I have read, heard, been told that Tylenol (acetominophen) can cause harm to the liver, yet on this forum I have seen many recommendations to take Tylenol. I am curious as to why Tylenol would be recommended when there are other things to take. My friend, who died of HepC/liver cancer, was told NOT to take Tylenol and to stick to ibuprofen. I prefer good old aspirin.
Acetaminophen (Tylenol) is a medication used to control pain (known as an analgesic) and fever (known as antipyretic). It does this without producing the stomach discomfort often experienced with aspirin and other nonsteroidal anti-inflammatories (NSAIDs). This characteristic has made acetaminophen a very popular alternative to NSAIDs. In small doses (less than 4 grams per day, or eight pills taken over a twenty-four hour period of time) acetaminophen is quite safe for the liver—unless combined with alcoholic beverages (see below). (Note: each acetaminophen tablet or pill typically contains 500 milligrams of acetaminophen.) In fact, acetaminophen is the recommended medication for relieving minor aches, pains, and headaches in people with liver disease.
However, when taken in excessive quantities or when combined with alcohol, acetaminophen may cause death due to liver failure. In fact, an overdose of acetaminophen is the most common cause of fulminant hepatic failure as well as the most common cause of drug-induced liver disease in the United States. After acetaminophen became readily available in 1960 as an over-the-counter medication, it became one of the most popular means of attempting suicide. For liver injury to occur, acetaminophen must generally be consumed in quantities exceeding 15 grams within a short period of time, such as in a single dose. Although uncommon, ingestion of 7 to 10 grams at one time may cause liver damage.
The consumption of alcohol in conjunction with acetaminophen significantly increases the likelihood that a person will incur severe liver damage. Therefore, people who consume alcohol on a regular basis should probably limit acetaminophen intake to a maximum of 1 to 2 grams per day (that is, two to four pills within a twenty-four hour period). Still, the best advice for people with liver disease is to totally abstain from alcohol.
People should take special note that acetaminophen is also an active ingredient in more than 200 other medications, including Nyquil and Anacin 3. Therefore, it is essential to read the labels of all over-the-counter medications carefully. Other commonly used medications, such as omeprazole (Prilosec), phenytoin (Dilantin), and isoniazid (INH), may increase the risk of liver injury caused by acetaminophen. It is always in the liver patient’s best interest to consult with a liver specialist prior to taking any medication.
Acetylsalicylic acid (aspirin) and other NSAIDs are drugs that are widely used for their anti-inflammatory and analgesic effects. They also have the potential to cause drug-induced liver disease. In fact, many NSAIDs have been withdrawn from the market due to their hepatotoxicity. All NSAIDs have the potential to cause liver injury. However, some NSAIDs are more hepatotoxic than others. NSAIDs presently on the market that have been frequently associated with liver injury are aspirin (ASA), diclofenac (Voltaren), and sulindac (Clinoril). Ibuprofen (Motrin) has been reported to cause severe liver injury in people with hepatitis C. A new generation of NSAIDs, known as the cyclooxygenase-2 (COX-2) inhibitors, has recently been approved by the FDA. This group of NSAIDs has the advantage of having fewer gastrointestinal side effects – less abdominal discomfort and less risk of gastrointestinal bleeding, than conventional NSAIDs. There are three different COX-2 inhibitors currently available to the public– Vioxx, Celebrex and Bextra. COX-2 inhibitors have been associated with some liver dysfunction, although not as commonly as other NSAIDs. Recently, Vioxx has been removed from the market due to heart-related problems. Celebrex and Bextra are currently being investigated for similar heart-related toxicities.
It is recommended that people with liver disease avoid using all NSAIDs. If NSAIDs are medically required for the treatment of another medical disorder, a reduced dose should be used for a limited period of time and only by people with stable liver disease. Older women with liver disease seem to be particularly susceptible to the hepatotoxicity of NSAIDs and are advised to avoid NSAIDs altogether. Since NSAIDs may cause salt and water retention people with fluid retention problems such as ascites or leg swelling may suffer worsening of these conditions. People with decompensated cirrhosis are at increased risk kidney damage stemming from the use of NSAIDs. Since this may lead to hepatorenal syndrome (see Chapter 6), people with advanced liver disease are advised to totally avoid all NSAIDs. Furthermore, people with ascites (fluid accumulation) may not respond to treatment with water pills (diuretics), while on NSAIDs, as they counteract their actions. ( see chapter 20). People with liver disease who have had internal bleeding, - from an ulcer or esophageal varices, for example, may be at risk for recurrent bleeding induced by NSAIDs, and should totally avoid this class of medications. People who are also taking corticosteroids (such as prednisone), or anticoagulants (such as coumadin) may have and increased risk of complications from NSAIDs. Finally, people with liver disease who smoke cigarettes or drink alcohol should avoid NSAIDs as they are also at increased risk for its complications.
It often comes up here which is the best pain med to take.Everybody is different as far as risks go depending on many health issues.Article below explains some of these for those that haven"t see it.
