Accidental
Poisoning from Acetaminophen
by Barbara D. Allan
Author of Conquering Arthritis
Acetaminophen is the most popular painkiller in the
US. It is best known by the brand name Tylenol but is
sold under 97 different brand names. It is also sold
in combination with other drugs in more than 100 products.
I am writing about it today because with cold and flu
season here, people who take acetaminophen for arthritis
are at risk for acetaminophen poisoning.
Taking just twice the recommended dose of acetaminophen
can cause acute liver failure. Unfortunately, this has
already happened to an alarming number of people because
it isn't hard to do. Two years ago, more than 56,000
people visited the emergency room due to accidental
acetaminophen overdoses and 100 people died from unintentionally
taking too much. Worse yet, the numbers appear to be
growing.
How Can This Happen?
This happens so easily because acetaminophen is found
in many different products. If you are taking the maximum
recommended dose of just two acetaminophen-containing
products, you can easily take an overdose.
For example, the maximum recommended dose of acetaminophen
per day is 4000 mg. That equals 8 extra strength acetaminophen
pills per day. You might easily take that much for arthritis
pain.
Now let's say you get the flu and decide to take a
Cold & Flu product for your aches and stuffiness.
Many of them include acetaminophen as the primary ingredient
for reducing fevers and aches and pains. So, that will
dose you with 1000 mg of acetaminophen every 6 hours
or another 4000 mg a day.
By taking both products at the maximum recommend dose,
you put yourself at risk for acute liver failure.
The problem doesn’t end there. You might get
a head ache and pop some Excedrin. That’s 500
mg more acetaminophen per dose. Maybe you are in a car
accident or have some dental work done. Prescription
narcotics like Vicodin and Percocet contain from 325
mg to 750 mg of acetaminophen inside each pill. That
can quickly add up.
Other Acetaminophen Complications
for People with Arthritis
For some people, arthritis is caused by suboptimal detoxification
pathways. Such people do not have the level of enzymes
necessary to carry out the sulfoxidation necessary for
a body to properly process and detoxify what is normally
considered a safe dose of acetaminophen. In these circumstances,
even the recommended level of acetaminophen may cause
acetaminophen poisoning.
Furthermore, this same pathway is necessary for detoxifying
many of the chemicals we are exposed to in our environment
and through our food. This means that our detoxification
system can also be weakened through chemical exposure.
Similarly, if we swamp our system with acetaminophen,
we don’t have enough detoxification power left
to fully deal with all the other assaults in our daily
environment.
If you have any known food sensitivities or chemical
sensitivities, it is best to assume that your sulfoxidation
pathways are already challenged enough, without adding
the extra burden of acetaminophen in your system.
How to Avoid Acetaminophen
Poisoning
Carefully read the label of any cold or flu medicine
or painkiller that you are considering to ascertain
how much acetaminophen it contains. People who are considered
at normal risk should never exceed 4000 mg a day total
from all sources for short term use.
People who are vulnerable to damage from acetaminophen
should take no more than 2000 to 3000 mg per day, according
to Dr William Lee of the University of Texas Southwestern
Medical Center.
Acetaminophen Guidelines
for Long-Term Use and for the Elderly
One of my readers, a nurse named Laura Pole, teaches
nurses and physicians how to safely and effectively
use medications to manage pain and symptoms. Laura kindly
provided some important additional guidelines on acetaminophen
usage.
She suggests that a maximum dose of 4000 mg/day acetaminophen
is for short-term use. For long-term use in a healthy
young person, that dose should be decreased to about
3250 mg/day.
Laura writes that for the elderly (who usually have
declining liver and kidney function) and the debilitated,
lower doses of 2000-3000 mg/day are appropriate.
She also mentioned that it is important for healthy
elderly people to know that they should take a lower
daily max dose than younger healthy adults.
Her dosage information comes from clinical pharmacist
Sandra Dawson, RPh, MSHA, who lectures on pain management
in long term care. Dawson’s sources include the
American Pain Society and the American Geriatric Society.
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