I'm always surprised at the hostility to Acetaminophen on HN (or Paracetamol as we call it here in the UK).
It's one of the most commonly used medicines in the UK - and certainly the most popular painkiller.
YouGov even did a survey confirming that - https://ygo-assets-websites-editorial-emea.yougov.net/docume...
The safety aspects of it are not something that gets raised in the UK much - other than suicide attempts, which are going to happen no matter what medicine you use.
Probably the biggest risk comes from people not realising that other medicines (e.g. for cold and flu) often include it, so they double up on a dose.
It’s the most popular in the UK because that’s what NHS GPs tell you to take for absolutely everything.
A friend of mine, Eric Engstrom, died of liver failure after taking (too much) Tylenol. Tylenol use over time can sneak up on you in the form of cumulative liver damage.
No, I'm not a doctor and this isn't medical advice.
Personally, a works-most-of-the-time treatment for headaches is going out for a walk. I don't know why it works, but it does.
My understanding is that if taken in the recommended dose, and not taken for a longer period of time (consecutive doses, I mean) than the bottle says to, you don't end up with cumulative damage.
The damage should only occur if you take more than the recommended dose, or continue using it longer than the recommended period.
(Also not a doctor and this isn't medical advice.)
You have to take a lot at one time, or chronic overdoses, to damage your liver.
Taking the maximum daily recommended dose (4g per day, thereabouts, in 1g doses) every day for months on end is fine and won’t do any damage.
I’m sorry about your friend but his experience is unrelated to the fact that using the medication as recommended, even long term, is not harmful in the least.
It's a common failure mode and most other OTCs won't kill you if you occasionally accidentally take an extra dose or two. Agreed that it's safe at the correct dose but the hazards are severe and dosing incorrectly is inevitable at population scale.
Headaches have various causes, and you have to look at where the pain is "originating" from to even try and figure out why. Going out of a walk could be due to a sinus getting irritated and going out for fresh air helps relax it. It can also just be a stress headache and going for a walk relaxes you.
Oh I fully agree that it working depends on the cause of the headache. But when one doesn't know the cause, it's well worth a try.
Yep, my mom worked in the pediatric ER, she never let Tylenol/acetaminophen in the house, my understanding is that she saw way too many cases of liver damage and death.
> or Paracetamol as we call it here in the UK
Mildly amusing anecdote: years ago I visited my then-company's office in London (I'm from the US), and fell sick during my time there. One of my London-local colleagues recommended I get "Night Nurse", and told me of the magical virtues of paracetamol. I'd never heard of it (either the brand name or the drug name), and assumed it was some great drug that for some silly reason the US FDA decided not to approve. It worked perfectly well, but frankly no better than what I'd take at home.
Much later I looked up "paracetamol" and discovered it's the same thing as acetaminophen... "oh, Night Nurse is just the UK version of NyQuil", I realized, somewhat disappointed, the magic lost.
> I'm always surprised at the hostility to Acetaminophen
I wouldn't say I'm hostile toward it, but the number one cause of headaches for me is alcohol consumption, and I was taught that alcohol plus acetaminophen is a strict no-no. Ibuprofen -- in the recommended dose -- is generally fine with alcohol. (I don't binge drink anymore, but as I get older, even 3 or 4 cocktails over the span of 4-6 hours can give me a headache later.)
But when I come down with a cold, it's (the cheaper, generic version of) NyQuil for me. A bonus is that NyQuil also contains dextromethorphan (cough suppressant) and doxylamine succinate (antihistamine) (or phenylephrine in the non-drowsy DayQuil variant), which IIRC Night Nurse/Day Nurse did not include. (Looks like it does contain dextromethorphan and promethazine now; not sure if it didn't back then, or if I'm just misremembering.)
Its so popular people will take it for mild inconveniences, which is absolutely not what you should do.
Why not?
Stresses the liver, also if its used frequently for mild inconveniences you should maybe go to the doctor, as frequent headaches or stuff like that can hint to more severe stuff.
It does not stress the liver at recommended doses. Plenty of people get frequent headaches and other aches that have no other severe stuff going on, or really anything that needs to be treated more than symptomatically. Scheduled tylenol is an effective element of a pain regimen for many people.
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Please don't do this here.
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Please don't post snarky putdowns or sneer at others. It only makes things worse.
Look at their bio. Why do you want them on this website, dang?
Sometimes, when treated nicely, people change.
Although I rarely take any form of painkiller, I've had headaches so bad I could barely exist. In those cases, pain killers were an important relief.
Yup. Anyone that flippant about "just a headache" definitely doesn't experience actual bad headaches themselves, and lacks empathy for those who do.
Drink more water
What makes you think people who take a painkiller for chronic pain generally don't report it to their doctor?
1. A lot of people won't go to a doctor in the united states
2. They may be so used to pain they don't think to mention it.
3. A lot of people lie to their doctors for one reason or another.
In the US there’s also deep religious influence that paints suffering as virtue that’s been exploited by capitalists to establish a norm of pushing through the pain and continuing to work instead of taking a break to figure out what the root cause is and address it. Some also just don’t have a choice, because taking time off means not getting paid which means losing a roof over their head.
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If you go to doctor with mild annoyance, they wont take you seriously.
If Paracetamol was invented today it would likely never receive an OTC (over the counter sale, meaning you can just buy it from a retail outlet the way you'd buy cough medicine or toothpaste) license in the UK. Yes, it's safe (and for a bunch of people including me, effective) at the licensed dose, but it's useless at about half that dose, and it's toxic, leading to very nasty deaths in some cases, at just about 3-4 times that effective dose.
