[Stitcher]

I am not saying to never take Tylenol/Acetominophen again, but to heed this warning.

I can personally attest to its accuracy. In 1995, four months after a serious car accident, the disc between L5 and S1, where the roots of the sciatic nerves are located, slipped out from between the discs. The pain was excruciating and I could not walk, even with my crutches. My neurosurgeon scripted me Tylox (oxycodone and acetaminophen). After two weeks on the medication, it was finally surgery day. Once on the surgical holding floor, the anesthesiologist reviewed my blood work and halted the surgery. Seemed my liver was so toxic from the Tylenol component of the RX that putting me under anesthesia would have severely damage my liver. So, I spent four days having my liver flushed out, before I was deemed safe for the spinal fusion surgery.

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The FDA's Painkiller Warning: How to Avoid Taking Too Much
An overdose of Tylenol can damage the liver. The problem is, we're often taking it when we don't even realize it

By ALICE PARK
Wednesday, Dec. 20, 2006
http://www.time.com/time/health/arti...572012,00.html

It's cold season, so you probably don't think anything of downing a dose or two of a cold medicine on top of the Tylenol you might be taking for that headache you got after muscling your way through the crowded shopping mall. Well, the Food and Drug Administration wants you to think twice about all that self-medicating you're doing with over-the-counter remedies. Every year, the agency says, about half of the deaths associated with taking pain killers containing acetominophen are due to unintended overdoses. Acetominophen, the primary ingredient in Tylenol, is also a common component of cold and flu remedies. The concern, says the FDA, is that people aren't aware of all the different compounds that contain acetominophen, so when they decide to boost their dose of Tylenol, or combine a pain killer with a cold caplet or two, they could be putting their liver in danger.

An overdose of acetominophen can damage the liver, which metabolizes and breaks down drugs. More than 200 million people take Tylenol in the U.S. each year, and about 200 a year die from liver failure when they accidentally take too much. What the FDA proposed is to require manufacturers of acetominophen-containing over-the-counter drugs to prominently note the presence of the compound, and warn people of the danger of liver toxicity when acetominophen is taken in excees of recommended doses.

According to Dr. Charles Cain, director of anesthesia at New York Presbyterian Hospital, it's not that hard to reach these danger levels. The average adult should not exceed 4g of acetominophen a day. If someone is taking two extra-strength tablets of Tylenol, which are 500 mg each, every four hours (instead of the recommended every six hours), and then adds a few doses of a cold medication during the day, then they're easily reaching about 4g-6g of acetominophen a day. Do that over a few days, says Cain, and you could damage your liver. Since most people are on several different types of medications already, the liver may be more vulnerable to danger when it's hit with an excess of acetominophen to process. And that's even before the glass of wine or bottle of beer that many of us like to have at the end of day; alcohol also puts the liver to work, and the combination of everything at once may be the perfect storm that sends the liver into failure.

The FDA warning is an effort to educate the public, says Cain, As the number of acetominophen-containing preparations becomes ubiquitous, the concern is that we are seeing instances where people are taking too much and wind up suffering from what should otherwise be a relatively safe medication.

At Columbia University Medical Center, doctors have been aware of the potential dangers of acetominophen overdose and for the past two months have provided patients with brochures indicating the daily amount of acetominophen their doctors recommend they take, and how much additional acetominophen they can safely take from other sources. Whenever I prescribe any medication, I always tell my patients that if they are buying drugs over the counter, to check for the label, and make sure that the medication does not contain any acetominophen, says Dr. Amit Sharma, an anesthesiologist at the hospital. If it does, then I tell them to cut down on the pain medication given by their doctor.

For the most part, Tylenol and acetominophen products are safe — that's why there are offered over-the-counter and without a doctor's prescription. But the FDA wants to alert people that like any drug, taking too much — more than your liver can handle — can be dangerous. And with more people taking more medications at a younger age, being aware of potential interactions among drugs, as well as potential overdoses, is critical. These over-the-counter drugs just have to be used with an eye toward the total dose per day, and amount being used over a period of days, says Cain. When used with care, acetominophen is extremely safe.

