Weekend warriors and hangover victims take note:
Tylenol can kill, and McNeil, the Johnson & Johnson-owned company that distributes it, has done startlingly little to protect its consumers over the decades. That’s basically the gist of a novella-length investigation into the drug and its most active ingredient, acetaminophen, published by ProPublica this morning. Despite decades of science demonstrating how frighteningly easy it is for consumers to overdose on the pain reliever—causing serious liver damage or death—McNeil remains stubbornly reluctant to implement the label warnings or dose limitations that have been called for since the 1970s…
Acetaminophen is also in Excedrin, some decongestants, and quite a few ‘multisymptom cold/flu’ elixirs (which is one reason 150 Americans manage to accidentally kill themselves every year, and more end up on the liver-transplant list).
Insert your own “somebody check on the bloghost” jape here…
Yatsuno
Are you saying JC overdosed on Tylenol? Odds are better him finding Jeebus and spending all day in church. Or Steve moves faster than Tunch (not saying much there I admit) and has taken out our esteemed bloghost already.
Stillers is a night game, so can’t be because of that.
Litlebritdifrnt
150 people a year? Really, people are worried about 150 people a year? How about 8,000 people killed by guns since Sandy Hook? Guns kill more people a week than Tylenol kills in a year. What a fucking joke.
MikeJ
@Yatsuno: I thought they were playing in London or some shit. Three AM game to avoid the footy crowds?
And did you see the Manchester derby this morning? What an embarrassment for
the YankeesUnited.SiubhanDuinne
I’ll just stick with acetylsalicylic acid, thanks.
Belafon
It’s easy to overdose on a number of OTC medication. You do have to follow the instructions. If you feel the need to significantly go over the recommended dosage, you probably need to see a doctor. Which might be more affordable now under the ACA.
eemom
IIRC, they never did find out who did those Tylenol poisonings back in the 1980s. Kind of a pharmaceutical Jack the Ripper.
shelly
Yay.
Tylenol’s bad for the liver
Ibuprofen’s bad for the kidneys
Aspirin can cause intestinal bleeding.
So whatever you use, you’re fucked
raven
Fact Sheets- Alcohol Use and Health
John Cole
I had a buddy of mine die from tylenol. He got a cold that wouldn’t go away and was taking tylenol in large amounts and also taking other cold and flu remedies that had tylenol in it without him knowing, so he basically fried his liver and died a month later. It was horrible.
Anne Laurie
@Litlebritdifrnt: Well, most BJ readers are already aware that guns are dangerous, but I know a great many smart well-informed people who think that Tylenol (aka paracetemol?) is “safer” than aspirin.
It’s worth reading the AtlanticWire link, even if you don’t have the time for the whole ProPublica paper.
sparrow
Given my habit of occasionally over-imbibing, I avoid tylenol unless I have a fever (in which case I’m usually not also drinking) for this reason. But I didn’t know about the advil being hard on your kidneys. That’s kinda scary, because I take it fairly often for headaches and womanly pains. hrm. :(
cathyx
You have a much better chance of dying by lightning strike than you do by taking acetaminophen each year.
pat
@John Cole:
Yup, that’s why I always check the ingredients if I feel I need some cold or allergy meds.
Anne Laurie
@shelly: Too true, but I figure bleeding is usually fixable, and dialysis is more accessible than a liver transplant. YMMV (tongue severely in cheek)…
@John Cole: Hi, John!
Aunt Kathy
Geez, I’ve been taking 4-6 Exedrin tablets throughout the day, every damn day for, like, 10 years. Still standing. Been trying to quit, but it’s the only vice I have.
khead
I guess I will have to stick with booze. Without Tylenol. I just hope no one has to cut my leg off. That scene in Gone With the Wind kinda sucked.
khead + a few
gogol's wife
@SiubhanDuinne:
Me too! It’s the only thing that works.
gogol's wife
I’m so glad the toenails have been replaced by pretty, sparkly conflict-free diamonds.
Amir Khalid
They did change their packaging to make it tamper-proof after the Tylenol killings in 1980 or thereabouts, didn’t they?
Belafon
@Anne Laurie: Eh, you might want to rethink that idea on GI bleeding:
gogol's wife
@eemom:
That freaked me out so badly, it’s still with me. I remember that one person was upset by the first death, so they took some Tylenol to calm down, and it killed them! Horrible.
Thank you for your nice comment in the thread below. That makes up for a lot of T&H and CS vitriol.
