The Perils of Painkillers
Tylenol Toxicity – and its Alternatives
By Zoltan P. Rona, MD, M.Sc.
Originally published in Vitality Magazine, March 2007
So, you think Tylenol is safe. Most of us have always assumed that Tylenol (acetaminophen) is the safest painkiller on the market. After all, it is the number one drug used in the world. While it is usually effective for mild to moderate pain, its safety is somewhat of a myth.
Acetaminophen, the generic name for Tylenol, can be found in over 200 different OTC and prescription medications. It is commonly mixed into migraine, arthritis, cough, sinus and cold remedies.
According to the U.S. FDA, acetaminophen is considered the most common cause of liver failure, accounting for at least half of the cases in the U.S. yearly.
Liver toxicity with acetaminophen is more likely when combined with heavy alcohol use, the simultaneous use of other drugs containing acetaminophen, as well as simultaneous use of drugs that affect the liver (e.g. antibiotics, anti-depressants, anti-fungals, seizure medications, the birth control pill, etc.).
Severe liver damage can occur in adults who use acetaminophen for more than 10 consecutive days at doses of 4000 mg or more per day. That’s the equivalent of eight extra strength Tylenol tablets per day. The liver toxicity dosage is lower in children (90 mg/kg) and in people who already have weakened liver function due to hepatitis, AIDS, anorexia nervosa, cirrhosis, alcoholism or other diseases. The toxic dose of acetaminophen after a single acute ingestion is 150 mg/kg in children or approximately 7000 mg in adults.
Acetaminophen is the commonest drug involved in overdoses of any kind according to the American Association of Poison Control Centers. In the U.S., it is estimated that acetaminophen results in 56,000 injuries, 25,000 hospitalizations, and 450 deaths every year. Acetaminophen is also the most common cause of liver failure requiring liver transplantation in Great Britain and the second most common cause of liver failure requiring transplantation in the United States.
Some of the symptoms of a toxic reaction to acetaminophen include nausea, abdominal pain, sweating, seizures, confusion, an irregular heartbeat, swelling, hives, difficulty breathing, unusual bleeding or bruising and closing of the throat. Diabetics should note that acetaminophen can change blood sugar levels, requiring adjustments in insulin or other diabetes medications.
Tylenol troubles are on the rise. Acute liver failure caused by acetaminophen has risen sharply from 28 percent in 1998 to 51 percent in 2003. That’s a near doubling of life threatening toxic reactions within five years. Unintentional overdoses (48%) on acetaminophen outnumber intentional (suicide attempt) overdoses (44%).
Most recently, researchers have reported that the use of acetaminophen has been linked to higher rates of asthma and chronic obstructive pulmonary disease (COPD), as well as reduced lung function. (American Journal of Respiratory and Critical Care Medicine May 1, 2005;171:966-971 and Medical News Today May 3, 2005)
What next? Marketplace Irony
The anti-stress herb kava kava was taken off the market in 2002 by Health Canada because of four reports of liver toxicity. No deaths were reported. Tylenol causes thousands of cases of liver toxicity and death in Canada each year, yet remains on the market.
Tobacco and alcohol also kill thousands in Canada each year and they also remain on the market._
Protecting Your Liver From Tylenol
If you are one of those unfortunate souls who has seemingly no choice but to take Tylenol for life, you can do a lot to prevent liver toxicity.
Acetaminophen does its damage to the liver by depleting the body of glutathione. You can offset this drug-induced deficiency by supplementing with NAC (N-Acetyl-Cysteine), an amino acid that boosts levels of glutathione. In fact, NAC is exactly what hospital emergency rooms use for acute acetaminophen toxicity. NAC is virtually harmless and can be safely taken by most adults at a dose of 1000 mg three times daily. Children under the age of 12 can take roughly half the dose._Other liver protective natural remedies include alpha lipoic acid, milk thistle, SAM (S-adenosyl-methionine) and the bioflavonoids rutin, catechin, hesperidin and quercetin._
Non-toxic Alternatives to Tylenol
When possible, everything should be done to determine the cause of pain and inflammation instead of suppressing it with a drug. Last time I checked, Tylenol was not the cure for any disease.
Stress, hormonal imbalances, nutritional deficiencies (e.g. vitamin B12, zinc, copper) or toxicities (e.g. mercury, lead, cadmium), food and chemical allergies, as well as body structure imbalances are usually at the bottom of chronic pain conditions. Sometimes a dentist or chiropractor can discover the source of chronic pain. A natural health care provider can usually help sort out the cause or causes for most people.
Until you get the opportunity to be assessed by a natural health care professional, one or a combination of the following commonly available health food store remedies may be good alternatives to Tylenol for pain control.
Ginger Root: A very effective traditional anti-inflammatory herb which also has anti-nausea effects.
Boswellia: Together with bromelain and ginger root, this herb has potent anti-inflammatory and pain relieving benefits in just about any kind of arthritis.
Bromelain: This pineapple enzyme has long been successfully used as a natural pain and anti-inflammatory remedy; it works best when taken on an empty stomach.
Curcumin: An extract of the herbs tumeric and cumin, this powerful anti-inflammatory can also protect the liver from damage caused by a long list of viruses, drugs and chemicals. The usual effective dose is 1000 mg three or more times daily.
Omega-3 Oils (EPA and DHA): Usually found in fish oil but also in hemp, Omega 3s can be anti-inflammatory in doses of 12 grams daily, reducing pain and inflammation in conditions as diverse as migraine headaches and sciatica.
Other Oils: Evening primrose oil, borage oil and black currant seed oil are all high in the essential fatty acid gamma linolenic acid (GLA) which has been found helpful in any kind of arthritis and eczema.
Capsaicin cream: An extract of cayenne pepper that can be applied to painful areas topically. It works to relieve pain by depleting the body’s supply of substance P, a chemical that transmits pain signals.
D,L-Phenylalanine: An amino acid that boosts the body’s production of its endorphins (opiate-like compounds), thereby producing pain control; the usual effective dose is 1000 mg three or more times daily between meals.
Dr. Zoltan P. Rona practices Complementary Medicine in Toronto and is the medical editor of “The Encyclopedia of Natural Healing.” He has also published several Canadian best selling books including “Return to The Joy of Health”. For more of his articles, see http://www.mydoctor.ca/drzoltanrona
• www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/2002/ 2002_56bk_ e.html_
• Johnson, G.K. 1977. "Chronic Liver Disease and Acetaminophen." Annals of Internal Medicine 87: 302-4. _
• Barker, J.D., et al. 1977. "Chronic excessive acetaminophen use and liver damage." Annals of Internal Medicine 87: 299-301. _
•Prescott, L.F. 1986. "Effects of non-narcotic analgesic on the liver." Drugs 32: 129-47._