Watching out for Tylenol and other pain meds!

ACETAMINOPHEN

INTRODUCTION

Pain relievers and fever reducers have always been the most frequently used medications and, we can count on Acetaminophen, commonly known as Tylenol as the most well known over the counter analgesic. It is also doctors’ first choice of drugs for pain relief, and is considered safe if used as recommended. But, overdose and toxicity can be a real big problem when it comes to Tylenol because of the fact that many people have misconceptions that this over the counter drug is very safe and harmless. Acetaminophen overdose can lead to serious consequences like liver damage and death.

HISTORY:

According to the FDA, more than 200 million persons take acetaminophen each year and about 200 of these die of serious liver damage due to toxicity. Statistics in the medscape website state that Americans take over 8 billion pills (tablets or capsules) of Tylenol each year and, the National Hospital Discharge Survey (NHDS) indicates that there are an average of 26,256 hospitalizations per year related to acetaminophen overdoses.
Acetaminophen was to blame for 28 percent of the liver poisonings in 1998, but it caused 51 percent of cases in 2003. The Food and Drug Administration has been more concerned about with the liver risk, warning two years ago that more than 56,000 emergency-room visits a year are because of acetaminophen overdoses and that 100 people die annually from unintentionally taking too much. It has placed regulations on companies to place labels about acetaminophen content in all medications.


PRINCIPLE OF OPERATION:

Acetaminophen overdose occurs when one consumes more than 4000mg of acetaminophen in one day. So, simply taking 2 extra strength Tylenol tablets, 500mg each, 4 times a day can cause acetaminophen toxocity. People accidentally overdose themselves when combining it with other medications that contain acetaminophen in them. Heavy drinkers who mix acetaminophen with alcohol are at high risk for acetaminophen toxicity because combining acetaminophen with more than three alcoholic drinks a day can lead to toxicity.There are many ways one can overdose acetaminophen unintentionally like taking acetaminophen in combination with more than 3 alcoholic drinks a day, varying dosing schedules and formulations of recommended drug in infants and children and combining it with other medications that contain acetaminophen as one of their drugs like: Anacin-3, Liquiprin, Panadol, Percocet, Decongestants, Tempra, and various other cold/flu medications


Signs and Symptoms of toxicity:
Initial symptoms may be flu-like, so doctors may not prompt for overdose treatment.
Sudden fever
Nausea and vomiting
Abdominal pain
Diarrhea
Irritability
Jaundice
Sweating
Coma
Convulsions.
But symptoms do not occur until 12 or more hours after acetaminophen consumption.
Require immediate assistance to the emergency, within 8 hours.

Prognosis:
If not treated, overdose can lead to LIVER FAILURE and DEATH.

Three clinical stages (phases) of acetaminophen-induced liver injury have been described.

During the first phase, that is, the initial 12 to 24 hours after the consumption, the person may feel very nauseated and vomiting. The second Phase which is next 24 to 48 hrs, the person feels normally well considering the fact that he/she threw-up most of the medication. The next 48 to 72 hrs which is the third phase, liver blood test abnormalities begin to appear. Most concerning would be high levels of AST AND ALT, which is very common with this type of liver injury. If the damage is bad enough and there is a sever acid build up in the blood, kidney damage or coma then death is almost certain and in these cases liver transplant is mostly suggested.


SAFETY ADVICE:

• 
  Read all the drug labels and add up all your acetaminophen, avoiding more than 4,000 milligrams a day (more than 200 other drugs contain acetaminophen as one of their ingredients.)


• 
  For extra safety, avoid alcohol when you are taking Tylenol or any other acetaminophen containing medications.


• 
  Do not switch formulations or vary dosing schedules with different strengths of liquid drugs.


• 
  Always follow the dosage recommendations and, ask the health care provider if you have any doubts.


• 
  Make sure to report early if you notice any signs and symptoms of toxicity or, if you accidentally overdose on any medications.

“www.druginfo,com.” < http://www.druginfonet.com/acetamin.htm.>
“www.medline Plus” <http://www.nlm.nih.gov/medlineplus/ency/article/002598.htm>
“http://www.medscape.com”./ < http://www.medscape.com/viewarticle/557074
http://www.medicinenet.com/tylenol_liver_damage/page6.htm