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Liver Poisoning becomes more Common—What You Need to Know to Prevent It

separator Let’s say you have the flu. You aren’t eating much, because you don’t feel like it. You start out taking Tylenol, which contains acetaminophen, to relieve your symptoms, but you still don’t feel very good. So you add an over-the-counter flu medication. You keep taking both drugs for nearly a week. Why not? Tylenol is safe, right?

What you don’t realize is that you’re putting yourself at risk of serious liver poisoning. There’s acetaminophen not only in your Tylenol, but also in your flu medication. It gradually builds up, until suddenly, it can result in the need for a liver transplant. It can also cause permanent brain damage. In some cases, liver poisoning is fatal.

The number of accidental liver poisonings resulting from taking too much acetaminophen is on the rise in the U.S. Many people are aware that the popular pain reliever called Tylenol contains acetaminophen. They also may have heard or read that too much acetaminophen is poisonous to the liver. But what they often don’t know is that acetaminophen is also found in other common over-the-counter drug products.

Common medications containing acetaminophen
Acetaminophen is found—in varying doses—in many cold remedies and combination pain relievers. Here are some of them:

  • Excedrin
  • Midol Teen Formula
  • Theraflu
  • Alka-Seltzer Plus Cold Medicine
  • NyQuil Cold and Flu

It’s also found in some prescription narcotics, such as

  • Vicodin
  • Percocet

How much acetaminophen is safe?
The recommended maximum dose of acetaminophen for adults is 4 grams per day, or 4,000 milligrams. Here’s how easy it is to go over that number:

  • Each Extra Strength Tylenol tablet contains 500 milligrams of acetaminophen. It’s easy to take 4,000 milligrams of these in one day.
  • One dose of Tylenol Cold and Flu Severe contains 1,000 milligrams.
  • One tablet of Midol Teen formula contains 500 milligrams
  • Arthritis-strength versions of acetaminophen contain 650 milligrams

You can see how important it is to keep track of the acetaminophen you’re taking. 

Symptoms of liver failure
The early signs of liver failure include

  • Loss of appetite
  • Tiredness
  • Paleness
  • Sweating
  • Nausea and vomiting

As the poisoning becomes more severe and progresses to liver failure, symptoms include:

  • Abdominal pain and tenderness
  • Swelling of the liver
  • Blood tests that reveal abnormal liver enzymes

During the final stages of liver poisoning, the skin and whites of the eyes become yellow due to jaundice. Kidney failure, abnormal bleeding and swelling in the brain may occur. 

Risk is low, if drug is taken properly
One reason that people take acetaminophen without worrying is that they’ve been led to believe that it’s got a high safety profile. Other pain relievers have been pulled from the market. Acetaminophen—taken in the right dose—is safer for children and teenagers than aspirin. And it’s less likely to cause stomach or kidney problems in adults than aspirin.

But there are certain conditions and behaviors that make you more vulnerable to liver poisoning by acetaminophen: 

  • Drinking three or more alcoholic drinks per day (Some researchers believe that binge drinking can also make you vulnerable.)
  • Going without much food for several days
  • Being a small woman
  • Being obese (Extra fat in the liver creates extra vulnerability)

You also should know that you may be able to take higher-than-recommended levels of acetaminophen for an extended period of time without any problem, and then suddenly, your liver isn’t able to manage the higher level, causing it to fail.

Hepatology,December 2005
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