Acetaminophen, commonly dispersed as Tylenol, is a well-known pain reliever. Regular Strength Tylenol is the most widely used painkiller in the US. It is well known that overdoses cause liver damage, renal failure, coma, and death, usually resulting from liver failure (Chan, 2011). Liver injury occurs when acetaminophen’s toxic metabolite, NAPQI, accumulates in the liver. Too much acetaminophen also depletes the liver’s detoxifying material, glutathione, causing damage to be maximized (Lee, ND). In the US, 10% of poisoning admissions involve acetaminophen. 40% of those admissions are a result of intentional overdose, but 60% are accidental (Dargan & Jones, 2002).
That’s right – it’s possible to accidently overdose on Tylenol. And as of now, the statistics regarding accidental overdoses are increasing.
Researchers from the University of Edinburg in Scotland found that “staggered overdoses”, or those that result from taking a little bit more than the recommended daily dose over several days, can be even more dangerous than a single, large overdose (Chan, 2011). Massive intentional overdose, taken as a suicide attempt, is treated with NAC, an antidote for the poisoning, or by pumping the stomach to remove excess acetaminophen. This prevents as much liver damage as possible. These dangers, however, present fewer immediate symptoms in patients with staggered overdoses. Repetitive use of slightly increased acetaminophen levels result in acute liver failure and hepatotoxicity (Dargan & Jones, 2002). In the study from Edinburg, compared with people who’d taken a single overdose of acetaminophen, those with a staggered overdose were more likely to have liver and brain problems, require dialysis or help with breathing, and were at greater risk of dying (Chan, 2011).
Staggered overdoses have been on the rise in the US for several reasons. The diverse cultures unique to the United States have caused a language barrier – misunderstandings and inability to communicate proper drug administration techniques results in an increase of accidental overdoses (Dargan & Jones, 2002). But the scarier reason is simple: people do not realize the risk of taking too much medication. In July of 2011, Johnson & Johnson, the manufacturer of Tylenol, reduced the maximum daily dose of the drug – from 4,000 miligrams per day (8 pills) to 3,000 (6 pills) - to lower the risk of accidental overdose (Johnson, 2011).
Tylenol is not a prescription drug; most of us use it frequently. Where does personal responsibility come in? Have you ever taken an extra pill, trying to get rid of that headache?
References:
Chan, Amanda. (27 November, 2011). Taking just a little bit to much Tylenol a day can lead to overdose, study finds. The Huffington Post. Retrieved from: http://www.huffingtonpost.com/2011/11/27/tylenol-overdose-staggered-health-risk_n_1110802.html?1322411285&ref=health-news
Dargan, P.I. & Jones, A.L. (2002). Acetaminophen poisoning: An update for the intensivist. Crit Care, 6(2): 108–110. Retrieved on 27 November, 2011 from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC137288/?tool=pubmed
Johnson, L.A. (2011). Maximum Tylenol dose lowered to prevent overdoses. The Huffington Post. Retrieved from: http://www.huffingtonpost.com/2011/07/28/tylenol-maximum-dose-lowered_n_912629.html
Lee, D. & Marks, J.W. (ed). (No date). Tylenol liver damage: How does an overdose of acetaminophen cause liver injury? Retrieved from: http://www.medicinenet.com/tylenol_liver_damage/page3.htm#tocg
I read an article on drugs.com about acetaminophen a while back and it said that a certain enzyme found in the liver is elevated when patients take drugs with acetaminophen in them, which can lead to the liver damage. Because of those studies, some places in England have apparently put a limit on the amount of pills that can be sold at one time.
ReplyDeleteI grew up taking Tylenol for everything. Whether it was a cold or a foot injury, my parents would always give me Tylenol. As I grew older, I learned that liver damage was common in my family, so, I reduced my acetaminophen intake. When I went to Asia this past summer, I had a terrible cold. The pharmacist in Vietnam recommended a drug called Dopogan or Panadol. I later discovered that these recommended drugs were paracetamol, better known as acetaminophen in the United States.
ReplyDeleteIt doesn’t shock me that Tylenol overdose is increasing in the United States. You have already stated two very good reasons. Tylenol, or other forms of acetaminophen, is popular and available internationally. With the rise in health care costs, I feel like people will lean towards more familiar over-the-counter medications, such as Tylenol.