Paracetamol/Acetaminophen

Posted by: Stuart M on 23 May 2009

I was originally posted this in the "What are you drinking" thread, but deleted as inappropriate. It was the talk of hangovers that started me off but also colds/flu etc, etc.

so <RANT>
If you have a hangover/cold or other conditions and take medicines that contain Paracetamol (Acetaminophen in the USA) you could unintentional kill yourself.

There are over 70,000 cases of self poisoning in the UK alone, many of these are by accident - In a day, take: pills to help with blocked sinus; pill for pain; a night medicine to help you sleep; an alcoholic drink to help you sleep drink or you had a few drinks in the days before then....especially if you did this over several days.. You could have, by mistake, trashed your liver and you die (and you will recover enough to know it will be a an unpleasant death and no way to stop it over the next few days without a liver transplant) - but at least you've time to say goodbye before you lose your mind.

See here http://www.pubmedcentral.nih.g...r.fcgi?artid=1113277

Compare this to the "evil" drugs such as Extacy, GBH, GBL that cause far fewer deaths a year than Paracetamol that millions of pounds spent when far more human casualties could be prevented by a simple change of law.

Why will governments spend a fortune trying to ban drugs that kill a few people but not mandate that any product containing paracetamol should contain the antidote to paracetamol poisoning (NAC = N-Acetyl Cystine) - perhaps because it will not smell nice (Rotten Eggs) - but they can make coated pills of that it will add 20p to a box of pain killers. And if it's a liquid - well medicines who ever said a medicine should taste nice. (The taste of 10,000 say vs the life of 1)

Paracetamol poisoning is subversive and even if you follow the labeling you can unknowingly overdose, if you've had a drink even more so. What causes more problems is Paracetamol has to be included with some over the counter medicines to prevent abuse, so people take multiple drugs not realising they have gone over the 4 grams a day maximum and this can end up killing people.

WHY when it can be made safe, do we not make it mandetory, when we spend a fortune attacking so called "illegal" drugs that do not kill so many.

This information has been known for years - I saw it first on "That's Life" if I remember correctly so why has nothing been done when laws are made for drugs that kill handfuls of people. Due to the press GBL is the new killer and will be banned, it's used to clean alloys, but going down that route we should also ban glue, methylated/surgical spirit, gas, NO2 etc, etc.
</RANT>

And drinking at the moment - Cognac & fresh orange juice.

Also for those of you that have kids (or even if you don't) you can buy NAC at many health food shops - if you chuck a handful of these down someones throat that you think has taken a Paracetamol/Acetaminophen overdose it could save their lives, but get them to A&E ASAP.
Posted on: 23 May 2009 by Bruce Woodhouse
The link did not work, but i think I can guess at the gist.

My wife (a hepatologist) tells me that the evidence for the safety of adding NAC is far from proven. It may be considered 'safe' as a single treatment for a paracetamol OD but adding it to every single dose of paracetamol taken across the globe, across all ages, requires a significantly higher safety threshold. I do not know if we have that data.

Incidentally the effectiveness is not proven, either; not just as an 'antidote' with every dose but as a public health measure. We do not know wether people would switch to taking alternatives when trying to deliberately self harm for example. It was hoped that reducing the total number of paracetamol available in a single purchase would reduce paracetamol OD deaths, I'm not sure wether the data supports this.

OTC meds in the UK (ie available without prescription) include lots of drugs with quite significant risk. Safe dispensing is a delicate balance. All drugs have a trace-off between safety and risk, and we should learn to use them with care. Perhaps a paracetamol packaged as 'totally safe' would actually encourage more 'unsafe behaviour' with this and other medicines? We don't know.

I understand your rant. It seems so obvious. It almost never is!

Bruce
Posted on: 24 May 2009 by matt303
At the start of the year I had an episode with my liver (alt peak 2000, now down to 48) which we are still trying to find the reason for as every test so far as come back negative. On my first visit to the consultant I raised the question of what pain killer to use if I had a headache and was told Paracetamol would be fine. This confused me a little because I'd always linked it with liver damage because of the damage a OD causes. Seems the level of OD required for liver damage from a single dose is a multiple of the 24hr limit so there is some safety margin but it is very important not to exceed the stated dose or take multiple products containing it.

Rather than adding NAC you could probably get a meaningful drop in accidental OD by altering the packaging and public information adverts.

Remember that Ibuprofen and Aspirin are not without risks either.
Posted on: 24 May 2009 by Derry
quote:
...And drinking at the moment - Cognac & fresh orange juice.

Not surprised you need painkillers...
Posted on: 25 May 2009 by Willy
Stuart,

By all means have a rant about the dangers of Paracetamol (an effective anti-inflamatory) however bringing a raft of recreational drugs into the argument, for me at least, somewhat devalues your point.

Regards,

Willy.