillers require a prescription. It boggles my mind that both the doctor and the pharmacist don't tell the patient, "Don't take OTC Tylenol while you're taking this, or you will die of liver failure. Take Advil instead. Read the label of anything else you take to make sure it has no Tylenol in it. When in doubt, call first to ask."
There is a reason we have the whole doctor/pharmacist/prescription system in place. It's to prevent these types of errors. All too often, pharmacists just dish out the pills and help the next person in line.
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
As a pharmacy student I can tell you that Acetaminophen is there mainly to prevent the abuse from the harder opiate drug. If patients try to abuse the acetaminophen containing drug they'll most likely get sick from the acetaminophen before they get too high off the painkiller, thus preventing abuse. If these drugs are pulled from the market, I can only see the separate drugs (oxycodone, hydromorphone) being prescribed with the doctor telling the patient to take it with Tylenol. This opens up the fact that patients are more likely just to take the opiate drug without the Tylenol, getting addicted, and causing even more problems.
It's the responsibility of the pharmacist to tell the patient how much acetaminophen to take in a day. I've been taught and trained to counsel the patient that they can only take a maximum of 8 per day (based on if a tablet of Vicodin has 500mg of acetaminophen, for example) because of the liver problems that acetaminophen may cause. And last I checked, maximum daily dosing on acetaminophen was 4000mg per day, not 2000.
I think a lot of people are missing the point, here (not everyone, but many). This isn't about banning acetaminophen at all. NOBODY has even hinted that's it's being banned. What may be banned are drugs that include acetaminophen, usually without the consumer's knowledge. Take Vicoden for instance. I had no clue it has acetaminophen in it. There's the big problem. I take OTC acetaminophen just like it says on the bottle, I also take 4 Vicoden, and I've went over the acetaminophen limit for the day.
So from a doctor's perspective I think there are a ton of bigger issues here. First of all, one of the first submitters said that you will die after 3 days after a Tylenol overdose. Not true. You will have liver failure and then try to get a liver transplant and then die.
Second, I think that one of the major reasons they are wanting to pull these prescription drugs off the market is the abuse that they create. I can give someone percocet and they will sell it on the street for quite a bit of money. Also there is the opportunity to get oxycodone and the like (oxycotin, etc), but these are abuse even MORE. Also we have had people die by taking too many oxycodone because it suppresses the respiratory drive and you just stop breathing... no oxygen to the brain = death.
Also you can take up to 40 mg/kg in one dose... For our "average" (not so average these days) 70kg male that means you can take 2100 mg. But also the other maximum dosage that we go by in the emergency department is 4000 mg/day.
I think the REAL reason this is being brought up is more the addiction, overdose, and the like. I can definitely tell you as a doctor that if percocet and vicodin are taken off the market, I will NOT be prescribing just oxycodone. You'll get more of ultram and the like from me. Probably a better solution and safer. It would decrease the risks of such pain medications.
And on a final note, we have been seeing more and more people who have taken many percocets and have actually had hearing loss associated with it and needed cochlear implants. Kind of a scary thought. I would think that if the Tylenol is taken out that people would be taking more oxycodone then and obtain this hearing loss.
Anyway, that's all. Please comment.
When you get your prescription for these drugs filled the pharmacist tells you not to take Tylenol with it. Your doctor should be asking if you're taking Tylenol. They're doing their jobs.
The specific combination of drugs is also important. My husband requires brand name Vicodin (at a premium cost) because there's something about the way they make it that just works much better than generics for him. Getting hydrocodone and taking it with Tylenol isn't going to do that.
If people can't read the labels and aren't following instructions then they're going to find another way to fuck themselves up. If you sell the narcotic separately do you really think for one moment that they're not going to abuse that? "Take one of these with 2 Tylenol every 4 to 6 hours" = "Take a whole bunch of the good ones and screw the Tylenol" in those people's minds.
I don't see taking a highly useful class of drugs off the shelf because people are stupid. Who do I write to stop this idiocy?
I think I'll need a citation for this one. I find the logic suspect that a typical recreational drug user would avoid abusing Oxys out of concern for acetaminophen overdose.
The article claims that acetaminophen and oxycodone, et al, are packaged together because they act on different pain receptors. I find this explanation to be far more believable than yours, sorry.
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
They are not. They are considering banning combination drugs that include acetaminophen, because there have been fatal overdoses when people additionally took acetaminophen.
I think there's a bigger problem if you've already taken your PRESCRIPTION pain-killers and then you still take Tylenol. At any rate, I prefer acetaminophen because it fixes my headaches and doesn't need to be taken with food like ibuprofen.
