Re: Tylenol, aspirin, ibuprofen?

June 20, 2001

Dose of Knowledge on Acetaminophen Needed

Many unaware that it can wreak havoc on liver

By Neil Sherman

HealthScoutNews Reporter

Related Stories:

Pregnant and Feeling Sick?

Pre-Labor Pains

Retrained Brain Eases Phantom Pain

TUESDAY, June 19 (HealthScoutNews) -- Doctors know the liver-damaging dangers

of acetaminophen, the active ingredient in Tylenol, but the general public

still needs to get the message, a survey of doctors reveals.

More than 95 percent of doctors in Michigan were aware that acetaminophen can

wreak havoc with the liver of those who take more than three alcoholic drinks

a day or who take more than the recommended 24-hour dose, the survey shows.

However, only 60 percent of the doctors knew the dangers of fasting and

taking the drug.

" There have been reports over the past several years describing cases of

acetaminophen-related liver failure that could have been avoided, " says lead

author Dr. Fontana, assistant professor of internal medicine at the

University of Michigan in Ann Arbor. " And there's a growing body of

literature suggesting that these poisonings are happening across the United

States. Because acetaminophen is the most commonly used medicine in the

world, we wanted to try and sort out who knows what and could we impact cases

of avoidable toxicity. "

Fontana surveyed almost 400 doctors in Michigan, using 28 questions to find

out how much they knew about the safety of acetaminophen and its risks.

Overall, 96 percent of the doctors knew that people who drink more than three

drinks a day and take acetaminophen are at risk for liver damage, the survey

shows. They also knew that taking more than the recommended dose in a 24-hour

period can raise the risk.

" Those we surveyed had a very good knowledge level, " Fontana says. " They were

also aware that taking acetaminophen and smoking does not increase your risk

for liver damage, and concomitant use of antibiotics was not a risk. Only

about 60 percent of the doctors knew that taking acetaminophen during

prolonged fasting may be a problem, while 95 percent knew that those with

cirrhosis of the liver have an increased risk for liver toxicity from the

drug. "

The findings were published in the June issue of the Journal of Clinical

Outcomes Management.

Acetaminophen is generally considered safe and effective as an

over-the-counter painkiller. But like most drugs, it is not entirely without

risk.

Too much acetaminophen can lead to liver failure and death, and taking the

painkiller with alcohol seems to speed up the process, according to the

American Liver Foundation. A practical and safe dosage limit for

acetaminophen for the alcohol users has not been established, but is likely

to be lower than previously thought. It is thought that the drug causes liver

damage in both alcoholics and fasters because drinking and fasting deplete

the body of glutathione, a detoxification agent normally found in large

quantities in the liver.

Information about the dangers of Tylenol has been widely broadcast, says Dr.

Temple, vice president of medical affairs for the drug's maker,

McNeil Consumer Healthcare of Ft. Washington, Pa. " The paper does demonstrate

that when an issue like the management of acetaminophen overdose is widely

discussed, even primary care givers will demonstrate a high level of correct

understanding of the problem. "

The fact that only 60 percent of the physicians were aware of the potential

toxicity of acetaminophen during fasting is not surprising, Temple says. " The

data on taking anticonvulsants or fasting while taking acetaminophen is still

very controversial. And the paper shows that physicians did not have a clear

understanding of the relationship between the drug and fasting, which makes

sense. "

Temple says there is a " lot of exposure in the U.S. to acetaminophen

overdose, but the vast majority do not result in liver toxicity. In large

measure that's because there is an antidote, n-acetylcyteine. "

And why is there a lot of exposure?

" The product is used by billions of people in the U.S. and worldwide, " Temple

explains. " Any product that widely available is going to be prone to people

taking too much, intentionally or unintentionally. "

What To Do

" We want to underscore to the people that they need to stick with the

recommended dose of Tylenol, " Temple says. " Read the label and be careful. "

For more information on acetaminophen, see MedlinePlus or McNeil Consumer

Healthcare.

What do you know about the liver? The Texas Liver Coalition has a primer on

this critical and versatile organ.

And look at the other HealthScoutNews stories on acetaminophen.

SOURCES: Interviews with Fontana, assistant professor of internal

medicine, University of Michigan, Ann Arbor; Temple, M.D., vice

president of medical affairs, McNeil Consumer Healthcare, Ft. Washington,

Pa.; June 2001 Journal of Clinical Outcomes Management

June 20, 2001

Dose of Knowledge on Acetaminophen Needed

Many unaware that it can wreak havoc on liver

By Neil Sherman

HealthScoutNews Reporter

Related Stories:

Pregnant and Feeling Sick?

