# Liver Damage



## STEELADDICTION (Dec 27, 2005)

liver damage 

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WASHINGTON - Think popping extra pain pills can't hurt? Think again: Accidental poisonings from the nation's most popular pain reliever seem to be rising, making acetaminophen the leading cause of acute liver failure. 

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Use it correctly and acetaminophen, best known by the Tylenol brand, lives up to its reputation as one of the safest painkillers. It's taken by some 100 million people a year, and liver damage occurs in only a small fraction of users.

But it's damage that can kill or require a liver transplant, damage that frustrated liver specialists insist should be avoidable.

The problem comes when people don't follow dosing instructions — or unwittingly take too much, not realizing acetaminophen is in hundreds of products, from the over-the-counter remedies Theraflu and Excedrin to the prescription narcotics Vicodin and Percocet.

"The argument that it's the safest sort of has overruled the idea that people cannot take any amount they feel like," says Dr. William Lee of the University of Texas Southwestern Medical Center, who laments that acetaminophen is popped like M&Ms.

Acetaminophen bottles currently recommend that adults take no more than 4,000 milligrams a day, or eight extra-strength pills.

Just a doubling of the maximum daily dose can be enough to kill, warns Dr. Anne Larson of the University of Washington Medical Center.

Yet, "if two is good, 10 is better in some patients' minds," she says with a sigh.

The Food and Drug Administration has long wrestled with the liver risk, warning two years ago that more than 56,000 emergency-room visits a year are due to acetaminophen overdoses and that 100 people die annually from unintentionally taking too much.

A study published this month by Larson and Lee has agency officials weighing whether to revisit the issue.

Over six years, researchers tracked 662 consecutive patients in acute liver failure who were treated at 22 transplant centers. (Acute liver failure is the most severe type, developing over days, unlike chronic liver failure that can simmer for years because of alcohol abuse or viral hepatitis.)

Almost half were acetaminophen-related. More remarkable was the steady increase: Acetaminophen was to blame for 28 percent of the liver poisonings in 1998, but caused 51 percent of cases in 2003.

That makes acetaminophen the most common cause of acute liver failure, the researchers report in the journal Hepatology.

While most patients pulled through with intensive care, 74 died and 23 others received a transplant.

Some 44 percent of the cases were suicide attempts.

But more, 48 percent, were unintentional overdoses, which "isn't hard to do," Larson says.

Say you take Tylenol Cold & Flu Severe for the flu's aches and stuffiness — 1,000 mg of acetaminophen, every six hours. A headache still nags so between doses you pop some Excedrin — 500 mg more of acetaminophen. Switch to Nyquil Cold/Flu at bedtime, another 1,000 mg.

Maybe you already use arthritis-strength acetaminophen for sore joints — average dose 1,300 mg. 

Depending on how often they're taken, the total acetaminophen can add up fast. 

That's the nonprescription realm. Surprisingly, 63 percent of unintentional overdoses involved narcotics like Vicodin and Percocet that contain from 325 mg to 750 mg of acetaminophen inside each pill. 

Some were chronic pain sufferers taking more and more narcotics as their bodies adjusted to the powerful painkillers, not knowing they were getting ever-higher acetaminophen at the same time. Or they added over-the-counter products for other complaints. 

Just this month, Larson treated an 18-year-old whose liver crashed after using Vicodin for three or four days for car-crash injuries. "She was just taking too much because her pain was bothering her." 

Led by Tylenol manufacturer McNeil Consumer & Specialty Pharmaceuticals, most over-the-counter products now voluntarily list acetaminophen on front labels. 

McNeil also runs ads about the risk, saying "if you're not going to read the label, then don't buy our products," says spokeswoman Kathy Fallon. 

But how strongly labels warn varies by product. A rule to standardize warnings, urged by FDA's scientific advisers in 2002, still is working its way through the agency. 

While FDA runs a consumer education campaign about the liver risk, nonprescription drugs chief Dr. Charles Ganley says the new study suggests the agency may need to further target narcotic-acetaminophen combinations. 

Lee wants to copy Britain, which saw a 30 percent drop in severe liver poisonings after restricting how much acetaminophen could be bought at once. 

That's unlikely. Meanwhile, the advice is simple: Read drug labels and add up all your acetaminophen, avoiding more 4,000 mg a day. For extra safety, Lee advises no more than 2,000 to 3,000 mg for more vulnerable people, who regularly use alcohol or have hepatitis. 

___ 

Lauran Neergaard covers health and medical issues for The Associated Press in Washington.



this article is about tylenol but here is a perfect example where adding up the stress from drinking, oral steroids and over the counter pain killers can place you at a severe health risk .


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## pincrusher (Dec 27, 2005)

yeah and on top of that imagine taking a few anadrol or dbol tabs.  very enlightening article about OTC products and how dangerous they really are yet steroids which clearly are no more dangerous are banned. makes you go huummm????


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## Nitrateman (Dec 27, 2005)

Good read.  Bump to Pin...OTC meds are by far the most dangerous, because everyone thinks that they aren't.  It's a common misconception that something is safe if it is readily available.

