Toxic tylenol

[img1]You see them all the time on television: commercials for acetaminophen that assure you the fastest, safest remedy for your headache is in their drug. However, a new study led by Dr. Anne Larson, director of the Hepatology Clinic at the UW Medical Center, suggests that acetaminophen is now the number one cause of acute liver failure (ALF), raising new questions about our society's perception of how safe the over-the-counter drug is.

Acetaminophen, known best by the Tylenol brand, is considered one of the safest painkillers on the market--if taken properly. It is used by 100 million people a year, which, according to Larson, translates into "millions and millions of tablets consumed daily."

Although toxicity occurs in only a small portion of the number of people who use acetaminophen, the consequences may be deadly. Merely doubling the recommended maximum daily dose of about eight extra-strength tablets can be fatally toxic, Larson warned, and at the very least cause severe side-effects.

"The complication [from acetaminophen overdose] is a very serious one if you don't follow the directions," Larson explained.

While some people tend to underestimate the consequences of not following the dosage of over-the-counter drugs, the costs associated with ALF are high and include brain swelling, coma and even death.

Freshman Scott Finley, a prospective prosthetics and orthotics major, is aware of this. As an athlete, he takes Tylenol for sore muscles and admits to taking more than the recommended dosage since he has a bigger build than the average person.

However, he does acknowledge that acetaminophen can be a dangerous drug.

"You can overdose easily," he said.

  The amount of acetaminophen we consume on a daily basis can quickly add up. Some common over-the-counter drugs that contain acetaminophen are probably found in most medicine cabinets. Those include but are not limited to Tylenol PM, Nyquil, Midol, Excedrin and other flu and cold remedies.

Prescription drugs which are a narcotic-acetaminophen combination are those as common as Vicodin and Percocet. Oftentimes, doctors don't inform patients that the narcotics they are prescribing also contain acetaminophen. On top of that, patients don't always inform their doctors about all the medications they are taking.

It can be easy to lose track of daily consumption of acetaminophen. For example, you may be taking Vicodin as a prescription for a sprained ankle, but you develop a headache so you take acetaminophen on top of that. For some, all it takes is two of these drugs at the same time to cause permanent liver damage.

Moreover, the effects of acetaminophen can be compounded by several factors. The young and the old are generally more vulnerable to drug toxicity at low doses, as are those who are malnourished. Alcohol may also enhance toxicity. Larson warns that chronic users of alcohol may develop liver problems even if they take the recommended dosage of acetaminophen. The combination of alcohol and acetaminophen alters the enzyme which processes acetaminophen in the body. Although it remains controversial, there have been reports citing such cases.

Despite all the harm over-the counter-drugs are evidently capable of, the reality remains that most people still don't read the label. Freshman Emily Cordova recently took Tylenol for a sore throat, but admitted she didn't look at the directions.

"I take it often enough to know the dosage and how often I need to take it," she explained.

Larson's study suggests that even if people are aware of the proper dosage, it doesn't mean they always take the recommended amount.

The study, which took place over a course of six years, indicates that acetaminophen-related liver problems are on the rise. In fact, Larson cites that the annual percentage of acetaminophen-re-lated ALF rose from 28 percent in 1998 to 51 percent in 2003. The study found most people ingest the equivalent to 48 extra-strength caplets a year.

The study began as an effort to find out more about what causes the uncommon, but what Larson characterizes as "dramatic, fatal condition," known as ALF. While collecting data on 662 subjects from 24 care centers across the United States, researchers observed that 42 percent of their cases were caused by acetaminophen liver injury. Upon closer analysis, they were alarmed to realize that half of those overdoses were unintentional.

In fact, 81 percent of the subjects with unintentional overdose were taking acetaminophen and other pain relievers to treat chronic or acute pain, falling into one of two groups. The first group comprised a majority of the unintentional cases--those who had overdosed by taking multiple acetaminophen-containing products to relieve pain. The other category consisted of those who had become tolerant to the effects of their pain killer, and had therefore increased the dosage to experience the same effect. This is prevalent in long-term narcotic users; in fact, 60 percent of the subjects were using narcotic-containing compounds when they overdosed.

What is important to note is that this study does not reflect the number of people who overdose on acetaminophen but don't experience ALF. There are those who contract less serious but still harmful cases of hepatitis, which is an inflammation of the liver.

This occurs when only a portion of the liver cells die, but the liver manages to survive, function and ultimately recover. Just this month, Larson treated three patients suffering from hepatitis.

"People think that if it's okay to take two, then it's better to take six," Larson said.

This harmful misconception is "mostly because of the advertising [of over-the-counter pain relievers]," said Larson. These advertisements appeal to consumers because they claim to provide an easy remedy for pain, but they fail to reiterate that there is a proper dosage.

Drugs such as acetaminophen, she explained, are "clearly advertised as a safe product," although lately, drug companies have been trying to convince consumers to abandon this mentality. Larson stresses that acetaminophen is a drug like any other, and there is a limit to how many you can take before it harms you -- a threshold that is different for each person.

In the end, Larson says, all drugs can cause complications if not taken properly, but most can be taken safely if taken as directed. The best piece of advice she can give to those who want to prevent themselves from consuming dangerous quantities of acetaminophen is very simple.

"Read the label and add it up," she said.