Pre-Labor Pains

Retrained Brain Eases Phantom Pain

TUESDAY, June 19 (HealthScoutNews) -- Doctors know the liver-damaging dangers

of acetaminophen, the active ingredient in Tylenol, but the general public

still needs to get the message, a survey of doctors reveals.

More than 95 percent of doctors in Michigan were aware that acetaminophen can

wreak havoc with the liver of those who take more than three alcoholic drinks

a day or who take more than the recommended 24-hour dose, the survey shows.

However, only 60 percent of the doctors knew the dangers of fasting and

taking the drug.

" There have been reports over the past several years describing cases of

acetaminophen-related liver failure that could have been avoided, " says lead

author Dr. Fontana, assistant professor of internal medicine at the

University of Michigan in Ann Arbor. " And there's a growing body of

literature suggesting that these poisonings are happening across the United

States. Because acetaminophen is the most commonly used medicine in the

world, we wanted to try and sort out who knows what and could we impact cases

of avoidable toxicity. "

Fontana surveyed almost 400 doctors in Michigan, using 28 questions to find

out how much they knew about the safety of acetaminophen and its risks.

Overall, 96 percent of the doctors knew that people who drink more than three

drinks a day and take acetaminophen are at risk for liver damage, the survey

shows. They also knew that taking more than the recommended dose in a 24-hour

period can raise the risk.

" Those we surveyed had a very good knowledge level, " Fontana says. " They were

also aware that taking acetaminophen and smoking does not increase your risk

for liver damage, and concomitant use of antibiotics was not a risk. Only

about 60 percent of the doctors knew that taking acetaminophen during

prolonged fasting may be a problem, while 95 percent knew that those with

cirrhosis of the liver have an increased risk for liver toxicity from the

drug. "

The findings were published in the June issue of the Journal of Clinical

Outcomes Management.

Acetaminophen is generally considered safe and effective as an

over-the-counter painkiller. But like most drugs, it is not entirely without

risk.

Too much acetaminophen can lead to liver failure and death, and taking the

painkiller with alcohol seems to speed up the process, according to the

American Liver Foundation. A practical and safe dosage limit for

acetaminophen for the alcohol users has not been established, but is likely

to be lower than previously thought. It is thought that the drug causes liver

damage in both alcoholics and fasters because drinking and fasting deplete

the body of glutathione, a detoxification agent normally found in large

quantities in the liver.

Information about the dangers of Tylenol has been widely broadcast, says Dr.

Temple, vice president of medical affairs for the drug's maker,

McNeil Consumer Healthcare of Ft. Washington, Pa. " The paper does demonstrate

that when an issue like the management of acetaminophen overdose is widely

discussed, even primary care givers will demonstrate a high level of correct

understanding of the problem. "

The fact that only 60 percent of the physicians were aware of the potential

toxicity of acetaminophen during fasting is not surprising, Temple says. " The

data on taking anticonvulsants or fasting while taking acetaminophen is still

very controversial. And the paper shows that physicians did not have a clear

understanding of the relationship between the drug and fasting, which makes

sense. "

Temple says there is a " lot of exposure in the U.S. to acetaminophen

overdose, but the vast majority do not result in liver toxicity. In large

measure that's because there is an antidote, n-acetylcyteine. "

And why is there a lot of exposure?

" The product is used by billions of people in the U.S. and worldwide, " Temple

explains. " Any product that widely available is going to be prone to people

taking too much, intentionally or unintentionally. "

What To Do

" We want to underscore to the people that they need to stick with the

recommended dose of Tylenol, " Temple says. " Read the label and be careful. "

For more information on acetaminophen, see MedlinePlus or McNeil Consumer

Healthcare.

What do you know about the liver? The Texas Liver Coalition has a primer on

this critical and versatile organ.

And look at the other HealthScoutNews stories on acetaminophen.

SOURCES: Interviews with Fontana, assistant professor of internal

medicine, University of Michigan, Ann Arbor; Temple, M.D., vice

president of medical affairs, McNeil Consumer Healthcare, Ft. Washington,

Pa.; June 2001 Journal of Clinical Outcomes Management

June 20, 2001

sarah said <<my doctor is a highly regarded hep c specialist and

liver transplant specialist, and he told me that I should not take aspirin

at

all, but that Tylenol (acetemephonin) and advil (ibuprofen) can be taken at

half the regular daily dosage (either full single doses, but half as often,

or half as much just as often). Does that make sense? That's a tough

limitation when you're achy all over, but better than nothing.

>>

sarah it all depends on your doc and your body.

I have no liver damage, so I can take what I want and I take aspirin mostly

cuz it is what helps me the most.

However, others can't take any NSAIDS and still others are told Tylenol is

bad because it is processed thru the liver.

