Dangers of Acetaminophen

 In 1994, researchers from John Hopkins Medical School published in the New England Journal of Medicine an article¹ noting that there is a risk of kidney failure associated with the use of acetaminophen, aspirin, and Nonsteroidal Anti-inflammatory Drugs (NSAIDs).  The study found that:

• “People who take analgesic drugs frequently may be at increased risk of end-stage renal disease (ESRD).”
• “Heavier acetaminophen use was associated with an increased risk of end-stage renal disease in a dose-dependent fashion.”
• Those who took 105-365 acetaminophen pills per year had a 40 percent increased risk of end-stage renal disease compared to those who took 2-104 acetaminophen pills per year.  For some, the risk of end-stage renal disease was as great as a 140 percent increased risk.
• For those who took more than 365 acetaminophen pills in a year, the increased risk of end-stage renal disease was 110 percent.  For some, the increased risk of end-stage renal disease was as high as 270 percent.
• For those who took more than 1,000 pills containing acetaminophen in their lifetime (compared to those who took fewer than 1,000 acetaminophen-containing tablets), their increased risk of end-stage renal disease was 100 percent.  For some, the increased risk of end-stage renal disease was as high as 220 percent.
• For those who took more than 5,000 pills containing acetaminophen in their lifetime, their increased risk of end-stage renal disease was 140 percent.  For some, the increased risk of end-stage renal disease was as high as 380 percent.
• The authors noted that 8-10 percent of the overall incidence of end-stage renal disease is attributable to acetaminophen use.
• The authors concluded, “People who often take acetaminophen have an increased risk of end-stage renal disease.”

In 1997, researchers from the Department of Internal Medicine, University of Texas Southwestern Medical Center, published in the New England Journal of Medicine an article noting²:

• Acetaminophen ingestion accounts for 12% of all patients hospitalized with drug overdoses.
• Acetaminophen ingestion accounts for 40% of patients with acute liver failure.

In 2004, Tim Davern, MD, a liver transplant specialist at the University of California, San Francisco, published an article in the San Francisco Chronicle³, stating:

• “First Do Not Harm” is a cornerstone of modern medicine.
• “I think the practice of combining acetaminophen and an opiate, such as hydrocodone bitartrate, together as a single drug (as Vicodin does) defies logic, if not common sense.”
• Acetaminophen is a “potent dose-dependent poison for the liver; simply stated, if you take too much, your liver dies.”
• Acetaminophen overdose is the “leading cause of acute liver failure in the United States today.”
• On the other hand, opiates, such as hydrocodone bitartrate and codeine, while safe for the liver, are highly addictive.
• “Vicodin is currently the most popular prescription drug In the United States.”
• Some patients become addicted to the opiate component of Vicodin and consume increasing amounts of acetaminophen, “ultimately leading to acute liver failure.”
• “With overwhelming liver injury from acetaminophen, what follows is a particularly grisly death punctuated by bleeding, confusion, coma, brain swelling, damage and death.”
• “Patients typically take too much acetaminophen for fever or pain over several days, not realizing the potential for live damage.”
• “Many are unaware that acetaminophen is contained n dozens of over-the-counter cold and flu preparations.”
• “This situation is particularly tragic in young children accidentally overdosed with acetaminophen, typically in the setting of a flu-like illness, by well-intentioned but misinformed parents.”
• Acetaminophen packaging should have better warning labels, and should not be sold in 1,000 pill mega-bottles.
• Acetaminophen-opiate combinations [like Vicodin] should be removed from the market.
• “The prescription rules in California have made it far easier for physicians to prescribe an acetaminophen-opiate combination, such as Vicodin, than a pure opiate, such as codeine, although the former is far more dangerous.”
• The FDA banned Ephedra, which “contrasts with its puzzling, relatively meager efforts to prevent acetaminophen hepatotoxicity, which kills far more Americans each year than Ephedra.”

In February 2006, regular PARADE columnists Isadore Rosenfeld, MD, published an article entitled, “Take This Painkiller Carefully⁴.  In this article, he notes:

• “Acetaminophen, whose best known brand name is Tylenol, is one of the most widely used non-prescription painkillers in the US.”
• Overdosing with it is the leading cause of serious poisoning in this country.”
• “Every year, too much acetaminophen accounts for 50,000 emergency room visits, 42% of liver failures, and an average of 458 deaths.”
• “Never take more than 4,000 mg a day – eight 500 mg extra strength capsules.”
• Numerous other drugs also contain acetaminophen, including Nyquil, Sudafed, Alka-Seltzer, Sinutab, Contac, Actifed, etc.
• “If you have two or three alcoholic drinks or more a day, be sure to consult your doctor before taking Acetaminophen.”
• “The symptoms of acetaminophen overdose are nausea, vomiting, abdominal pain and lack of appetite.” [Note: these are symptoms that some may take Tylenol for, flu-like symptoms.]
• The specific antidote is N-acetylcysteine (NAC).

In 2005, researchers associated with Harvard Medical School published in the American Heart Association journal Hypertension, an article noting⁶:

• Acetaminophen [Tylenol, Atasol, Anacin-3, Panadol, Excerdrin {has acetaminophen, aspirin, and caffeine}], is one of the most commonly used drugs in the United States.
• Compared with women who did not use acetaminophen, older women who took >500 mg per day had a 93% increased risk of hypertension.
• Younger women who took >500 mg per day of acetaminophen had a 99% increase of hypertension.
• Compared with non-users of acetaminophen, older women who consumed >500 mg per day for headache had a 240% increased risk of hypertension.
• Compared with non-users of acetaminophen, younger women who consumed >500 mg per day for headache had a 370 percent increased risk of hypertension.
• Higher daily doses of acetaminophen significantly increase the risk of hypertension in women.
• Acetaminophen impairs renal function by depleting glutathione, leading to renal endothelial dysfunction.
• Clinicians commonly DO NOT understand that Acetaminophen is NOT SAFE, and causes significant hypertension.

There are three Nutritional strategies to boost levels of glutathione to protect oneself or patients against the toxicity of acetaminophen and other drugs, as well as protect our bodies from other toxins, such as, mercury, lead, cadmium and aluminum⁵.

• Take B6, B12, and Folic Acid – they help the body convert the harmful amino acid homocysteine into the beneficial amino acid cysteine. Cysteine is the rate-limiting factor in the construction of the antioxidant/detoxifier glutathione.
• Take N-Acetyl Cysteine, or NAC.
• Consume undenatured whey protein.  According to Dr. Gutman (5), undenatured whey protein is probably the best method to elevate one’s levels of glutathione.

References

(1)   Perneger TV, Whelton PK, Klag MJ; Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsterodial anti-inflammatory drugs; New England Journal of Medicine; Dec 22, 1994; 331 (25): 1675-9.

(2)   Schiodt FV, Rochling FA, Casey DL, Lee WM; Acetaminophen toxicity in an urban county hospital; New England Journal of Medicine; Oct 16, 1997; 16;337 (16): 1112-7.

(3)   Davern T; The Danger Of Mixing Candy and Poison; San Francisco Chronicle; Aug 14, 2004.

(4)   Rosenfeld I; Take This Painkiller Carefully; Medical News That Matters, Second Opinion; Parade, February 19, 2006, pg 6.

(5)   Gutman J; Glutathione, You Body’s Most Powerful Protector, Kudo. Ca Communications, 2002

(6)   Forman JP, Stampfer MJ; Cuhan GC; Non-Narcotic Analgesic Dose and Risk of Incident Hypertension in US Women; Hypertension; September 2005; 46-500.