In the UK you can only buy ~Qty. 10 (I forge the exact number) Acetaminophen at a time at supermarkets, the checkout computer blocks or requires overrides.
I also remember watching "Tomorrows World" as a kid, and one program had mentioned and "invention" of putting the Acetaminophen andtidote in the tablets so you couldn't overdoes or have liver damage. I'm assuming it was N-acetylcysteine (NAC) , but it could have been somethign else. This was TWENTY YEARS AGO. But for some reason lost to me and probably a lot of people it never happened.....
This is good for me as I'm allergic to acetaminophen. It could kill me so I'd have to make sure I didn't get any. My dentist who was made aware of my allergy unwittingly prescribed Hydrocodone to me, my pharmacy missed it and luckily my wife knew Hydrocodone contained acetaminophen otherwise I wouldn't be typing this.
....... Thus ends my attempt at wit or whatever
I've suffered from a chronic form of cancer for three + years now and I have a perscription for one of the "recommended to be banned meds."
This is insane. A few asshats abuse NyQuil (uncontrolled) and the FDA wants to pull all the carefully controlled meds from the market while leaving said NyQuil ON the shelf?!
People like myself are beyond outraged and I'm now drafting a letter to the FDA explaining that if these pain meds are taken off the market, all you're doing is making the people who truly need them suffer while allowing said asshats to abuse the same meds.
Remember how we in the USA kept making fun of the USSR's 'secret police' in the mid 80's? Why isn't anyone outraged that Russia and the US have swapped paranoia?
Short answer: NO
We have two alternatives: (1) Educate people to understand that a little bit of acetaminophen can enhance the pain relief from opiates, give then an opiate prescription and advise them to take a few Tylenol (with a clear warning that they can up the opiate dose, but not the Tylenol dose, if they aren't getting enough pain relief). The Failure Mode is that a few people who might benefit won't understand to do this, and will get slightly less effective pain relief, and perhaps take a bit higher dose of opiate than they would otherwise. But the hazards of opiates are generally less than the hazard of acetaminophen (2) Sell the drugs as a combo, and try to educate people to understand that they shouldn't take extra pills, no matter how much pain they are in. The Failure Mode is that people who take extra pills because they don't understand, or because the pain is so overwhelming that they can't think straight, destroy their livers.
And of course, there is also the abuse problem. Pain relievers are often abused, particularly by teenagers who are unlikely to understand and appreciate the risks of acetaminophen (it's just Tylenol, right? They wouldn't sell it over-the-counter if it wasn't safe!). It is unlikely that the acetaminophen ever dissuaded anybody from getting high on Vicodin. And while a pain pill habit is a bad thing, it is not nearly as bad as liver failure.
These combinations were always a stupid idea. The give only modest improvement in pain relief, they don't really prevent abuse (ask any teenager if the kids in his school are passing around "pain pills" to get high), and they result in a large number of cases of liver failure.
the issue is not education, as everyone getting a medical degree in anesthetics is impractical, nor is it competency and monitoring, as these celebrities are people who certainly could afford that, and still wound up dead. the issue is the fact you are dealing with addictive substances and intolerant thresholds to real damage and death
banning is superior to warning, as simple human nature is incompatible with responsible use of these substances. warning simply doesn't work
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
The problem is that most people think the company with its army of lawyers has said that the limit should be 4 pills per day because they know people are going to take more than that and if they print the limit as 4, and the real limit is 8, less people are going to push it. Anecdotally, I've read an OTC medicine that said "take no more than X" per day, but had a doctor say if you're really hurting or really sick you can take "Y" ammount and be OK, just don't do it everyday. For example, the generic ibupropen bottle I have says take no more than 8 pills per day (1600mg), but I have an Rx for 800mg tablets, taken 3 times a day for backpain, which other than being bigger, are the same as taking 4 OTC 200mg ones. Why should I take the 1600mg limit on the bottle seriously when the doctor says go for it pretty frequently when my back flares up.
The problem with the nanny state is when they complain about everything, and put warning labels on absolutely everything because somewhere one person didn't know that a pack of peanuts could contain peanuts, they start taking everything with a grain of salt, including the really important ones and assume it is all there to cover the company's ass to protect against the family that sues because Timmy didn't know that taking 16 tylenols aren't going to make the problem go away faster.
While we're on the subject, APAP "PM" formulations with sleep aides in them serve no purpose if you're awake do to insomnia and not pain. My parents both take them all the time to adjust to shift-work changes which I know would be better if they took just the sleep aide for. It is one of those things that is in everything, and has been around for so long, and is so easy to get that no one questions it.
Forgive my spelling from time to time. I'm often posting during short breaks.
Thanks FDA. Now I look forward to unmanaged pain.