[RLSmi]

Detoxification of acetominophen depletes the liver of glutathione, the major antioxidant inside of cells. The cells in your body normally make enough glutathione to keep the destructive reactive oxygen species (ROS) that are a by-product of mitochondrial energy production under control. ROS produced in neurons, especially dopaminergic neurons, are thought to be a trigger for setting off the release of more ROS by brain microglial cells, resulting in the functional loss and/or death of dopaminergic neurons in the basal ganglia seen in Parkinsons disease.

PWPs already tend to have lower than normal brain glutathione, and some of the brain glutathione may be provided by the liver through the blood. For this reason, we should be especially careful about using Tylenol and other medicines containing acetominophen.

[reverett123]

...that we take a heck of a lot of other meds and the liver has to deal with them and their by-products as well.

Acetaminophen is very dangerous both because it is hidden as noted and because there is such a small difference between the effective dose and a dangeous one. And no one has ever tested it specifically on PWP, either.

Ya gotta do your homework on ever' blamed thing with PD. At the very least, google any new med/herb/supplement along with "danger" and look for red flags. And even then start slow.

[Stitcher]

ALWAYS DO YOUR HOMEWORK...never assume the pharmacist or the doctor have done it for you!!

Anytime I am given a new RX I do two things.

1. I read two or three Internet postings about the medication.
   
2. I ask the pharmacist specifically to check for interaction. The pharmacy I use maintains a database that not only holds the meds I take, but also the medical conditions I have (which are too many anyway...LOL). So, not only can he check med-to-med interaction, but the can check med-effect-on-condition.

For example, I was prescribed Reglan over the summer. I never filled the script because I did my personal homework. I discovered that, "Reglan may cause symptoms similar to those of Parkinson's disease, such as slow movements, rigidity, tremor, or a mask-like facial appearance."

No way was I taking that pill heck I already have those symptoms...don't want to make them worse!!

Then a couple of weeks later I saw my MD neuro and mentioned that I had been suspect for gastroperisis, for which Reglan is the gold standard. I barely got the sentence out when she said, "Don't let the prescribe Relgan. It will make your PD symptoms worse." (Turned out I had bile reflux from my small intestine.)

[lindylanka]

Acetominophen is marketed in the UK as paracetamol and is widely prescribed and available over the counter. It is also used in combination with other more heavy duty pain relief, especially post--operatively and often prescribed to be used in tandem with tramadol and other such drugs, and is generally assumed to be 'safe'. The fact is that is it quite easy to go over the limit with this drug, especially if you have or have ever suffered from any liver damage is not so widely known. A few years ago the daughter of a close friend, then 16, took more than the daily recommended dose while suffering from bad headaches after a viral infection, and wound up needing a liver transplant. She was fortunate that a liver was available for her. Go cautiously with tylenol, it is good that there are now proper warnings about possible dangers.

Lindy

[Stitcher]

Lindy, if the first anesthesiologist had not been diligent in his duties the day I was initially suppose to have the fusion surgery I am told I would have needed a liver transplant. The damage begins with they Tylenol, but the addition of the anesthesia is what "kills" the liver completely.

What made me the most angry about my ordeal, and I didn't know this part until after the fact, was that the arrogant neurosurgeon went through four anesthesiologist before giving up on my surgery that day. Each one told him that if they were to put me under I would come out of the surgery needing a liver transplant. He neuro surgeon even admitted to me later than he almost can to blows (fist fight) over the fact that he wanted to do the surgery and couldn't.

Now arrogant is that!!

To be told something that life threatening to me and still want to find an anes. that would do the job.

He did get his payback in a way. The day after the surgery, when I was awake, he came in and showed me his thumb...very swollen and red. Apparently my hip bone was so hard, that when he had to carve the bone pieces out of my hip to put between the metal plates, his thumb paid the price.
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