The dangers of Acetaminophen

In good health

By Malka Eisenberg

Acetaminophen-related liver injury was the main cause of acute liver failure between 1998 and 2003 according to a multi-center study in the US quoted by the FDA.

Acetaminophen is a useful drug for pain and fever so long as proper and accurate dosage is followed. Taking too much of the drug can cause damage to the liver and even death.

“Follow the guidelines on the packaging,” warned Dr. Mitchell Weiler of South Island Pediatrics in Cedarhurst. “Always read the ingredients of all medicines given at the same time to be sure of no duplication. Consult your physician or pharmacist to make sure that there is no crossover in dosage.”

He pointed out that most accidents happen when a child takes a bottle or chews pills. Poison control should be called if an overdose is suspected and the child may require medication, hospitalization and observation.

“It has to be done quickly to counteract the risk of liver toxicity,” he said.

Dr. Robert Van Amerongen, Chief of Pediatric Emergency Room at Methodist Hospital in Brooklyn and medical director of Priority Pediatrics in Lynbrook, said there are three groups of people who tend to overdose: small children, teens and the elderly. He said that infants and toddlers are sometimes given the wrong dose or are attracted to the colorful, flavored liquids or pills. He noted if medicine is left around, children can “gulp a whole lot down.”

He pointed out that when rotating between ibuprofen (Motrin) and acetaminophen (Tylenol), parents may, at times, mix up the dosages since they differ, giving too much of one or too little of the other. Van Amerongen also recalled a study on the wide range of teaspoon sizes purchased at various stores and recommended using a medication syringe with exact measurements.

Although a child might “just grab” some medicine, Van Amerongen noted that, “accident implies that there is no way to prevent it” and stressed the need for “good parental oversight.” It’s never good to leave medicine where it’s available to get a hold of, he said. Overdoses happen in times of turmoil, such as when someone is injured in the house and a parent is distracted, or when grandparents visit and leave medicine on the nightstand that the child saw them take. If there are many visitors around parents don’t pay as close attention and medicines that are not normally left around can become available.

Van Amerongen pointed out that acetaminophen may cause damage to the liver hours or days later.

An overdose may require hospitalization and medication and the washing out of the gastrointestinal tract, Dr. Weiler said. Some symptoms of toxicity include abdominal pain, loss of appetite, vomiting, diarrhea, jaundice, nausea, and sweating. Children require observation for “a couple of days to make sure there is no toxicity” and following levels of acetaminophen in the blood, explained Weiler.

More extensive treatment is sometimes required to alleviate toxic effects.

The FDA noted that although, overall, acetaminophen is a safe drug, the level that reaches toxicity is not clearly defined and symptoms of overdose are not obvious or can be mistaken for flu. Some people, based on genetics or nutrition, may develop toxicity at lower doses.

According to the FDA, and the physicians interviewed, the wide range of products, both over the counter and by prescription, that contain acetaminophen, do so in varying amounts and dosages. It is found in headache preparations, cold medicines and narcotics such as vicodin. They are sometimes labeled “APAP” (the chemical name N-acetyl-paraaminophenol) for acetaminophen, further confusing consumers. An additional risk for small children is the different strengths or concentration between infant and child medications since the infant version is usually more concentrated, so less medicine has to be administered. A parent may inadvertently give too much by using a larger amount of a more concentrated dose.

Elderly people may be seeing a number of different specialists, each prescribing medications, and can overdose on acetaminophen, or other drugs from duplicate or overlapping medicines. “The doctors are not communicating,” emphasized Van Amerongen. “This is termed iatrogenic, or a doctor-caused overdose.” Doctors or pharmacists should be asked to review all the medications to insure that there is no overlap to eliminate the possibility of overdose.

Teens and young adults may overdose intentionally to try to hurt themselves, said Van Amerongen.

“Tylenol, Advil, they take a whole bunch,” he said. “It’s readily available and commonly used, so commonly that they don’t realize the problem.”

Van Amerongen said that he has seen “lots of cases” of overdoses although “in general, toddlers rarely drink enough to cause a problem.” One the other had, in teens and young adults, he said, “I had a patient who required a liver transplant due to an intentional overdose.”

The patient ingested a whole bottle of extra strength Tylenol.

“Kids do these things,” said Weiler. “It’s terrible.”

The nationwide poison control number is 1-800-222-1222. In New York City the number is 212-POISONS. The 800 number is recommended since calls are directed to the nearest poison control center in the caller’s area, facilitating rapid assistance.