Those of us on Coumadin aka Warfarin (that's a lot of us, it's daily and permanent) can't take ibuprofin because it significantly disrupts blood clotting rates ("thins the blood" too much, prone to hemorrhaging), and only acetaminophen can be taken to manage pain without prescription.
Good thing my headaches can be cured with a shot of whiskey, now that the FDA is worried I'm stupid enough to OD on Tylenol.
Can we get a "-1 Wrong" moderation option?
...the wrong week to quit drinking.
Have gnu, will travel.
and drug seekers everywhere rejoiced
oxycontin for every kid with wisdom teeth :)
If they successfully put through this ban, how long until they ban acetaminophen outright? Like another responder said, it won't prevent the mixing of acetaminophen with codeine based medications to get the same effect.
As it is now, acetaminophen is one of the few OTC analgesics that are in the mainstream. You have aspirin, acetaminophen, ibupophin and naproxen. Doctors are shying away from naproxen as there are poswible detrimental side-effects, ibuprophin has had its share of kidney related complications, etc, etc.
Me, I can say there were times that between vicodin and extrastrength tylenol, I probably took as much as 6000mg a day of acetaminophen. I used to take 3 or 4 500mg caplets at a time. Last I checked, I am not dead. I have enough medical issues that I have had a lot of blood work done over the years and never once was there a concern over my liver. Granted, I no longer do that. I choose to live with my pain rather than live under a drug induced mask.
I am not saying there are not risks, but at some point we need to be allowed the opportunity to decide for ourselves. These law, bazns, regulations, etc, often do nothing more than inconvenience the intelligent and/or law abiding citizens of the planet.
Everything out there has the ability to bring harm to us. That is why we develop common sense. Those who don't may find themselves the brunt of a Darwin Award. Take, for example, Dihyderogen Monoxide, it can be very deadly if you do not use common sense when around it. But when use/handled correctly, there is nothing wrong with it.
See here. It states in part that combining hydrocodone with other substances changes it from a Schedule II substance to a less restrictive Schedule III substance. The two example drugs they cite for this are Lortab and Vicodin - both containing acetaminophen.
Happy people make bad consumers.
The problem is, the lethal dose is very close to the effective dose. In addition, the effect of an overdose is not getting sick, its death. It is not a drug that should be sold over the counter. It is simply not safe.
To compound that, it is being misused. It is being mixed with opiates to prevent people overdosing for kicks on the opiates, by mixing the opiates with a substance which is lethal if too much is taken. This is a misuse of Acetaminophen, it is not being compounded with the opiates for the therapeutic effect, but for social purposes to do with our attitudes to opiate abuse.
Something similar happened in the UK with cough mixture. Everyone, pharmacists and doctors, knows that the only effective cough suppressant is codeine. However, in the mania about stopping abuse of codeine based cough syrups, it is sold either mixed with other positively harmful ingredients or not at all. In Gee's Linctus, for example, an optium extract is sold mixed with Quill, which is a truly noxious substance and one of the worst things to give to an invalid.
We need to do a few things. One is to focus more on getting the opiates to people who are sick, stop worrying about people who are sick and need them abusing them. They will not. This implies that if people need opiates, prescribe the things to them, not mixed with crap they do not need. The second thing is we do have to have a rational drug policy which prevents the crime and disease associated with opiate abuse - but what we do not need is to screw up sick people's access to drugs they need in the name of doing this. Not that it does it, anyway.
The third is we need to take Acetaminophen off the over the counter list altogether.
If a doctor wishes to prescribe a mixture of opiates and Acetaminophen, that's a professional decision. There is no reason why Acetaminophen despite its dangers should not be available on a prescription basis, it may have unique applications. But there is every reason why a drug with those characteristics, and to which there are perfectly good over the counter alternatives, should not be sold over the counter, let alone mixed in half the over the counter pain relief and cold remedies.
We should not be telling people to read the ingredients and not take two over the counter pain or cold remedies at the same time under danger of dying. That is just a totally ridiculous, even criminal policy. We should be making sure that any painkiller ingredient where taking two medicines with it in at once will kill you, is not freely available over the counter.
I left hospital recently with a huge stock of this crap - opiate pain relief mixed with Acetaminophen, with the recommended daily dose right at the limit of how much Acetaminophen you can safely take. I got myself off the stuff as fast as possible at the price of feeling some pain. It was a choice I should not have had to make.
Comment removed based on user account deletion
You should have known better. Keep track of your god damn meds and if you are that fucked up by them (wimp) then perhaps you need to find someone to keep track of them for you.
