More reasons to use extra caution when taking painkillers like Tylenol

A college friend had a pretty common hangover-prevention trick. After a night of drinking—and the weekend at our school  often started on Wednesday—she'd pop a multivitamin, plus at least two Tylenol, followed by a big glass of water, before passing out in bed. If it had been a particularly indulgent night, Bud Light- or Southern Comfort-wise, she'd take three or four Tylenol. This regimen usually worked like a charm to ward off a headache, though there were mornings after when she'd need to pop a few more acetaminophen before being able to head to class or the library without pain.

Acetaminophen is what I've always grabbed when I have a throbbing headache, or a teething baby to soothe, or a fever to tame. And I have to say, when the headache's excruciating, or the fever's raging, I sometimes supplement the recommended dose with an extra pill, or take the next dose an hour earlier than advised.

 

But I won't do that ever again. This dosage-fudging is extremely dangerous. The FDA is meeting today and tomorrow to discuss the need for making warnings on OTC painkiller packaging even stronger because of reports of liver damage—even the need for liver transplants and deaths—in consumers who accidentally took excessive doses of Tylenol.

 

Our assumption that acetaminophen is safe and that we can engage in creative dosing at will could easily push any of us into the liver-damage danger zone.  The danger is especially of concern for children. If you've had to give an inconsolable baby some liquid painkiller at 3 a.m., you know how tricky it is to read the dosing level and get it into your kid's mouth with any shred of accuracy.

 

According to market-research firm Mintel, close to $3 billion was spent on over-the-counter analgesics in 2007, the most recent year for which statistics are available. (And this figure doesn't count sales at convenience stores or discount clubs like Costco—where I usually procure my jumbo-size bottles of Tylenol for my family).  This statistic does include ibuprofen (found in non-steroidal anti-inflammatory meds like Advil) along with acetaminophen tablets and liquids such as Tylenol.

 

However, it should be noted that Mintel's researchers expressed concern that much of the public erroneously believes that Tylenol can help with inflammation and swelling—say, from a sprained ankle—when it's ibuprofen that's helpful in that respect. "Twenty-one percent of respondents say that the drug reduces swelling, even though it has no documented anti-inflammatory action (but it does come as a specific product for arthritis pain)," says the Mintel paper. Yikes.

Researchers have also found the liver-damaging potential of acetaminophen is compounded when it's taken along with caffeine. Tell that to teens who keep downing Red Bull and other energy drinks.

 

To their credit, Tylenol and Advil currently include warnings on their Web sites warning about potential risks from taking their products. The one on the Advil site, it should be noted, is dramatically more noticeable. The two links on the Tylenol.com site are in tiny type, and one is at the very bottom of the page. If I weren't looking for them, I'd have a hard time finding them on my laptop, even though it's in red.  

 

Hiding something, are they?

 

It remains to be determined what additional precaution recommendations or warnings may be added to the painkillers' packaging. At the least, the FDA may repeat its recommendation (from just May of this year!) to change infant formulations to one strength, to avoid accidental confusion or overdosages when they're mistaken for extra-strength medication. The FDA is recommending that the maximum adult dose be 650 milligrams That's less than two extra-strength tablets (which are 500 mg each).

So, while the FDA debates just how strong a warning to add to packages of Tylenol and NSAIDs, the next time I get a headache, the only thing I'll be popping is ice cubes into an ice pack.

For more information on acetaminophen's potential dangers and how to protect your and your family's health, read the FDA's Consumer Health Information report on acetaminophen and liver injury.

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