Nitrateman


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## stealthmeister (Dec 27, 2005)

Nitrateman said:
			
		

> Good read.  Bump to Pin...OTC meds are by far the most dangerous, because everyone thinks that they aren't.  It's a common misconception that something is safe if it is readily available.
> 
> Nitrateman


Good review Steel, thanks. I strongly suspect more of the "unintentional overdoses" are actually suicide attempts though. True about the dose however, they used to say no more than 30 mg/kg per day was acceptable, which would be about 2100 mg for the average person. That's not hard to accumulate with extra-strength (500mg) tabs.

Nitrateman, I also strongly agree with you re: the perceived safety of OTC drugs. Even moreso is the perceived safety of herbal meds that don't require nearly the strict testing that most drugs do (because they are considered 'nutritional supplements'), yet can be very dangerous.


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## Andrew (Dec 28, 2005)

*moderation*

Moderation is the key.  Too much or chronic use of anything is detrimental.  That's why we cycle on and cycle off.  However, I don't like to use moderation when it comes to sex.  More is always better!


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## MR .T (Dec 30, 2005)

I had a gf that used to take 12 500mg acetaminophen ed. She also drank 1 or 2 days a week. and took birth control I would tell her it was liver toxic but her moron doctor sad it was fine to take that amount. She was only 125-130lbs. She took them for headaches but I also thought they where the cause of the pain.


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## kell11 (Jan 4, 2006)

Yes,Vicodin for example-Loaded with 750mG of acetaminophen(synergises w/ the hydrocodone) per tablet--Pop goes the liver--Would be a much safer drug
without it...the Hydrocodone would still do it's job and you wont need a Liver transplant later...i dunno?

*Nitrateman,You are right on the money with your OTC meds remark*


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## powermad (Jan 21, 2006)

People are simply uneducated when it comes to acetominaphen/tylenol and how its properties affect the body.

I've known many people (mainly women, no offense to the females here) who regularly drink heavily and then attempt to combat the hangovers with tylenol or something that contains tylenol.  For example, one of my girlfriends in college would regularly party on friday nights, have several drinks and then pop 2 tylenol before bed.  When she woke up the next AM she'd take some alka-seltzer (or other med with tylenol in it) and every few hours take more to reduce the hangover effects (mainly headache).  Then she'd go out that same night, drink and repeat the process on sunday.  This isn't an isolated case, the behavior is too common and these weekend warriors just don't realize how much harm they're doing to their liver.  

I've tried to reason with more than one person who parties(read:gets drunk) every weekend and takes tylenol regularly, but they never seem to grasp just how dangerous their behavior is.  I tell them to take ANYTHING but tylenol--even aspirin and ibuprofen are better (nothing is best) than tylenol for hangovers.  But since it kills pain immediately/very well, people will continue to overdose the drug, which IMO should'nt be taken more than 1g/day 3x a week at most.


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## MaSTa LifTa (Jan 21, 2006)

Tylenol is a very safe drug.  It has very minimal and not serious drug-drug interactions.  A person can take up to 4 g/day, and a max of 1 g per dose.  Unless they have some sort of liver dysfunction.  The thing is people never read labels and if they take the max dose of tylenol, they might want to take something else like the article said and they never realize that there is acetaminophen in the other drugs that they are taking too.  It's not the OTC meds that are dangerous, it's people not being educated enough about them that is dangerous.  They are OTC for a reason, because they are considered safe enough for the general public to take w/out a physician writing a script for.  Just my .02


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## powermad (Jan 21, 2006)

The problem with tylenol is even if it is safe at the 4g/day dose, it has VERY serious interactions with alcohol, and many people are unaware of this.  Add to that the fact that the LD 50 is only a little bit higher than the maxium safe dose and things get worse.  As far as interactions, yeah, there are few but the alcohol one is serious.  And the fact is that most of the population drinks and doesn't bother reading the labels on the back of the stuff (that contains tylenol) they regularly take for headaches, back pain, PMS, etc. half of the time and it is a recipe for disaster.  

A lot of people are not even aware that acetominophen is just a generic name for tylenol and, just as the article states, ends up taking too much everyday b/c they use excedrin for headaches, Tylenol ES for back pain, alka-seltzer for upset stomach/hangovers, etc. It obviously is the fault of the end-user for being uneducated, there needs to be some sort of change in the education of people regarding the effects of Tylenol, and acetominophen-containing products should contain a LARGE warning on the FRONT of every package so these cats know they're taking multiple doses of a toxic OTC drug.

Seriously, offering hydrocodone OTC would probably cause less deaths/ODs than tylenol, take a look at canada--they sell codeine cough syrup OTC and though people may be addicts they aren't killing themselves/OD'ing by taking twice the recommended amount.

Just my 2 cents.


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## ASHOP (Nov 13, 2007)

Nitrateman said:
			
		

> Good read.  Bump to Pin...OTC meds are by far the most dangerous, because everyone thinks that they aren't.  It's a common misconception that something is safe if it is readily available.
> 
> Nitrateman





Just like the old comparison. if you took 50 aspsirin you would probably die..you could take 50 dbol and maybe get headache and a little oily skin at worst.


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## Ammycin (Mar 9, 2010)

Exactly! drug to drug interactions vary it. When you take aspirin for mild pain.


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