"The FDA has determined that Tylenol enhancing pain killers are dangerous enough to potentially be pulled from the market. Drugs including Vicodin, Hydrocodone, Lortab, Maxidone, Norco, Zydone, Tylenol with codeine, Percocet, Endocet, and Darvocet"
1. Vicodin is Hydrocodone
2. None of these painkillers require APAP to function, the anti-inflammatory effects of acetaminophen are auxiliary. The primary reason APAP is added to these drugs is to make them difficult to take in doses addicts can appreciate.
3. Acetaminophen is STILL effective at what it does and despite the misuse of it from ignorant users it is less harmful to the lining of the stomach than aspirin, does not increase the risk of people taking lithium or have sodium sensitivity like naproxen, and is not as definitely fatal in case of overdose as ibuprofin.
Acetaminophen is not perfect, but there's no perfect alternative and that is the very reason why we need to sustain as many options as possible for the diversity of medical needs people have.
"Most people, I think, don't even know what a rootkit is, so why should they care about it?"
The reason why more than 2g acetaminophen kills you is that your liver has finite supplies of glucuronide, that it attaches to the drug. When that runs out, the other metabolic pathways (I forget which) cause the formation of free radicals that kill you. Glucuronide is cheap, and can be added to packs for little cost. Why hasn't it...?
How about doctor administered only, instead of just COMPLETELY illegal.
If i take about 5000mg of caffeine all at once, wont that damage my liver too, then maybe we should illegalise caffeine too?
If people are stupid with drugs, then that is their fault, in Europe, you have weed which is legal, why are we still in this neo-nazi community where they have to wait to the last possible moment before legalizing something (ie - alcohol) before they realize once legal, then people will be more responsible with dosage, as they will have to become more informed!
My wife is pregnant, and the only over the counter pain medication approved for use in pregnant women is Acetaminophen.
Just because a bunch of idiots are abusing the medications doesn't mean that the rest of us who are not morons should be denied its use. Most of the medications they've listed are prescription drugs that should only be used while under a physicians order. If they need to change the prescribig rules that's fine, but taking the drugs away completely is akin to cutting off your nose to spite your face.
Bureaucracy expands to meet the needs of the expanding bureaucracy.-Oscar Wilde
Then what will I take for that FDA-Sized pain in my ass?
I'm trying to teach myself to set people on fire with my mind... Is it hot in here?
Doesn't anyone RTFA? Not even the submitter?
They are talking about removing the acetaminophen from the prescription meds. They are not talking about removing it from the market entirely.
This is to prevent inadvertent overdosing. Take a vicodin and a tylenol and you are double dosing on the acetaminophen. Most people don't know this.
IMHO this makes huge sense. Any time you combine prescription and over-the-counter meds in the same pill, you risk ODing on the o.t.c.
-
Survival of the smartest... why change anything. Its not like the human species is on the verge of extinction.
I hope it's just those drugs when mixed with acetaminophen.
Because there are some of us who develop a resistance to pain meds.
Being able to access the core medication without acetaminophen is still critical to many of us.
I get about 3 doses of something, then it never works again.
I've known this about myself since high school.
I most acutely experienced this about a decade ago after hernia surgery.
they tried giving me the same drug (didn't know this at the time, found out later by studying my medical record for that visit), by different delivery methods, with vastly different names (and sometimes not telling me what it was even for); but after the 3rd dose of whatever it was, that was it... It didn't work anymore.
Another painkiller was tried with the same results.
This was all noted in my med rec for that stay.
So, asprin, acetaminophen, ibuprophin,,, all worthless to me.
I've been purposely avoiding naproxen just in case I REALLY need it someday.
So if they want to cut something, cut the acetaminophen.
As others have noted, it's like purposely adding poison to otherwise helpful medications.
(think denatured alcohol during prohibition).
Joking about lupus isn't any funnier than joking about cancer or aids. You're not being funny by marginalizing diagnosis, treatment and the patients who suffer from this disease; you're being assholes.
You're a programmer not a doctor? It doesn't sound much like a programmer since programmers are also usually engineers? I knew from all of the documentation since I was in my mid-teens not to take too much acetaminophen. That's a silly argument that it was their fault; its your fault, the information is out there. Were you told to take two pills every 4-6 hours? Lack of common sense is what you have, and unfortunately still alive to spread your genes.
So they want to ban an entire chain of medicine because some people are irresponsible and cause harm to themselves? That makes sense, this is America after all.
Yes, let's protect people from their own stupidity.
I agree in principle with your opposition to a nanny state. But isn't the the whole reason the FDA mandates that some drugs be available by prescription only to protect them from their own stupidity? Considering that these drugs are already only available by prescription, I'm not sure I see the point in further restrictions, since they can be safely used as directed, but ...