SiubhanDuinne
@John Cole: Do hospitals and doctors routinely check for that? I am thinking about my cousin who died about 10 months ago. No one has ever quite known what killed him at the young age of 54. He had previously had liver problems but by all accounts it had regenerated once he quit drinking. Now I’m wondering whether he had been taking Tylenol and it did to him what it did to your friend.
Fair Economist
@shelly:
Tylenol causes 150 accidental deaths per year. Aspirin causes about 4. There *is* a difference.
It’s almost obscenely easy to OD on tylenol. A dangerous dose is only about twice the maximum dose. Even dangerous illicit drugs generally have better safety margins. And, like Anne Laurie mentions, it’s hidden in all kinds of over-the-counter meds.
One thing you can do to substantially reduce the chance of accidental OD is to never, ever use any “combination” medication containing acetaminophen. It’s very easy to goof, and equally easy to swallow an additional pill if you really need it along with your decongestant or whatever. With the combo medications, you are paying many times the price to vastly multiply your chance of accidental overdose. Very bad idea.
Nope, 150 per year for acetaminophen, 79 per year for lightning. It’s a bad analogy, anyway. Death by lighting is uncommon, but it’s not nearly as rare as the analogy implies.
SiubhanDuinne
@gogol’s wife: I actually almost never have to take a pain-killer (very lucky, and I know it) but I do take a baby aspirin every day on cardiologist’s orders, and on the extremely rare occasions I get a headache, I just take two or three. It’s probably been five years since I’ve felt the need, though. As I say, I am very lucky. Usually if I get a headache of any kind, I can woo-woo it away within a few minutes, with no resorting to pharmaceuticals.
Cassidy
Easy fix to this problem, just in case you’re confused. Medicine comes with directions. Follow them. Don’t die because you’re stupid.
ETA: For those confused about Ibuprofen. You can take up to 800mg four times in one day. That’s it. Your body will not metabolize more than that in one dose and you’ll piss it out and piss off your kidneys.
Anne Laurie
@gogol’s wife: Oh, great, now somone’s hacked our NSA server…
JPL
@Anne Laurie: The problems with Tylenol have been known, and the industry protects it own in the form of money to buy silence.
Fair Economist
@Belafon:
The thing about the NSAID deaths is that they are almost never aspirin alone, except for suicides. It’s among people taking cocktails of nastier NSAIDs, and acetominophen is not much of a help there, because it’s not anti-inflammatory and so not very helpful in arthritis. Although they do try, and my late godfather’s wife, who had bad arthritis, gave herself severe brain damage by OD’ing on tylenol. Presumably an accident, but afterwards although she could talk she didn’t have enough cognition left to discuss her motives. so we never knew exactly what happened. Caring for her was a horrible hardship on my godfather for over a decade afterwards.
Keith G
So ecstasy is safer than acetaminophen.
TheMightyTrowel
I nearly OD’d on a cold/flu powder (you add hot water) with acetaminophen when I got sick during conference season back in 2010. Thankfully, I’ve got a pretty good vomit reflex so I hoarked it all up good but I felt like shit for weeks after.
Cassidy
@Keith G: Maybe, but losing the ability to regulate your body;s temperature is a bitch.
JCJ
I had a comment get eated. I mentioned specific other medications with acetaminophen. Do they get zapped by FYWP?
WereBear
@Keith G: Sounds like it. And most people don’t know that prescription drugs are killing about 100 people a day.
Just the past two weeks I’ve encountered two older people who have thrown out ALL their prescription drugs; they were taking a truly staggering number. One declared he felt so much worse after seeing the doctor, going back to his original complaint would be an improvement. The other declared he was already feeling better.
JCJ
Well, I’ll try again. Some “painkillers” contain acetaminophen including mixtures of hy-dro-c0-d0ne and 0x-y-c0-d0ne. They might not be labeled as Tylenol or acetaminophen – the prescription might name the nar-c0-tic then APAP. Some sleep meds also contain acetaminophen in combination with di-phen-hydramine.
Broke things up to try to avoid the filter.
hamletta
@Amir Khalid: The Tylenol killer struck in the early ’80s, ’82, I think. I remember because I was in college at the time.
And it changed not just medical packaging, but all packaging, forever. Whenever I have to fight a bag of chips, I say, “Thanks, Tylenol killer!”
I had Intro to Public Relations the next semester, and we studied the company’s handling of the crisis as a case study in how to get ahead of bad news. Compare that to the more recent Tylenol scare a few years ago, where it was tainted by bad industrial practice, and the new owners of the brand kept denying anything was wrong.
