In the United States, acetaminophen is widely available and included in hundreds of cold and cough medicines. Unfortunately, it can also be easily misused and has been responsible for deaths by suicide and unintentional poisoning.
Why Is Acetaminophen Toxicity Rate So High?
“Acetaminophen is by far the No. 1 cause of acute liver failure in the United States,” Dr. Nima Majlesi, director of medical toxicology at Staten Island University Hospital in New York, told The Epoch Times.He noted that most cases result from unintentional chronic acetaminophen overdoses, often due to misuse of medications such as Percocet, Vicodin, and Tylenol PM or taking multiple acetaminophen-containing products without recognizing the danger of high daily doses.
“Medications such as Percocet, Tylenol PM, Robitusson, and Nyquil all can contain acetaminophen,” Majlesi said. “In fact, acetaminophen has been reported to be present in about 600 different products.”
People should take medications as directed, but even then, there’s concern that not all doctors prescribing combination opioid/acetaminophen drugs ensure that patients understand not to take any other acetaminophen medication, according to Dr. Kevin Zacharoff, a chronic pain and substance-use expert.
Accidental Deaths and Suicide
Acetaminophen is often combined with opioid drugs, such as Percocet, and prescribed for pain management. However, many people taking this type of medication are unaware of the presence of acetaminophen, Zacharoff said.“I think if I said to you, ‘Make sure if I’m prescribing Percocet to you, that you don’t take any other medicine that has acetaminophen in it,’ you may or may not know that Tylenol is another word for acetaminophen,” he said.
“That sets the stage ... for people to unintentionally be exposed to too much of it,” Zacharoff said.
The accessibility of the drug also makes it a potential means to commit suicide.
FDA Stance on Acetaminophen
In 2009, a U.S. Food and Drug Administration (FDA) advisory panel voted to recommend banning the combination of acetaminophen and opioid drugs under the brands Percocet and Vicodin and reducing the maximum daily dose of acetaminophen. However, the drug combination is still prescribed in the United States but with generic labels such as hydrocodone and acetaminophen or hydrocodone/APAP.“If the FDA truly wanted to reduce the risk of chronic acetaminophen poisoning, it would eliminate all combination preparations and force people to take a pill for each individual medication they needed,” Majlesi said.
This would mean that patients take a single pill for every ingredient contained in their medication.
Acetaminophen May Not Even Help Treat Acute Pain
Acetaminophen has been used since 1878 and might have been assumed to be harmless, like aspirin, another old drug. Unfortunately, some research suggests that acetaminophen use is linked to increased rates of heart attack and kidney failure.“Nobody really knows exactly how acetaminophen works in the treatment of pain,” Zacharoff said. “There is a fairly well-substantiated basis for acetaminophen being used to treat someone with a fever, as an antipyretic, similar to that of nonsteroidal anti-inflammatories (NSAIDs), but acetaminophen does not have any anti-inflammatory activity in and of itself.”
Acetaminophen is often mistakenly considered a conventional NSAID, such as ibuprofen, naproxen, and diclofenac, but it isn’t.
“The pharmacology is very different,” Majlesi said.
He explained that while NSAIDs can cause gastrointestinal irritation, bleeding, and kidney issues when used excessively, acetaminophen can lead to liver failure with chronic overuse. In contrast to NSAIDs, the symptoms of toxicity from acetaminophen aren’t easily recognizable until severe damage has already occurred.
How to Prevent Acetaminophen Overdose
“As a consumer, you should be aware of every medication that is going into your body,” Majlesi said. “If you are taking combination preparations, then know what each drug in the prep is and why you are taking it.”He recommended that people stop using brand names when discussing their medications and focus on the generic names of each drug in their daily regimen.
“There is almost no reason anyone should be chronically using a combination preparation containing acetaminophen on a daily basis for more than one week,” Majlesi said.
For individuals in that situation, he recommended having an open conversation with their doctor to question the effectiveness of such a treatment regimen.
“I cannot think of any combination preparation containing acetaminophen that should be used chronically,” Majlesi said.