It is hard for most slashdotters to understand why banning these meds may be good. It boils down to this:
0- A lot of slashdotters have a libertarian streak and hate government making decisions for them, however:
1- A lot of people are a lot less educated than slashdotters in general.
2- Many people don't know that taking too much pain meds can kill your liver
3- In a civilized society one has to treat even the uneducated or the stupid.
4- Liver transplant or death is *extremely* expensive to society.
So it comes down to optimising the cost function. In this case don't allow painkiller cocktails. It doesn't matter really as the individual components remain available.
They keep more life saving drugs from people then life threatening ones. Ten minutes with the research done by Mary Ruwart will show you that the FDAs existence is counter to their goal. Prohibition will be a net loss.
I'm sure a lot of people will be happy with this. Now they'll be able to abuse narcotics more easily without worrying about liver damage.
The only reason the tylenol is in the super-meds, is to prevent people from ODing or getting addicted to the good stuff.
I think you guys clearly need a greater focus on education. I'm simply not sure which, so help me out.
Either your citizens can't read directions/prescriptions and don't know how many to take, and simply take a random amount of random drugs.
Or they don't know how to call a nurse/pharmacist and ask for help.
Or your communities don't know how to set up information telephone numbers for exactly this sort of thing (we have numbers, like 411, but for other things. One for community information like getting a hold of your local municipal minister/representative, another for talking to a nurse who won't give you medical advice, but will help you to identify an unbottled pill or which pills you can and cannot take together.
Or you don't know how to prioritize actual national problems over insignificant problems that don't kill nearly enough people (by comparison) to be worth all of the trouble.
Or you don't know how to realize that if you don't make it easy for people to intentionally kill themselves, that they'll simply go to more trouble to kill themselves anyway.
Or you don't know how to realize that you government is covering up the fact that they can't solve actual problems by fabricating new problems and then dumbass solutions to those new problems even to the detriment of existing solutions -- like medicating the ill.
It's funny, on of my businesses manufactures a 45-lbs electronic device. We've had to go through all sorts of safety tests to ensure that if someone wants to commit suicide, they can't stick their finger into the box and touch a live electrical circuit even though it's pretty well low-powerred. Funny part is that it's a 45-lbs device. If you wanted to kill yourself, you could just drop the device onto your head.
Of course, you could always just run head-long into a concrete wall.
Maybe that's the education that your citizens need -- how to easily kill yourself so you don't make perfectly legitimate industries go through hell.
43,000 people die each year in car accidents. Let's get rid of those while we're at it.
We should also ban all forms of drinking and driving, not just up to a certain limit. 140,000 people die that way every year.
Seriously, why don't we just ban anything and everything that causes people to die. 2x4s, windows, sidewalks and streets (deceleration trauma :P).
Oh, fabulous, the US is running out of money and so where do they look? Let's ban some drugs that many people use for painkillers. Wow, excellent, now when people go to the 'underground' to buy these, let's arrest them and charge outrageous fines. Beautiful country we live in...
Oh yeah, a big bold warning on a tiny fucking bottle.
The moment you forget when you took your last dose, you should immediately document the next dose. Normally you can take a second does within the time frame as long as you don't keep doing it. As a parent, I know that if we forget when the last dose was, we try to figure out an approximate time frame and then go from there. After that, we both look at the clock and say the time back to each other, repeatedly, so we know when it was taken. If we didn't have the other person there, it would get written down (much like we did with our first child, feedings and changings get written down so you can look at that when asked).
According to rxlist.com, the proper dosage is one or two pills every 6 hours, not every 4-6. The pharmacist probably told you this when you picked them up. Again, if you have trouble remember when your last dose was, write it down the first time that happens. To quote Henry Jones "I wrote it down so I wouldn't have to remember it". LIVE BY THAT!
Again with the alcohol thing. Once you know this, you shouldn't have to read it. I haven't needed to read that on a bottle in years because it's freaking known. Sure, someone else who's younger needs to read it, but once you know it, you know it. Do not drink alcohol with acetameniphen! Am I the only one that doesn't take tylenol if I'm planning to go out drinking?!
