Is Tylenol ‘By Far the Most Dangerous Drug Ever Made?’ – By Josh Bloom — September 11, 2017
Aric Hausknecht, M.D. July 30, 2017:
“Each year a substantial number of Americans experience intentional and unintentional Tylenol (acetaminophen) associated overdoses that can result in serious morbidity and mortality. Analysis of national databases show that acetaminophen-associated overdoses account for about 50,000 emergency room visits and 25,000 hospitalizations yearly.
Acetaminophen is the nation’s leading cause of acute liver failure, according to data from an ongoing study funded by the National Institutes for Health. Analysis of national mortality files shows about 450 deaths occur each year from acetaminophen-associated overdoses; 100 of these are unintentional.”
Therapeutic Index – A cornerstone of pharmacology
When evaluating drug toxicity, a critical parameter is called the therapeutic index (TI). The TI is the ratio of the toxic dose to the effective dose. Obviously, the higher the TI the better, since the greater the separation of the therapeutic and toxic doses, the less likely an overdose.
Tylenol (acetaminophen) an analgesic (pain reliever) gets a free pass in the minds of many people because it doesn’t come with the liabilities of the NSAIDs, such as aspirin and ibuprofen – bleeding, heartburn, kidney toxicity, ulcers, and salicylate allergy. The absence of gastrointestinal toxicity is responsible for the widespread perception that Tylenol is safer.
when treated in time, irreversible liver damage from an acute overdose of acetaminophen can be prevented.
There is an antidote called N-acetylcysteine. But the danger of the drug is not only from acute doses. Both acute and chronic use of acetaminophen can lead to permanent liver damage, not because acetaminophen itself is toxic, but because the liver converts it into something that is [toxic].
Before 2011 the maximum daily dose of acetaminophen recommenced by the FDA was 4,000 mg. It is now 3,000 mg. The estimated lethal dose of the drug is 10 grams in one day, which is not terribly different from the maximum daily dose. The TI is thus about 3, which is pretty bad, especially compared to other drugs which are perceived as far more dangerous:
It is very difficult to die from a Valium overdose in the absence of alcohol, opioids or other central nervous system depressants. (See: “Can Valium Kill You?”). In two case studies, people survived overdoses of 500 and 2,000 mg (50 and 400 five milligram pills, respectively). But, 50 regular strength Tylenol pills (16.25 g) is approximately twice the estimated lethal dose.
Yes, a single dose of 500 Valium pills is less dangerous than 50 Tylenol pills.