Annamal
I vaguely remember something about reducing the number of attempted suicides by paracetamal by requiring that it be sold in blister packs rather than pill bottles.
I imagine blister packs would make it harder to accidently overdose as well
Belafon
@Fair Economist: I was trying to make the point that GI bleeding is not something that to be taken lightly.
JoyfulA
The problem with Tylenol is that it’s added to most prescribed narcotics, such as what I took for my joint replacements. It is of no use for patients like me because it isn’t an anti-inflammatory.
I understand pain meds are being reformulated to omit the Tylenol and also to make illicit uses difficult or impossible.
Now, let’s see if I managed to avoid “bad” words.
WereBear
@Annamal: I remember reading that too! I was kinda thrown by how well it apparently worked.
Makes a good point about suicidal impulse; for many, it passes, and the harder it is to fulfill it, the more lives could be saved.
diana
yes to all the dire warnings about Tylenol, but what a way to go:
http://www.huffingtonpost.com/2013/04/17/tylenol-death-anxiety-existential-dread_n_3101606.html
WereBear
@diana: Interesting.
I’m one of those people who never get any pain relief from Tylenol, so I always avoid it (and just as well, apparently.) So heaven forbid I develop any existential dread.
kc
@Litlebritdifrnt:
Yeah, it’d be great to see a gun control post on this blog just once, right?
150 needless deaths a year, big whoop.
scav
@kc: indeedy yes, horrors! an open thread about some trivial number of easily preventable deaths instead of the all-important out-of-focus cat photos! what is the internet coming to?
PurpleGirl
I threw out a bottle of Tylenol because it was over 10 years old and I didn’t use very much of it. I found it didn’t help me with fevers and does nothing for inflammation. I use aspirin for headaches and ibuprofen for back pain (usually caused my nerve inflammation). It’s a system that works for me.
fuckwit
I have to bet that booze kills more people than Tylenol or guns.
And that driving kills even more people than that.
Still, people do get headaches, and need to go places because our public transit system sucks, and have small penises to compensate for by packing heat.
pseudonymous in nc
@Litlebritdifrnt:
Yeah, because a paracetamol overdose fucks your liver, and it does so in a rotten way, so you might neck a handful in a suicide attempt, decide you want to live, and by that time, it’s too late and there’s nothing even the best medicine can do about it.
In the UK, you can’t get it in packets of more than 32; there’s ample evidence that making that change has saved lives. (Of course, in the US, it’s easier for suicidal people to go to the Wayne LaPierre shop.)
And that’s before considering the accidental poisoning that you get from different combination treatments where you don’t really know the dosage or ingredients.
glocksman
@Fair Economist:
Indeed.
I can’t take NSAID’s at all due to high risk of bleeding ulcers, so my doctor made sure at the time to instruct me on using acetaminophen at the proper dosages, the risks involved in OD’ing, and to read labels on multi-medication products like NyQuil.
There are times I’ve been tempted to pop an aspirin or two, but the memory of shitting bloody tar and having a 70/30 BP upon admittance to the ER keeps me far away from the Bayer or the Advil bottles.
When I have the occasional gout flareup, my doctor prescribes a prednisone dospack and a small 8-10 pill scrip of vicodin for the pain.
trollhattan
University I attended has a pharmacy school and they knew all the important shortcomings about acetaminophen back in the ’70s. But hey, what’s forty years, give or take?
trollhattan
Aw crap, FYWP mod word….trying this.
University I attended has a pharmassey school and they knew all the important shortcomings about acetaminophen back in the ’70s. But hey, what’s forty years, give or take?
MarkusOfarkus
I spent a week at a conference drinking every night fairly heavily (it’s not our fault; we didn’t know the bars were 24 hours!) and then idiotically taking two tylenol every morning. By the end of the week my pee looked like tea. Basically I was developing what’s called “drug-induced hepatitis”. Mine turned out to be mild and cleared up quickly when I went home, but a colleague of mine told me he had a similar experience that left him sick for 3 or 4 months.
Yeah, we have a bit of a drinking culture at work.
jon
I treat headaches with caffeine. Seems the best way. And on occasion, I’ve had a breakfast beer to nurse a hangover. It seems to do better than pills and other stuff. Probably not a highly-recommended treatment, but it’s rare for me to have more than two hangovers a year.