While living in mainland China, I've been preferring those based on paracetamol. It works well for me, without any side effects I have noticed. But now spending some time in HK, all their popular pain-killers are based on this acetaminophen, which I had never heard of before. So I held off buying, decided to research a bit online, and then of course, forgot to actually do it. Thanks Slashdot :-P
I've worked in a liver transplant unit, which is where Tylenol poisoned patients land... The whole idea is to make drugs like vicodin toxic in high doses and lethal IV. These are called "Compounded" drugs. They have a maximum dose, over which it becomes toxic. Drugs like oxycontin have no maximum dose (if you are adequately physically tolerant to opiate drugs) It's like similar to the practice of adding an adulterant (e.g. isopropanol, methyl ethyl ketone, methanol, etc ) to ethanol to make it undrinkable. In addition to Tylenol, atropine and aspirin are used as adulterants. The theory is that they will have less value to opiate addicts and it works. Compounded drugs are worth less on the street than uncompounded drugs. Almost Invariably, people who OD (not counting suicide attempts) on the Tylenol portion of a compounded drugs are abusing it. Furthermore, they are usually malnourished alcoholics who already have underlying liver disease... Last of all, most people aren't as susceptible to Tylenol toxicity as the people who get into trouble. I've seen quite a few addicts who were downing 40 pills a day of percocet or vicodin, with no ill effects.
in teenager's underwear
Nullius in verba
So MJ dies, some speculate that it's due to him taking too many pain killers and now this silly idea comes out? Ok, so that maybe a coincidence...
However, what is this nonsense? Pretty much any medication is poison in the wrong dose, doesn't anyone see that this is totally misguided? Poisons are all around us, use too much bleach while cleaning up and end up breathing in poison that was used in wars to kill people. I mean cigarettes are legal and nicotine is poisonous. Advil will ruin your stomach lining in wrong doses (or even in normal doses if you have an ulcer.) Antibiotics are great, but will kill your flora and you may end up sick because of that. Too many vitamins can kill you.
This is stupid and retarded, I just had a root canal done a couple of months ago, without Tylenol with Codein I wouldn't be able to do anything without bashing my head out for a week at least (I was on antibiotics for a week before the doc could even freeze the tooth, the first time he couldn't even freeze it.)
Terrible, good thing I have a huge stash.
You can't handle the truth.
For the international audience:this conversation is about paracetamol
Patent litigation: A doctrine of Mutually Assured Destruction... in which everyone seems willing to push the button
You're not worth the karma points so I'm replying as an AC. Fuck you. 2 tablets every 4-6 hours was typed on the fucking prescription bottle. So I'm supposed to research my meds and the prescription instructions in advance of taking them when I'm recovering from open heart surgery. mmmm-kay...
Idiot.
Anybody? Believe it or not plutonium is less toxic than acetaminophen http://www.chemistrydaily.com/chemistry/Plutonium
Did you know 80 to 90% of the moderators on slashdot wouldn't recognize a troll even if one dragged them under a bridge.
You would see an overweight guy. Pushing 250 pounds.
I wish there was some easy way to tell if I am getting the right dose of common OTC drugs. I suspect that the safe dose for me for Acetaminophen is pretty much the same as it is for anyone else. But is it the same for other drugs, like Loratadine or Ibuprofen or Naproxen ? The FDA should publish better information as well as the black box warnings.
presumably the dose is calculated based on some "average human" but there must be some smaller people that are ODing without knowing it.
Nullius in verba
> The problem is the key ingredient -- acetaminophen -- can easily damage
> or destroy a patient's liver if more than 2000 mg are used per day.
Yeah, but 2000 mg in one day? Come on, who needs that much? What are you trying to do, anesthetize yourself at home for DIY surgery?
Okay, so if you take over 2000mg of acetaminophen every day, you can hurt your liver. Did you know, you can also hurt your kidneys by drinking more than twenty quarts of water a day? It's all about dose.
I've only once had pain that half that amount wouldn't solve permanently, and that was an absessed tooth. (What *did* take the pain away that time? Amoxycillin. Took one of those babies, and an hour later the pain started to subside. Within four hours, the pain was totally gone. You better believe I took those things as prescribed until the bottle was empty. Never try to treat a symptom when you can go straight to the cause.)
For any *normal* amount of pain, 250mg of acetaminophen is enough, or maybe 500 tops. And I know the package says wait four hours before taking more, but, honestly, you ordinarily *don't* have to take more, unless some new cause comes along and creates new pain for a new reason. You take the Tylenol, headache goes away, problem solved, and you don't think about it again until weeks later when you get another headache. Well, that's been my experience.
The other thing is, I cannot think of a single drug on the market that has fewer or less problematic side effects than acetaminophen. The stuff takes away pain and, umm, oh, yeah, if you happen to have a fever, it might bring the fever down some. That's it. To my knowledge, taken in sane doses, it doesn't do anything else. That's quite rare in a drug. Certainly I don't know of any other pain-killer that's nearly so well behaved.
I mean, what else do you take for pain?
Asperin is a blood thinner, which is frequently a bad thing.
Ibuprofen has various effects, a couple of which are more pronounced than its pain-killing (though, granted, the anti-inflammatory effect is seldom a very big problem and frequently useful). Oh, and it's hard on the GI system in an assortment of ways, which is always fun.
