Acetaminophen: The Painkiller With a Broad Reach

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Acetaminophen: The Painkiller With a Broad Reach

It's found in many remedies, so read labels carefully

SUNDAY, Feb. 22 (HealthDayNews) -- Open any medicine cabinet in America and

there's a good chance you'll find at least one bottle of acetaminophen

inside.

That's just the start of it.

Cold remedies around? They often contain the painkilling, fever-reducing

drug, too. Babies in the house? Many infant drops that make teething

bearable (for

the whole family) get their kick from acetaminophen, the active ingredient

in

the mega-brand Tylenol.

It's estimated that each year 24 percent of Americans take some form of

acetaminophen for pain, fever and other discomfort.

But experts worry that the over-the-counter status of these medications may

give consumers the misleading impression that the drugs are safe at any

dose.

So how safe is acetaminophen?

The U.S. Food and Drug Administration says 458 people a year in the United

States die of complications related to the drug. Of those, about 100 of the

deaths are thought to be unintentional, according to a 2002 report on

acetaminophen toxicity.

In addition, acetaminophen poisoning sends more than 56,600 people to the

emergency room each year and leads to 26,000 hospital admissions. Children

make

up 22 percent of unintentional hospital cases, the FDA says.

Despite those statistics, Dr. Fries, a joint disease specialist at

Stanford University School of Medicine, says consumers shouldn't be afraid

of

acetaminophen. The drug is " safer than you thought, " says Fries, who

recently

published an article in the Journal of Rheumatology that compared the risks

of

acetaminophen with those of aspirin and ibuprofen in patients taking the

drugs

chronically for arthritis symptoms.

Rates of gastrointestinal bleeding were basically the same for all three

medications. " As you get down to lower and lower doses of over-the-counter

analgesics you can no longer tell the difference between them. All are quite

safe, "

Fries says.

Problems can occur with all three drugs in people with a propensity for

ulcers and other stomach trouble, but these cases are rare. And, at least as

far as

acetaminophen is concerned, " the mechanism [for harm] may be that there's a

false feeling of safety among people at risk of [gastrointestinal] bleeding

from other causes, " he says.

While acetaminophen might be essentially benign on the gut, its effects on

the liver can be less friendly -- at least in some people. Fries says

there's

" no evidence " that routine amounts of the painkiller, up to 4 grams a day,

injure the organ. But, some people who combine higher quantities of

acetaminophen

with heavy drinking can do serious, and even deadly, damage.

Ironically, acetaminophen's safety profile can lull people into thinking

they

can get away with overdoses. " It's pretty safe with regard to the liver

unless you chug a whole bottle, " Fries says. " But a lot of people think that

[acetaminophen] is so safe that they do take a whole bottle. "

What's more, acetaminophen poisoning can be " sneaky, " Fries adds. It starts

quietly but can suddenly detonate into full-blown liver failure, requiring

an

emergency transplant. If one's not available, patients can die quickly.

Dr. Temple is vice president for medical affairs at McNeil Consumer

&

Specialty Pharmaceuticals, the Philadelphia-based maker of Tylenol. He says

company research has shown that healthy people don't suffer abnormal liver

function when they take as much as twice the recommended daily dose. McNeil

also

has conducted tests on alcoholics and hasn't found evidence of liver harm

from

the drug at the 4-gram-a-day level, Temple says.

The bottom line: Acetaminophen can cause liver damage, but the risk is

greatest for chronic drinkers who overdose. " It's not just that you take a

couple of

tablets and have a drink, " Temple says.

McNeil, a division of & , agreed in 2002 to add warnings on

all products containing the drug, cautioning about the potential for liver

harm.

Packages with older labels that don't carry the warning may still be on

pharmacy shelves.

One problem with over-the-counter analgesics, experts say, is that so many

products contain them that consumers can easily take too much if they're not

careful.

Someone with a bad cold, for example, might take Tylenol tablets for their

fever and a decongestant for their stuffy nose, but fail to realize that the

decongestant has acetaminophen, too.

" Labels are small and you really need to look at them carefully, " Temple

says. " We try to promote reading the label and counting the doses. It's not

that

you can't use two products on the same day, but that you have to keep your

total dose to 4 grams or less. "

People who do take more than 4 grams of acetaminophen in a 24-hour period

should contact their doctor or a poison-control center, Temple says.

SOURCES: Temple, M.D., vice president, medical affairs, McNeil

Consumer & Specialty Pharmaceuticals, Philadelphia; Fries, M.D.,

professor,

immunology and rheumatology, Stanford University School of Medicine, Palo

Alto,

Calif.

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