Do what you and your doc think is best for you with your health. We can't

tell you exactly, just what we have experienced

alley

June 20, 2001

sarah said <<my doctor is a highly regarded hep c specialist and

liver transplant specialist, and he told me that I should not take aspirin

at

all, but that Tylenol (acetemephonin) and advil (ibuprofen) can be taken at

half the regular daily dosage (either full single doses, but half as often,

or half as much just as often). Does that make sense? That's a tough

limitation when you're achy all over, but better than nothing.

>>

sarah it all depends on your doc and your body.

I have no liver damage, so I can take what I want and I take aspirin mostly

cuz it is what helps me the most.

However, others can't take any NSAIDS and still others are told Tylenol is

bad because it is processed thru the liver.

Do what you and your doc think is best for you with your health. We can't

tell you exactly, just what we have experienced

alley

June 20, 2001

Did he say anything about Aleve? My liver guy....who is not the

best...told me to use aleve if I had to use anything.

Alley/Pat wrote:

> sarah said <<my doctor is a highly regarded hep c specialist and

> liver transplant specialist, and he told me that I should not take

> aspirin

> at

> all, but that Tylenol (acetemephonin) and advil (ibuprofen) can be

> taken at

> half the regular daily dosage (either full single doses, but half as

> often,

> or half as much just as often). Does that make sense? That's a

> tough

> limitation when you're achy all over, but better than nothing.

> >>

>

> sarah it all depends on your doc and your body.

>

> I have no liver damage, so I can take what I want and I take aspirin

> mostly

> cuz it is what helps me the most.

>

> However, others can't take any NSAIDS and still others are told

> Tylenol is

> bad because it is processed thru the liver.

>

> Do what you and your doc think is best for you with your health. We

> can't

> tell you exactly, just what we have experienced

>

> alley

>

June 20, 2001

Did he say anything about Aleve? My liver guy....who is not the

best...told me to use aleve if I had to use anything.

Alley/Pat wrote:

> sarah said <<my doctor is a highly regarded hep c specialist and

> liver transplant specialist, and he told me that I should not take

> aspirin

> at

> all, but that Tylenol (acetemephonin) and advil (ibuprofen) can be

> taken at

> half the regular daily dosage (either full single doses, but half as

> often,

> or half as much just as often). Does that make sense? That's a

> tough

> limitation when you're achy all over, but better than nothing.

> >>

>

> sarah it all depends on your doc and your body.

>

> I have no liver damage, so I can take what I want and I take aspirin

> mostly

> cuz it is what helps me the most.

>

> However, others can't take any NSAIDS and still others are told

> Tylenol is

> bad because it is processed thru the liver.

>

> Do what you and your doc think is best for you with your health. We

> can't

> tell you exactly, just what we have experienced

>

> alley

>

June 21, 2001

Mine told me I could use whatever I wanted. I could even have a glass

of wine every night. It won't affect me..yeah right.

;o)

Time to find a new specialist, one who doesn't bring his dog to work?

Sondra

>

> > sarah said <<my doctor is a highly regarded hep c specialist and

> > liver transplant specialist, and he told me that I should not take

> > aspirin

> > at

> > all, but that Tylenol (acetemephonin) and advil (ibuprofen) can be

> > taken at

> > half the regular daily dosage (either full single doses, but half

as

> > often,

> > or half as much just as often). Does that make sense? That's a

> > tough

> > limitation when you're achy all over, but better than nothing.

> > >>

> >

> > sarah it all depends on your doc and your body.

> >

> > I have no liver damage, so I can take what I want and I take

aspirin

> > mostly

> > cuz it is what helps me the most.

> >

> > However, others can't take any NSAIDS and still others are told

> > Tylenol is

> > bad because it is processed thru the liver.

> >

> > Do what you and your doc think is best for you with your health.

We

> > can't

> > tell you exactly, just what we have experienced

> >

> > alley

> >

June 26, 2001

Hi Alley,

I'm trying to catch up on email and saw your response to my email about OTC

pain relievers.

I realize that everyone is different in regard to their body and problems. I

was just putting my two cents in with what other people were saying and

asking about in other emails going around at that time about this topic. I

was saying what my doc told me, for me, prior to treatment, after my biopsy

showed I was Stage 3 (scarring) / Grade 2 (inflammation).

ALL drugs are processed through the liver, so almost anything can be harmful

if done in large doses. His opinion was that aspirin would do the most harm,

and that ibuprofen and tylenol would be okay at half dosages....at least for

me, that is. I have seen that thinking written elsewhere as well. I wonder

if now that I've gone through the treatment and come out non-detectable if he

would still say the same dosage recommendations for me.

I only get my blood tests through my Primary Care Physician now, but will go

back to my hep c doc if I start having problems with my bloodwork levels or

any other symptoms again. Everyone should do and take what they believe is

best for them.