Then there are opium-derived things, probably the safest of which is darvocet (which, come to think of it, is generally sold with some Tylenol included). Don't even get started on morphine and so forth; in terms of side-effects, compared to those things, Tylenol may as well be a sugar pill.
OBTW, you know why they can't keep Tylenol in the jungle? Because, parrots-eat-'em-all. Don't hate me; you know you needed a chuckle, or at least a groan.
Cut that out, or I will ship you to Norilsk in a box.
Save me, government!!! My doctor and I are unable to determine the proper dosage of medications for me based on my illness, physical condition, other medications, diet, and financial situation. But I believe that a few hundred bureaucrats in DC can establish a blanket rule that applies to me and everyone else!!! Save me from my and my doctor's incompetence!
Okay, so aspirin and some of the NSAIDs are not for kid fever use because it increases the risk of Reye's syndrome. Now we have a push to ban paracetamol because (not surprising at least for me, looking at the chemical structure) it fscks the liver up (and also why I always advice people to never take acetaminophen for a hangover). So, what of kid's fevers now?
Acetaminophen is much more dangerous than weed, and weed is illegal. At least the Powers that Be seem to be aiming for consistency!
Le français vous intéresse?
Acetaminophen (a.k.a. Paracetamol) is the main cause of liver failure. It should be handled with care and only available by prescription, not over the counter as is currently the case.
Excuse me, but please get off my Pennisetum Clandestinum, eh!
Banning Acetaminophen Pain killers sounds like a dumb idea. People who are on SSRI, etc. antidepressants, aren't supposed to take Aspirin or other NSAID's because of risk of increasing GI tract damage and thinning their blood to the point that it can't clot properly.
OK let me get this straight.
Guns kill people, but they are OK and not banned.
Paracetamol may cause liver problems, but they are banned.
The USA is all f%$cked up!!!!! They need to sort out priorities.
environmental puritans are often opposed to safe and effective means of disposal of nuclear waste
I would tend to parse those comments as demonstrating poor listening skills.
There's a certain kind of person who divides a debate into factions and then argues in terms of the silliest things said on either side. It's usually easy to spot the polarizers in any debate, they tend to lead with labels (e.g. "puritan").
I've discussed environmental issues with a hundred different people, all of whom had different opinions on the subject, and none as silly as the one you quote. I've overheard the kind of silliness you quote in a public hot tub on the other side of town. Disturbed me enough that I no longer visit that pool. I was waiting for their discussion of the environment to segue into Uri Geller, but I lacked the stomach to stick it out to collect on bet with self.
I don't know anyone on the green side of the debate who would concede that "safe and effective storage of nuclear waste" has yet been achieved. Nor do I know anyone on the hard science side of the debate who thinks that "safe storage" of nuclear waste is a slam dunk.
From http://www.world-nuclear-news.org/WR-Yucca_Mountain_cost_estimate_rises_to_96_billion_dollars-0608085.html
The latest estimate puts the cost of research, construction and operation of the geologic repository over a 150 year period - from when work started in 1983 through to the facility's expected closure and decommissioning in 2133 - at $96.2 billion (in 2007 dollars).
Surprisingly similar time line to Duke Nukem Forever, but with public expense dialed up to 11.
From http://blogs.wsj.com/environmentalcapital/2009/02/26/nuclear-waste-yucca-mountains-scrapped-so-what-now/
The draft budget removes funding for the planned nuclear-waste storage facility in Nevada, which has been 20 years and more than $9 billion in the making. A Department of Energy spokeswoman told Bloomberg that President Obama and Energy Secretary Steven Chu "have been emphatic that nuclear waste storage at Yucca Mountain is not an option, period."
It's just the crazy puritans who are unconvinced by a $9 billion dollar dry hole? If you kick a straw man in the testicles, does he go "oooff"?
What's pretty clear about safe storage is that we don't yet have an option where the party who advocates the solution is still around to clean up the mess if the whole thing goes south after billions of dollars of mostly public money is spent. That should give any pragmatic person cause to pause and think.
In any debate there will be factions (on both sides) who make a point of pride of their ignorance and who become more invested in the drama of the debate than the merits of the final outcome. It's absolutely true that I wish upon these people that their obstreperousness boomerangs and smacks them in the face. There's nothing profound about it, it's just a way to deal with a disheartening reality while plugging away for something better.
Ebert said much the same thing, if you read between the lines.
http://rogerebert.suntimes.com/apps/pbcs.dll/article?AID=/20070507/COMMENTARY/70507001
"Ill bet you hated to change your mind," I was told. No, I was happy to. It is a hard and frustrating thing to make a movie, and credit must be given where due.
