Cardiovascular Health, Kidney Disease, and Cancer Interestingly, those with higher levels of certain gut bacterial metabolites may be more susceptible to acetaminophen toxicity ( 11 ).
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I’ve written before on the Kresser Institute blog about the role of the gut microbiota in drug metabolism. Overdose with acetaminophen causes massive necrosis of the liver tissue, which releases a protein that results in leakage of bacteria from the gut into the bloodstream ( 10). Acetaminophen can also cause intestinal permeability. Gut Health and Microbial Drug MetabolismĬhronic use of acetaminophen doses greater than 2,000 milligrams has been associated with a 3.7 times increased risk of bleeding in the upper gastrointestinal tract ( 9 ). Interestingly, prompt administration of N-acetylcysteine (NAC), the precursor to glutathione, can prevent mortality from acetaminophen toxicity ( 8).
SIDE EFFECT OF TYLENOL FREE
Glutathione helps protect cells from damage by free radicals. How does it cause liver damage? Acetaminophen depletes levels of glutathione, the body’s master antioxidant. The FDA dragged its feet until 2011, when it finally issued a statement urging drug manufacturers to limit the strength of each capsule to 325 milligrams of acetaminophen and mandated warning labels about liver toxicity ( 4 ).Īcetaminophen toxicity is increased when combined with narcotics like codeine or hydrocodone, when more than the prescribed dose was taken in a 24-hour period, when more than one acetaminophen-containing product is taken at the same time, or when alcohol is consumed while taking acetaminophen ( 6, 7 ). Moreover, the elevations in ALT often persisted for several days after the acetaminophen was discontinued ( 5 ).Ĭoncerns about liver toxicity were raised as early as 1977, when an FDA advisory panel said it was “obligatory” to add warning labels about liver damage. Yet according to a 2006 study published in the Journal of the American Medical Association, even this dose, taken for four or more days, frequently causes elevated serum alanine aminotransferase (ALT), a marker of liver injury. Think twice before you reach for Tylenol.Ĭurrent guidelines recommend taking no more than 4,000 milligrams of acetaminophen daily ( 4 ). This staggered overdosing may be more dangerous than a single large overdose ( 3 ).
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Taken over several days, as little as 25 percent above the maximum dose, or just two additional pills a day, has been reported to cause liver damage. In fact, over half of all acute liver failure cases in the United States are due to acetaminophen overdose ( 2 ). It’s responsible for more than 56,000 emergency room visits and an estimated 458 deaths every year due to acute liver failure. Overdose with acetaminophen is the leading cause for calls to poison control centers in the United States, with more than 100,000 instances per year ( 2 ). In this article, I’ll discuss the many reasons we should avoid acetaminophen whenever possible and share several safer alternatives for pain relief. Acetaminophen is generally considered safe when taken as recommended, but the margin between a safe dose and a potentially lethal one is incredibly small.Įven when taken as recommended, acetaminophen use can have major side effects. The ubiquitous use of acetaminophen, both by itself and as a component of over-the-counter and prescribed medications, is a major public health issue. adults, or 52 million Americans, use a medication containing acetaminophen, according to the Consumer Healthcare Products Association ( 1 ).
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