I’m lucky in that I don’t have migraines. I can’t even imagine what such people are going through. Pain is terrible, and I often think the illegal ways are the most humane and safest ways to deal with it. But it’s not really me I’m suggesting that for, just saying those who take such things probably have a reason.
maye
My liver doctor says Tylenol taken as directed will not hurt you. However, never take it while drinking or for a hangover. Combined with alcohol, it will cause liver damage. If you’re a teetotaler like me, small doses are OK. That said, as a pain killer it is virtually useless. About all it can do is bring down a fever.
glocksman
@maye:
Pretty much the same thing here.
Now vicodin works, but it’s not the APAP in it that kills the pain.
Though I really don’t like taking it either because of the nausea side effect, but better nausea than gout pain. :)
Anne Laurie
@Aunt Kathy:
Is Excedrin still formulated with a big shot of caffeine? I know someone who “couldn’t give it up” because trying gave them a massive headache (to go with the joint pain), until a nurse-practitioner convinced them to cut back on the Excedrin and drink a big cup of coffee instead…
jay Noble
@hamletta: The Tylenol poisonings and the dangers of overdosing on it both came in the early to mid 80’s. Have almost never taken it since. This was also the time frame that I learned how bad tar sands are and how stupid people were for developing along our coasts due to – global warming and rising sea levels. Darn liberal media
David in NY
There was a great This American Life piece on this — they joined with ProPublica in the research and so on. One underlying problem is that people take more OTC drugs than in the package directions all the time. Another related problem is that many people believe Tylenol-acetaminophen has no dangers. And even those who know it has side effects don’t realize how tight the “safety margin” is with Tylenol — double the dose for a day or two and you could be dead (not everybody is so sensitive, maybe not most people, but some are). The package dose is quite safe, however. I got the impression from the program that it was much harder to kill yourself accidentally with other painkillers. The package warnings have gotten better, but still don’t make clear the crucial importance of following dosage instructions.
David in NY
BTW, my wife found Tylenol quite effective for the pain from her hip replacement surgery. Worked better than the stronger stuff though maybe because of fewer side-effects (morphine took her BP way down and the Oxy-one made her feel really weird).
Glidwrith
@Anne Laurie: Yep, 65 mg caffeine per pill. Since they changed the Excedrin labels to ‘don’t take more than one dose in 24 hours’, I’ve started to take the allowed dose, then when the aspirin in the combination wears off in four hours, taking the aspirin and counting down the clock until 24 hours have passed when I can take the Excedrin again. Three day long migraines gets tiring….
ETA I will also hunt up massive caffeine doses – Thai iced tea is a wonderful thing!
kc
@scav:
My bad, I forgot the sarcasm tag.
Aunt Kathy
@Anne Laurie: Yep, 65 mg caffeine, 250 mg aspirin, & 250 mg acetaminophen. Although, looking at the bottles of Exedrin & Tylenol, I still may be just under the limit. Drinking another form of caffeine doesn’t seem to do much as a replacement. At this point it’s probably just all in my head. Har.
Ruckus
@JoyfulA:
Another bonus from the war on drugs.
Many narcotics are mixed with the idea that who would want to take the mixed drug to get high. Also probably to sell more acetaminophen. It was also considered a safe drug. Oh well die and learn.
@jon:
Consider yourself lucky that you don’t suffer from migraines. If the pain is high enough, and it can be, the concept of suicide may be entertained. Not always like that but I have had a few where the knob was twisted all the way to 12. There are currently drugs that knock them out but they are all prescription which means you have to afford $15-25 per dose, not counting the cost to pay the Dr to write it. No health care and a chronic problem is a bitch.
jon
@Ruckus: I have some friends who suffer them on a regular basis. Knocks them completely out of commission. I get told it’s like the worst hangover ever, so I can imagine the need to just be still, in darkness, and quiet. I wish the best for anyone suffering that.
Pain mitigation is a huge part of the prescription and non-prescription use, and I can’t say how much. I do know the attitude that they’re just milking it for drugs is problematic. I also know that some people do abuse it. To which I say, just give them their fix and stop being a bunch of judgmental ninnies worried that someone might enjoy a high. If that’s how someone needs to be, let’s reduce the harm rather than have them breaking into cars and stealing bicycles to get their fix. If they decide they need help, it’s easier to find them if they can get their help and their problem at the same place.
scav
@kc: No no, and if so, your lack of tag was entirely replicated in my own. arid is the way to go.
Pogonip
I worry about people I know who pop multiple Tylenol-containing concoctions. They’re Muricans so you can’t tell them a damn thing, they know it all, but pretty nice Muricans, so I would hate to see them die horribly of liver failure.
