Acetaminophen: A Leading Cause of Liver Failure – Essential Cautions for Safe Use

Earlier this month on September 7, I wrote an article on How to Use Drugs (Especially New Ones) Safely – And Why It Matters.   This article appeared on GOOGLE NEWS Top Stories of the Day, Basil and Spice.com, and other online sites as Drug Interactions Cause Over 200,000 Deaths Each Year in U.S.A.   In keeping with the theme of addressing critical issues pertaining to proper drug use, I am writing today about one of the most commonly used drugs familiar to all in the U.S. – A drug known as ACETAMINOPHEN (commonly addressed often as TYLENOL).  As a research scientist who speaks regularly both to physicians and lay audiences on chronic disease prevention, I find that drug misuse or over use is perhaps one of the most lethal, yet unrecognized problems in Western nations.  Indeed, it is a problem that has led both to an unnecessary and tragic loss of life, as well as loss of health for thousands.  This is certainly the case for the drug we are about to discuss today.

In June of this year (2009), an FDA panel cited the alarming statistic that the commonly used painkiller Acetaminophen (popularly available over the counter in Tylenol, Excedrin, and dozens of other medications) was the leading cause of liver failure in the United States.  The panel further cited that 60% of deaths involving Acetaminophen occurred when also taking one or more prescription medicines.  In light of these numbers, I feel that it is critically important for ALL to understand how to use this widely and commonly used drug safely.

 WHAT IS ACETAMINOPHEN ?

Acetaminophen is the generic name of a drug found in many over the counter (OTC) products such as Tylenol, as well as in prescription products such as Vicodin and Percocet.  In the UK and several other countries, this drug is often referred to as Paracetamol.  Acetaminophen’s  main uses are to help relieve pain and reduce fever.  It is frequently found in combination with other active ingredients, especially in medications used for allergies, colds or the flu.

 INCORRECT ACETAMINOPHEN USE AND RISK OF LIVER INJURY:

Although Acetaminophen is generally considered safe if taken as directed, it is now well known that this drug can cause serious liver damage if more than the recommended amounts are taken.  Symptoms of early stage liver damage may be loss of appetite, nausea, vomiting, or a perception of having the flu.  Because these symptoms can often so easily be ignored as being not very serious, in most cases liver damage can go undetected.  However, liver damage can quickly progress into liver failure or even death.   Here are some simple cautions you can take to lower your risk of liver damage when using Acetaminophen:

• Follow dosage directions strictly as prescribed by your physician or as indicated on the drug label.  Even a small amount of this drug – when used in excess of what has been directed – can cause liver damage or possible liver failure.
• Don’t take more than one medicine that contains Acetaminophen at one time.  This is most likely to happen when you have symptoms such as those of a headache and a cold at the same time.  Consuming two or more medications – each of which contains Acetaminophen - is extremely risky and must be avoided.
• Do not take Acetaminophen longer than is needed or for more days than is directed.

 DEVELOP AWARENESS OF WHICH MEDICATIONS CONTAIN ACETAMINOPHEN:

All medicines have ingredients listed on their labels, but most individuals tend to ignore this information.  Before taking any medication, read the medication label and the drug facts.  If your medicine contains Acetaminophen as an active ingredient, be aware of how much you are taking, and refrain from combining it with other medications that also contain the same drug.  Acetaminophen is often listed on over the counter drug bottles as APAP.  It is NOT safe to use over the counter Acetaminophen if you are a regular alcohol drinker and/or have liver disease.  If this is the case, consult your physician before you take this or any other pain medication.

 SAFETY CONCERNS FOR CHILDREN:

All of the above  precautions should be kept in mind when giving Acetaminophen to children.  Due to the fact that it is very easy to overdose children accidentally, certain extra precautions must be taken as well:

• When dosing children, it is very important to use the measuring tool to dispense the medication that comes with it.  Do NOT use a kitchen or other spoon to measure medication.
• Again, be especially cautious not to give a child more than one medication that contains Acetaminophen at one time.  If the suggested dose does not provide needed relief, consult your doctor rather than risk overdosing.

 EMERGENCY NUMBERS:

Research suggests that in spite of best efforts on the part of many, accidental overdosing can happen.  If that is the case, waiting to get help can be fatal.  If you suspect an overdose of Acetaminophen, immediately call 911 or Poison Control at 1-800-222-1222 to receive directions on the correct course of action to follow.  As signs and symptoms of liver damage are often not noticeable for hours or even days after taking this drug, waiting may lead to severe liver damage, or death.

I hope this article will help you use Acetaminophen with much greater awareness than you may have had before.  As with most medications, Acetaminophen is a useful drug when used correctly.  However, a lack of simple awareness and knowledge vis-a-vis important precautions, that must be kept in mind to use this drug safely, has cost many lives.  Please help build much needed awareness about this very commonly used drug by forwarding this post to any and all that might benefit from it.  

 FOR FURTHER READING:

ACETAMINOPHEN POISONING (Journal of the American Academy of Pediatrics)

FDA – A Guide to Safe Use of Pain Medicines