Liver damage. Acetaminophen, the No. 1 nonprescription pain reliever, does not cause GI bleeding, but long-term frequent use or even large single doses can cause severe liver damage. In fact, acetaminophen overdosing is the most common cause of acute liver failure in the U.S., often as the result of suicide attempts. Most people still don’t know about this risk and don’t realize that acetaminophen is in hundreds of OTC cold, allergy and headache products and some prescription pain relievers. Check labels for acetaminophen, and don’t take more than 4 grams—equal to eight Extra Strength Tylenol tab--lets—a day from all sources. Alcohol (three drinks or more at a time) and certain other drugs increase the risk. Heavy drinkers and those with liver disease should atleast limit, acetaminophen. Taking the drug while fasting also increases the risk.
• Kidney damage. NSAIDs (and acetaminophen to a lesser extent) can damage the kidneys. If you have kidney disease, talk to your doctor about pain reliever safety.
Here’s our advice
For healthy people who take OTC pain relievers as directed, the risks are relatively small. However, because these drugs are so popular, thousands of Americans are affected every year. Don’t let these concerns prevent you from taking the drugs if you need them, but do follow this advice, especially if you take pain relievers often:
I agree about taking aspirin. Unfortunately too few doctors these days even mention aspirin.
When I asked my hepatologist about taking tylenol during tx, he said since I couldn't take aspirin due to my low platetes, he'd prefer I take tylenol and getting rid of hep C was the best thing I could do for my liver's health.
In my opinion, the only reason it's still on the market is due to the strenght of the industry which produces it.
It is in my view, vastly over prescribed and viewed by too many as being harmless.
Both tylenol and ibruprofren are not good for your liver and can do harm.
Tylenol was almost pulled from the market a number of years ago when a child died from taking adult extra strength tylenol.
There's a young woman on my transplant forum who had an emergency liver transplant due to a reaction to tylenol. She woke up after being raced to the ER to discover she'd had a transplant.
Recent action has been taken by the FDA to more adequately warn consumers about the increased risk of liver failure possibly associated with the use of the popular pain-reliever, Tylenol. On January 13, 2011, the FDA announced that it was advising manufacturers of acetaminophen products to limit the maximum amount of acetaminophen in their products to 325 mg per tablet or capsule.
According to the American Association for the Study of Liver Diseases, approximately 500 deaths and 50,000 emergency room visits are attributed to acetaminophen overdoses.
"I have read, heard, been told that Tylenol (acetominophen) can cause harm to the liver, yet on this forum I have seen many recommendations to take Tylenol."
You are correct on both counts.
Taking too much acetominophen or combining it with alcohol can cause liver damage or if certain amounts are taken, liver failure.
BUT that doesn't mean the acetominophen is inherently toxic to the liver. In fact it is less dangerous to the liver then NSAIDs. For people with advanced liver disease the only analgesic that should be used is acetominophen. "people with advanced liver disease are advised to totally avoid all NSAIDs." As stated in the article above, NSAIDs can worsen complications of advance liver disease which can cause life-threatening events.
ANY drug taken in excess can be dangerous. It is important to know how and when to take a drug and what the maximum dosage level is.
"My friend, who died of HepC/liver cancer, was told NOT to take Tylenol and to stick to ibuprofen."
I don't know why she was told that. Maybe she had a unique health issue going on at the time. The standard protocol for all persons with End-Stage Liver disease is if needed to only take acetominophen up to a maximum dose of 2,000 mg or 1,500 mg. That includes patients with liver cancer. This is the standard at all US Liver Transplant Centers and the standard treatment by all hepatologist treating patients with various degrees of cirrhosis. There is no debate on this issue. It has been the case for many many years.
"I prefer good old aspirin."
As Will said, for a person with little liver damage aspirin can be taken with adverse effects on the liver.
For a person with End-Stage Liver Disease a dose which is safe for a healthy person could cause kidney failure, massive internal bleeding and other nasty things that should be avoided at all costs.
Dr. Gish says to take up to 2000 mg a day of TYLENOL as needed - so that doesn't mean all the time by a long shot. But Tylenol is what he prescribes. And he says no Motrin, no Aleve, nothing but Tylenol for pain. He recommends Extra Strength Tylenol.
Anyone can take this as they wish to, of course. But I accept the expertise of Dr. Gish - my life is in his hands now.
I always tell the doctor or dentist that I can't take Acetaminophen if they're going to prescribe pain meds and they'll usually substitute Oxycodone or Percocet instead without a problem. My chart at the hospital states I can't take it too.
I have been taking a baby aspirin probably for a year now because I was concerned about my health. When I started tx my NP told me to stop the baby aspirin because my platelets were probably going to tank and they have (81). But she told me to take Tylenol for pain but no more than 2,000 mg per day. Also told me to take 2 tylenol before my shot to relieve any sx. I haven't had any sx to speak of so I just take 1 before my shot. As I get further into tx this will probably change but for now this is what I am doing.
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