Acetaminophen Aches

Boston, MAIt might just be one of the best-known drugs on the market, but acetaminophen is now coming under fire after it was linked to an increased risk of liver failure.

The situation is of a high enough concern that a US Food and Drug Administration (FDA) advisory committee met in June, 2009, to discuss potential action to lessen the rate of acetaminophen poisoning, which is now linked to acute liver failure. In fact, according to a Los Angeles Times article, (July 20, 2009), acetaminophen is the most common cause of acute liver failure in the US. Compounding the concern is that acute liver failure can come on quickly, in as little as 48 hours. Furthermore, the Times notes, of 8,000 cases of acetaminophen overdose in California in 2008, over half were unintentional overdoses.

Acetaminophen is a widely used pain reliever, used to treat headaches, fevers and muscle aches, and is found in Tylenol, Vicodin and Percocet. Making the situation more complicated is that patients may be taking more than one acetaminophen-containing product—putting them at risk of an overdose without realizing it. For example, a person with a cold might take both Tylenol and NyQuil to combat cold symptoms, but both products contain acetaminophen. That person, if taking the maximum daily dose of both products, could wind up overdosing.

The L.A. Times article notes that some prescription drugs do not include component drugs on their label, so a person could be ingesting acetaminophen without knowing it. That puts the person at an increased risk of liver failure. In fact, in addition to being a pain reliever, acetaminophen is found in products to treat colds, flu, allergies and sleeplessness, according to the FDA.

Symptoms of acetaminophen overdose include stomach pain, nausea and vomiting within 24 hours of the overdose. Following those 24 hours, patients may experience jaundice, mental confusion and sleepiness. Patients who experience liver failure often require a liver transplant to survive.

The FDA's advisory panel suggested lowering single and daily dose recommendations for over-the-counter acetaminophen products. The panel further recommended that prescription medications that contain acetaminophen and narcotics be abolished or, at the very least, feature a prominent warning about the risk of overdose.

In April, 2009, the FDA required manufacturers of over-the-counter pain relievers containing acetaminophen to include warnings about the risk of liver damage.