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Tylenol
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Tylenol

I was told by a Doctor that tylenol was not good for my liver and to take Ibprofen if needed but in moderation.... True?
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87972_tn?1322664839
You should always follow your doctor’s advice; he has your chart, and knows things about you that no one here ever will. With that said, Tylenol (acetaminophen) is probably the most commonly used OTC analgesic for HCV patients; it’s even used by cirrhotic patients for pain. There’s no evidence that it has any *cumulative* properties; so taken in mfgrs recommended doses, it’s usually considered safe unless cirrhosis is present; then a doctor might restrict the daily amount somewhat. It is highly hepatotoxic when taken in large doses, however.

Bill
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Did yo get this info from your primary care physician or your specialist?
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I was told to take "only" tylenol but in moderation.  My platelets were low so it was suggested that I only take a couple before my shot.  But, as Bill says, your Doctor has your chart.
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I was told ibuprofen too. and yesterday he said that I could take many as 800 mg at a time twice a day for headaches etc. I rarely touch the stuff though except on shot nights and then I only take one 200 mg. It never took much for me anyway.
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412873_tn?1329178055
The way my hepatologist explained it to me was that Tylenol is toxic to the liver at high doses, but not at the lower, recommended doses.  And they are already closely monitoring my liver because of the hvc.

Other drugs-aleve for example-can cause kidney failure in some people.

Her thought was...why risk damage to another organ.  It is enough fun dealing with one organ (the liver)........throw kidney failure on top and it's a whole other ballgame.

But that's her looking at my chart...as stated above.....your doc knows you best.  
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233616_tn?1312790796
>>>>>>>>>The way my hepatologist explained it to me was that Tylenol is toxic to the liver at high doses, but not at the lower, recommended doses.  And they are already closely monitoring my liver because of the hvc

that's not a correct statement. Tylenol toxicity depends on the state the liver is in as to stage/grade of disease, and also what other medications the patients already has to be on.
Therefore for some liver patients any tylenol is too much, There are safer drugs for pain control, although they have some dependancy issues and are not 100% safe either, they are considered much safer for the liver than tylenol and you should discuss other options with your doctor. Even though his blanket statement is not taking into account that you are already compromised just from the toxicity of the treatment, it might be good to point out to him you would rather taker a safer narcotic type drug than to push your liver into failure with one as taxing as acetominophen
.
Some doctors will admit that tylenol isn't the best idea at any stage of this disease...but then they feel they end up having to write more pain Rx's for the HCV group who are already suspected of having drug/alcohol seeking behaviors even though many do not enough do that all are lumped together....and I think that's primarily why some hepatologists still say a little tylenol is alright. I seriously doubt they themselves would take it...with this disease. Just google tylenol and liver disease and safety together and you will see why.

mb
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233616_tn?1312790796
sorry I was so drained the other night I forgot the other issue...
ibuprofen

ibuprofen and all NSAID class drugs have this is common: they thin the stomach wall and cause more internal bleeding and deaths from internal bleeds than all other causes combined.

Even though the evidence was in 20 years ago....and 60 minutes or 20/20 did a special that long ago on it...these drugs are still pushed on us everyday as if they did no harm.
Which only proves if you have a non-addictive pain killer and a powerful drug lobby you can keep anything from getting pulled.

for liver patients, already at a much higher risk of ascites, ibuprofen is not a good choice for this reason alone, although many more contraindications do exist as well.
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Avatar_m_tn
I amend the previous statment of "following your doctors advice" to following a liver specialists (hepatologists) advice. For example, many here report that the doctors recommended them taking ibuprophen and aspirin during treatment when in most probablity a liver specialist would have told the same patient to take Tylenol instead. My doctor specifically said no aspirin during treatment but did allow Tylenol within proper dosing limits.

-- Jim
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Avatar_f_tn
2 liver specialists have told me Tylenol is fine and I have advanced liver disease.  

There are those who take rx drugs that we know harm the liver and can be addictive.  I sure don't advise that over Tylenol.  We can justify anything if we feel it doesn't apply to us right?

The bottom line is follow your doctors advice and if he says ibprofen is good for you, go for it.  

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Avatar_m_tn
I have no idea where you come up with the stuff you post. My transplant center prescribes Tylenol - no more than 1 - 2 grams daily depending on the situation - and it is a prestigious center which does a lot of transplants. These are the same surgeons who put livers into people and I doubt seriously that they would jeopardize a transplant because it's convenient to prescribe Tylenol. You said: "I seriously doubt they themselves would take it...with this disease." That is so absurd I am at a loss for words. Well, I really do have words but, if I am frank with you, this post will be deleted. Suffice it to say that patients should rely on the advice of a their GI or Hepatologist and definitely ignore your advice. You don't even know the nature, degree or source of her pain and you are suggesting narcotics as a better choice? Astounding.
Mike
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Avatar_f_tn
uh huh, pretty scary stuff sometimes.
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I'm pretty amazed by Tylenol.

When I had my bone pain in weeks 20, 24 and 31, I'd take just a 325 mg and it would take the edge off the pain, in a miraculous way. Two of them would put me out and what a relief that was.

Some evenings, I'd be in bed saying to my husband with all seriousness that I'd never had any idea what a wonder drug it is. And so inexpensive.