Ruckus
@jon:
I’ve had hangovers after spending a couple of hrs passed drunk out in the snow. I’ve had hangovers after being knee dragging, commode hugging drunk. They are nothing like a decent migraine. On the Dr 1-10 pain scale a bad hangover is maybe a 5 or 6. Most of my migraines are in the 6-9 range with a few at 10 and above. Hell I don’t even take anything until they approach 5 or 6. Otherwise I would be taking meds on a regular basis, meds that are not good for you on a regular basis. You learn all the methods to help reduce the need for drugs. Ice, darkness, sleep. Yes you learn to go to sleep in extreme pain, because you have to.
All of the above is to point out that your second graph is true. If someone is miserable for a reason that drugs can fix, even if only for a while, why do we continue to subscribe to the inane idea that suffering is good for us, builds character, toughens us up, gets us ready for the really shitty stuff. Like what shitty stuff, suffering 40+ yrs with migraines? Like having abusive parents who never should have had kids? Or whatever. How is being even addicted to drugs/alcohol worse than so many other shitty things in life? And yes I know the answer to that, it affects the person and usually so many others in such negative ways. But the concept that we have to be pure and suffering, that’s a bullshit religious ideal.
Chris T.
Yes, Ty-le-nol (aka a-cet-a-min-o-phen in the US and at least some of Canada, pa-ra-cet-amol virtually everywhere else) is hepatotoxic (“bad for your liver”), and in particular can lead to problems at just 2 to 4 times the effective dose, especially when combined with other hepatic-metabolism drugs like ethanol (drinking alcohol).
On the other hand, aspirin and ibuprofen can also be bad for you; all three can lead to GI bleeds. The development of COX-2 inhibitors (Ce-le-brex, Vi-oxx, Mob-ic, etc [I’m using – in the hope of hiding from the filter]) was supposed to avoid this problem, but alas, it turns out those also can lead to GI bleeds … and can increase heart attack and stroke risk a bit (from tiny to still-tiny, yes, but this can still be roughly 2x worse in some cases). Curiously, aspirin and ibuprofen can be good for you: they have a cardioprotective effect, which appears to be more than just their blood-thinning effect, but it’s really hard to tease this out of the data.
Meanwhile, statins do lower cholesterol but can cause rhabdomyolisis, especially in combination with fibrates and/or at high doses, and the clearance mechanism (the P450 system in the liver, again) competes with grapefruit juice (among other things, especially other drugs). And it’s not really clear that forcibly lowering cholesterol numbers actually does anything positive in the end: yes, there’s definitely a correlation between cardiovascular disease and cholesterol readings, but it seems likely that both simply share some common causation, and dialing down the cholesterol is like blowing cold air on the thermometer and claiming that this has cooled down the whole house/outdoors/whatever.
Heck, water is toxic if you overdose on it (hyponatremia = sodium-too-low, resulting from peeing out too much sodium). In the end, you pays your money and takes your chances.
Matt McIrvin
I heard recently about codeine/ibuprofen pills killing people in… was in Australia? Somewhere that you can get them over the counter. It’s pretty simple: people get hooked on the codeine and OD on the ibuprofen.
Given that, as far as I know, the OTC dose of Tylenol is way closer to the lethal dose than with ibuprofen, I can only imagine that Tylenol/codeine would be a more effective killer. And I know you can get that OTC in many countries.
(I got prescribed some of it after my most recent bout of oral surgery. I only tried taking it once, and mostly discovered that I really, really do not like the sensation of being doped up on codeine, to the point that I’d rather take some pain. Hard to imagine that people would get addicted to that sensation, but I guess it affects everyone differently.)
John’s story is one of the reasons I stay away from those multi-symptom cold/flu remedies. I want to take the ingredients separately so I can control which ones I get.
Matt McIrvin
…And, by the way, after said oral surgery (which happened in multiple stages), my regular drug regimen was alternating doses of OTC Tylenol and twice-as-big-as-usual ibuprofen pills, alternating, I suppose, so that I wouldn’t OD on either one individually. It can’t have been doing anything good to me. Fortunately I generally didn’t need to be on that for very long.
satby
@JPL: I was in nursing school in 1975 and had to do a research paper on Tylenol. From that day I’ve avoided it as much as possible and for a long time it was not only in every combo (i.e. cold&flu med) but being actively pushed by the medical community as “safer than aspirin”. Which it never was. And 40 years later most people still don’t realize.