Acetaminophen Overdose

Oct 10, 2016

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"What is a Royal Crime Watch Area?" I have to admit, I was stumped. During a bike ride this summer, Eric and I were stopped on the highway to Valley River for a rest. Then Eric started asking me about Kings and Queens committing atrocities. Or at least that is where my mind went when he said "Royal Crime". I asked Eric what he was talking about and he pointed at the sign.

People have been walking under our new IDA sign lately and asking me about Tylenol or acetaminophen. They have been hearing news reports that Tylenol is dangerous. People don't want to take Tylenol because it is going to hurt them. They want something safe like Aleve. There seems to be a lot of confusion and fear about acetaminophen lately. And, in my opinion, some news reports about acetaminophen have been less than helpful.

I think the CBC article titled, "Why acetaminophen is the 'most common cause of liver injury' in Canada" exemplifies the problem. Nothing in the CBC article was wrong, but the emphasis was misplaced. The CBC story says 4500 Canadians are hospitalized from acetaminophen overdoses every year. Not that isn't a tragedy for each of those people, but that isn't a large number. There were over 7000 people hospitalized from falls on ice 2011. To look at it another way there were about 2.7 million hospitalizations in Canada in 2014. So 4500 hospitalizations are about 0.2% of the people in hospital. Again, terrible if you are one of the 4500 people who overdosed, but far from an epidemic.

The important part of the statement from Health Canada that CBC de-emphasized is: "Acetaminophen has been widely used for over 50 years in Canada to treat pain and fever and, when taken as directed, is a safe and effective medicine. Despite its established safety profile, acetaminophen is the leading cause of acute liver failure in Canada." Let's unpack that.

What is acetaminophen? Acetaminophen is a pain killer and fever medication. It's most common brand name is Tylenol. Acetaminophen is very safe if used properly. How much acetaminophen can you take during a day? In Canada, for adults, the maximum is 4000 mg per day or 8 acetaminophen 500 mg tablets. In the US it has been reduced to 3000 mg per day. That is 6 acetaminophen 500 mg tabs per day. Health Canada may one day agree with the FDA in the US and go down to 6 tablets of Extra Strength Tylenol, but not yet. In the elderly, and in people who take acetaminophen every day for something like arthritis, we keep them under 6 tablets of Extra Strength Tylenol. If you drink more than 3 alcoholic beverages per day, we recommend you stay under 6 tablets of Extra Strength Tylenol per day.

Despite the concerns about taking too much acetaminophen, which are valid, it is important to point out acetaminophen or Tylenol, is very safe. For example, no medications are 100% safe in pregnancy, but acetaminophen is as about as close as we have to a safe medication for pregnant women to take. For arthritis pain, sore teeth, and headaches ibuprofen, advil, aleve, and naproxen work, but they have potential side effects. All these NSAIDs can cause stomach ulcers, high blood pressure and kidney problems. Acetaminophen or Tylenol won't. Good old fashioned ASA or aspirin can cause bleeding issues in adults or Reye's Syndrome in children. Acetaminophen or Tylenol won't. There are no 100% safe medications, but if used properly, acetaminophen, or Tylenol, is about as close as we get.

Acetaminophen can cause liver problems. But, the main problem with acetaminophen is dosage. If you take too much acetaminophen, like any other medication, it can be harmful. One reason acetaminophen overdose is a concern is because acetaminophen is in so many different over the counter medications. It isn't just in the pain control aisle. Medicines for allergies, colds and flu's can all have acetaminophen in them. There are different strengths of acetaminophen liquid in children's pain aisle. Some prescription pain medications have acetaminophen in them as well. This is the confusing and possibly dangerous problem. This is where the emphasis should be.

How should you avoid getting confused in the OTC aisle and accidentally taking too much acetaminophen? Talk to your pharmacist! People already come to me routinely to ask if this cough medication is okay with their blood pressure pill. Ask your pharmacist, does this allergy medication have acetaminophen in it? And that is the crux of the new Health Canada warnings. Health Canada is going to start requiring more clear labels on OTC products, including if they contain acetaminophen and how much.

The take home message is to be careful not to take too much acetaminophen. Have your pharmacist help you determine if the different OTC products you buy have acetaminophen in them. Don't take two different products with acetaminophen in them together. Play it safe and use 3000 mg or less per day of acetaminophen. That is 6 or fewer 500 mg acetaminophen tablets per day.

As you have probably guessed, Eric and I were beside a sign that said "Rural Crime Watch Area". No atrocities by Kings and Queens were going on that I am aware of. However, whether it is Royalty stealing land from peasants or Tylenol doses, it is important to read the signs.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

CBC Story - Why acetaminophen is the 'most common cause of liver injury' in Canada - http://www.cbc.ca/news/health/acetaminophen-toxicity-health-canada-1.3764672

Health Canada Acetaminophen safety - http://www.healthycanadians.gc.ca/drugs-products-medicaments-produits/buying-using-achat-utilisation/products-canada-produits/drugs-devices-medicaments-instruments/acetaminophen-eng.php

Canadian Centre on Substance Abuse - Hospital Costs and Impacts of Substance Use http://www.ccsa.ca/Resource%20Library/CCSA-Substance-Use-Hospital-Impact-Report-2014-en.pdf

Hospitalization Rates, Canada, Provinces and Territories - Alberta Ministry of Finance - http://www.finance.alberta.ca/aboutalberta/osi/aos/data/Hospitalization-Rates.pdf

Number of Hospitalizations Due to Falls on Ice. Canadian Institute for Health Information - https://www.cihi.ca/en/types-of-care/specialized-services/trauma-and-injuries/table-3-number-of-hospitalizations-due-to

 


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