Your ode to pharmaceutical schadenfreude is way overstated.
There's one thing not mentioned in the summary that is really important. Only part of the problem is the added-up doses. The other part of the problem is that many of these drugs that have acetaminophen in them also have components that are highly addictive. So now you have people who are addicted to drugs with acetaminophen in them (Tylenol alone is not especially addictive), and they take larger and larger doses of the pills to get the same effect. Meanwhile, they're getting higher doses of acetaminophen. Plus, even if you don't up the dose over time, you are still likely to stay on the drug, which means lifetime consistent use of acetaminophen -- until your liver wears out. If you're going to get addicted to a drug, you should pick just one. Don't get addicted to a combination, it's likely to have un-researched problems.
Remember one from when I was working at a research hospital. Takes a while to die without a functioning liver. Expect residents to pop in on you to take a look at the "dumb shit." Probably not what you had in mind?
Sorry to be the grammar Nazi, but you, or perhaps others, might enjoy this bit of orthographic hairsplitting: it's scrip not script.
I can tell this /. thread is going to make my inner GN antsy enough to burn down the Reichstag.
$META_SIG_JOKE
Do not have Lupus, but my liver has failed with no good prognosis. I totally believe this as my life didn't include alcohol or hepititas.
I do this anonymously as it is too late for me, but it might help someone else. Believe It!!!!!
They set you up PERFECTLY for an OD. Thyey actually suggested taking OTC acetaminophen and then doubling up with percocet when it inevitably fails to control the pain adequatly.
It seems that the FDA has been 'uncomfortable' with the lack of more stringent warnings on acetaminophen labels since the late 70s...but never really did anything about it. So there's a great argument to make about the efficacy of the oversight, but the bigger issue is the potential risks for consumers.
I'm fascinated by Tylenol's response, which has been to effectively say that there's no problem. This is in stark contrast to how it responded to the product tampering issue in the 80s. I wonder if it'll do the brand more harm than good?
I've riffed on it a bit if you're interested in checking it out: http://tinyurl.com/re3bbs
I take Excedrin tension headache. One dose has 1000mg and they not to exceed 4 doses in a day. That's 4g of acetaminophen, twice what they say not to take in a day!
Over at the chemistry Daily Website they are talking about much larger doses than are being bandied about here:
http://www.chemistrydaily.com/chemistry/Acetaminophen
However, paracetamol single doses above 10 grams or chronic doses over 5 grams per day in a well nourished non-consumer of alcohol, or above 4 grams per day in a poorly nourished consumer of alcohol, can cause significant injury to the liver. Without timely treatment, paracetamol overdoses can lead to liver failure and death within days. Because of the wide over-the-counter availability of the drug, it is sometimes used in suicide attempts.
Then later on they discuss some of the risk factors:
Risk factors for toxicity
The toxic dose of paracetamol is highly variable. In adults, single doses above 10 grams or 140 mg/kg have a reasonable likelihood of causing toxicity. In adults, single doses of more than 25 grams have a high risk of lethality. Toxicity can also occur when multiple smaller doses within 24 hours exceeds these levels, or even with chronic ingestion of smaller doses. However, unintentional paracetamol overdose in children rarely causes illness or death. This may be due in part to the immature cytochrome P450 (CYP) enzyme system in children. Excessive consumption of alcohol can impair liver function and increase the potential toxicity of paracetamol. For this reason, other analgesics such as aspirin or ibuprofen are recommended for hangovers.
Some individuals are more susceptible to hepatotoxicity, with toxic doses as low as 4 g/day, and death with as little as 6 g/day. Fasting is a risk factor, possibly because of depletion of hepatic glutathione reserves. It is well documented that concomitant use of the CYP2E1 inducer isoniazid increases the risk of hepatotoxicity, though whether CYP2E1 induction is related to the hepatotoxicity in this case is unclear (Crippin, 1993; Nolan et al., 1994). Chronic alcoholism, which also induces CYP2E1, is also well known to increase the risk of paracetamol-induced hepatotoxicity (Zimmerman & Maddrey, 1995). Concomitant use of other drugs which induce CYP enzymes such as antiepileptics (including carbamazepine, phenytoin, barbiturates, etc) have also been reported as risk factors.
Shop smart, Shop S-Mart.
This is just simply retarded. The FDA mandates APAP is put into these drugs to make sure people can't abuse them. So when people abuse them anyway and start having liver failure, now they're saying "OH SHIT WE BETTER PULL THESE OFF THE MARKET!"
What about hydrocodone? It isn't available by itself in the US (Dicodid in Europe). What about all the chronic pain patients that need these types of medications?
This is simply intolerable.