Poison in the Medicine Cabinet

Acetaminophen deaths prompt a recommendation of lower doses and stronger labeling.

Acetaminophen overdose is the leading cause of liver failure in both the United States and Great Britain. Fifty percent of all acute liver failure in the United States is attributed to acetaminophen consumption.¹ While many of these cases result from an overdose, either intentional or unintentional, even “correct dosage” has been cited as causing liver damage, liver failure and death. In the United States, approximately 56,000 liver injuries requiring emergency treatment, 26,000 hospitalizations and 458 deaths per year are attributed to acetaminophen consumption.2

The Ease of Overdosing
One of the main problems with this popular drug is how easy it is to overdose unintentionally.  As most of us know, acetaminophen is the primary ingredient in medications like Tylenol®. But acetaminophen is also in almost 200 brand-name and generic products, most of which are available over the counter. These products are as varied as headache and backache pills, cold and flu remedies and sore-throat medication. It is not hard to imagine a patient taking acetaminophen for pain and fever and then taking other medications for a sore throat, cough and cold symptoms. Without a thought, the patient is overdosing. Compound that with the added risk of fasting, alcohol consumption or genetic predisposition to liver disease, and the patient is destroying his or her liver.

Intentional and unintentional overdoses of acetaminophen can destroy the liver, but so can taking the correct therapeutic dose in particular people or circumstances. We now know that fasting is as dangerous as alcohol consumption when taking acetaminophen. When someone cannot eat because of illness and is also taking acetaminophen, the likelihood of liver injury increases.

The FDA is well aware of the dangers of this popular drug and recommended stronger label warnings in 2002.  In 2009, it recommended that the standard dose be lowered.

Make no mistake about it: This medication can be dangerous, and the consequences for its adverse effects are grave. Surprising is the fact that we really do not have a firm grasp of how acetaminophen works or what the appropriate dose is.

Drug-Free Pain Relief
In cost-analysis studies, chiropractic care is often compared to “usual and customary care”—such as acetaminophen and other analgesics—for determining our cost benefit in treating certain conditions. On first blush, these studies seem to point to a cost advantage to using analgesics instead of chiropractic. However, if the devastating long-term effects of analgesics are factored into this equation, including the 56,000 liver injuries, liver transplants and deaths, then chiropractic care looks much more attractive than using this popular drug.

Chiropractic, as a profession, remains committed to wellness and avoiding the unnecessary use of medications. It is our responsibility to share this information with both our patients and their medical providers. Acetaminophen should be used sparingly, if at all.

source; ACA Today, By William Morgan, DC
1. Larson AM, et al. Acetaminophen-Induced Acute Liver Failure: Results of a United States Multicenter, Prospective Study. Hepatology 2005;42:1364-1372.
2. Nourjah P, Ahmad SR, Karwoski C, Willy M. Estimates of acetaminophen (Paracetamol)-associated overdoses in the United States. Pharmacoepidemiol Drug Saf 2006 Jun;15(6):398-405.

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