That's a very narrow efficacy window. There are modern drugs with a narrow efficacy window but they have pharmacy only licenses or require prescription, which both mean somebody who knows what the hell they're doing sold you the drug, not the automated checkout at a supermarket. That's a vital opportunity to spot that e.g. you're taking this every single day (so it's ongoing pain, probably needs a different intervention, paracetamol is contrandicated) or you have an obvious wound, which needs medical attention not painkillers. Or sometimes very dumb things, like, hey, the actual symptoms you have described mean you're likely pregnant did you even realise that? Would you like a pregnancy test instead ?
Always surprises me as an American in the UK how hostile the UK is to paracetamol. You buy it in like 300-pill packages in the US, and I've literally never heard of anyone having a single accidental over-dose. I'm not sure I've ever heard of anyone intentionally overdosing on it, but I guess I can't rule that out since I'm aware of who 1-2 people personally have taken "a handful of pills".
The efficacy window of driving cars is pretty narrow, and represents existential risk to third parties. But as with cars, sometimes the balance favors wide availability.
> Always surprises me as an American in the UK how hostile the UK is to paracetamol.
This is so funny because there's a post in another subthread by someone from the UK saying the same thing about Americans being hostile toward it.
I've only been to the UK a few times, but I feel like it's a funny meme that people in the UK unhesitatingly suggest and take paracetamol for everything. I guess that's not really true, or at least has some truth to it but is an exaggeration?
I’m more referring to the fact that it’s treated like a controlled substance here and sold in limited quantities from behind the counter. It’s the same treatment the U.S. gives to Sudafed which is an input to meth as I understand it.
The problem becomes, 8 tablets a day, minimum of 4 hours between doses is fine for a week or so, but do that for months and the liver toxicity creeps up on you.
If you feel the need for 8 tablets a day for months, go see a doctor. Your liver is probably the least of your concerns.
It doesn't make much sense to think of efficacy windows for driving, it's not a medical intervention.
Besides US traffic deaths are crazy high by UK standards.
I believe the numbers normalize a bit when you adjust for the fact that everyone drives in the U.S. and tends to be alone when driving. So it’s like accident per mile driven and you see it’s around the same. But in the UK many fewer people drive as a proportion of the population and especially those who are more dangerous (e.g. young, old, disabled, drunk) tend to opt out here due to the availability of mass transit which doesn’t work in the U.S.
The small packages available in the UK are entirely to reduce the chance of suicide.
iiuc it's really hard to OD on tylenol but really easy to end your quality of life through drug interactions with tylenol
I'm by no means an expert in assessing OTC drug safety, but your efficacy window feels... fine... to me? I feel like it shouldn't be hard to avoid taking 3-4 times the effective dose of something? But I guess people still do it, and mess up their liver anyway.
I'm always very torn on how to best protect people from being stupid. The label on the bottle says not to use the drug for longer than a certain period. Sure, people might not read it, or might not understand the risks and ignore it. Sure, someone might be too dumb / in denial to realize they might be pregnant, and take inappropriate medication. I do really want to protect these people from themselves, but I also don't want to go to the doctor every time I have the common cold to get a prescription for one of the only things that clears up my symptoms enough so I can sleep.
You don't need a doctor. In the UK today there are pathways for Advanced versions of several non-doctor careers which get you either limited, or in some cases full blown unlimited prescribing rights. I think ordinary Advanced Midwife is just a set of common pregnancy drugs, stuff so you can keep down food, sleep properly and so on despite some of the nastier but still non-critical pregnancy side effects, but Advanced Nurse Practitioner and Advanced Pharmacist are both full blown prescribing rights.
The only thing which I think Advanced Practitioner doesn't get you is going entirely off piste, like fuck it, maybe this untried drug will fix your cough. But the person with their name on the pharmacy paperwork can sign off any ordinary stuff, far beyond just "common cold" treatments, anti-nausea, anything a doctor signs on an average day unless they're in some weird research field. The idea isn't that you'd need a GP appointment but that probably it shouldn't be with the bubblegum and cornflakes in the supermarket without even talking to a professional.
Not to mention veterinary pathways. My ex GF was volunteering at a vet practice, where they kept no track of their meds, other than "hey boss, we seek to be low on Ketamine, swing past the animal pill shop and get a load of it pls".
Also there are travel pharmacies, which will sell you prescription drugs, so long as you insist you're about to go travelling somewhere remote.
The whole pretence that dangerous drugs are controlled and kept away from people is a pretty thin veneer.
personal responsibility is more common in the UK, it is assumed that one can cross the road safely without needing traffic lights for example, or walk along a stretch of an ancient monument without needing a handrail.
I've never met anyone here who has ever had any issues associated with paracetamol abuse/overdose, and only a single person who failed to cross the road correctly.
It's weird that you're surprised, it's one of the most dangerous otc drugs, and is the leading cause of liver failure on the planet. I'm always surprised that British people treat it like aspirin, because an overdose can easily kill you.
I'm serious. Over 50% of all liver failure is due to acetaminophen, and 20% of liver transplants.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4913076/
> I'm serious. Over 50% of all liver failure is due to acetaminophen, and 20% of liver transplants.
That's not what that study says.
It says it is responsible for 50% of the overdose-related acute liver failures. Acute liver failure is rare, especially compared to chronic liver failure.
Well, c'mon, let's be fair. Your source says overdose-related liver failure. And reading further, most of the overdoses are either intentional (suicide attempts) or a result of addiction and opiate/acetaminophen combination drugs.
I've heard people claim that Acetaminophen wouldn't be approved as an OTC drug if introduced today as it is too liver toxic.