My Pegasys insert does say to take either Tylenol or Ibuprofen for side effects but my hepatologist said up to 2 g per day of Tylenol should be the first recourse. My nurse said I could try Ibuprofen if the Tylenol didn't work. They certainly never alluded to prescription drugs as a first or second response.
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MerryBe, I have significant liver damage, and treated with a prominent San Francisco transplant center; they recommended acetaminophen time and time again for aches and pains. If you’re going to post info like this, at least support it with citations; there are thousands of people that read this forum, and some of them might act on the advice here.

Bill  
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87972_tn?1322664839
http://www.hcvadvocate.org/hcsp/articles/Herrera.html

Jorge L. Herrera M.D.
Division of Gastroenterology
University of South Alabama College of Medicine

“Acetaminophen use: Contrary to popular belief, acetaminophen (the active ingredient in Tylenol®) is perfectly safe for patients with cirrhosis as long as it is used cautiously. Any person who drinks alcohol regularly should not consume any acetaminophen. For patients with early cirrhosis (CPT class A or B), the use of acetaminophen is safe as long as the recommended dose is not exceeded (1,000 mg per dose, repeated no more often than every 6 hours). Patients with more advanced cirrhosis should take only ½ of the recommended dose. *In fact, for patients with cirrhosis, acetaminophen, when used as described, is the preferred medication for the treatment of pain.*”

Bill
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233616_tn?1312790796
you astonishment is nothing to my own in discovering that most of the physicians I've talked to know nothing about the P450 issues between and liver issues.

They don't even know which drugs effect which cytochromes.

My liver doctor, whom I thought knew more than most, recently precribed me cipro as a substitute for the horribile macrobid...

However, he did not know that cipro was also listed as one of the worst drug for the liver
in the inhibitor class ...

ergo, NO liver doctors do NOT necessarily know as much about these drugs and interactions as they should. My hepatologist was Stanford educated and has a long pedigree...and it did not stop him from being unfamiliar with potential risks.

I actually make no apology for suggesting a small amount of narcotic as the most liver friendly solution....even though too much narcotic can itself cause fibrosis, one weighs that against serious toxicity issues in ANY liver patient, and especially in those in later stages OR taking other meds.
As I tried to explain in my P450 thread, which no one seemed to heed, the effects of all
drugs are cummulative and sometimes become exponentially more toxic when combined with others.
Unless someone has the time and capacity to ferret out all these myriad interactions one cannot say definitively that tylenol could not tip the scale in ANY one case.

I think perhaps you may be stymied because you haven't had to deal with chronic debilitating pain and find a solution. In my estinmation, the wrong solutions for chronic pain only exascerbate and even cause a great deal of the fibrosis attributed to HCV...especially if those substance have been consummed along with unsuspecting patients many of whom do not take very seriously the warnings that accompany their meds regarding combining drugs with alcohol or other drugs.

I also think a lot of people don't believe that the public have been duped into beleiving the OTC pain killers are safe when indeed they are not. There are doctors who will honestly admit that were these OTC to have to pass muster today, they never would.
I worked for years with doctors helping patients recover from painful surgeries and strokes, and so my remarks are not hearsay, I spoke myself to doctors...
many of whom said neither aspirin, tylenol nor ibuprofen would pass today's FDA standards for safety.  So the question becomes, if they are not safe...then WHY are they still there for us?
One might reasonably ask, why is tobacco still there...and get closer to the real truths.

Or here's an item for meditation:
Every year a certain number of healthy babies are lost to "unexplained liver failure"...
the explaination in many cases has proven to be tylenol and one other drug. Not always the same other drug mind you...one cough product in particular is a culprit but others are as well...but since the baby or child's  liver is small, it only takes one wrong additional med to prevent clearance and effectively overdose the patient.
Especailly in 3rd world countries this happens a lot, as the combo is still sold, and babies are often underweight, making them more sucseptible....I'll try to recall which drug it is...starts with a P  but escapes me just now..

For minor pain, toughing it out is a much better choice for adult, neither tylenol nor ibuprofen do much for serious pain, and usually, if one waits about 5 minutes the body's own endorphines will kick in.
I know this because I have been living with a spinal cord injury that cannot be fixed surgically...it involved my going through a windshield, and includes a bent spinal cord
and several ruptured disks and damaged nerves.

I take !/10 th of the narcotic precribed for me each day and find that less meds works better than more...too little...zero and I can't walk...too much and I get rebound effects causing more pain and hence the need for more meds. So the key to pain management is to use the least amount of the least harmful drugs one can find.

mb.

there is not only the matter of the liver not being able to throw off or clear these drugs Mike, but also the fact that NONE of them were ever recommended for long term use.
example: The package label for adult TYLENOL® acetaminophen products instructs adults not to take TYLENOL for pain for more than 10 days or for fever for more than 3 days unless directed by a doctor. The package label for Children's TYLENOL products instructs parents not to administer TYLENOL to children for pain for more than 5 days or for fever for more than 3 days unless directed by a doctor. As with all over-the-counter (OTC) analgesics, this warning is necessary so that patients and parents will seek appropriate medical evaluation of their condition if it persists beyond these time periods.

Now mind you, and liver patient may have as little function as a child....
yet most are adults taking other meds for blood pressure, heart, thyroid, diebetes (diabetes), or the like..serious conditions that require medication....ergo, it makes the above constraints as to dosages and lengths of time as great or greater of a safety concern for adult than it is for children even.

mb
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412873_tn?1329178055
I'm sorry you feel I am giving incorrect information.  Kimbaalee asked a question based on her experience with her doctor's recommendation of ibuprofen over tylenol.  

I answered her question based on my experience with my doctor's recommendations.  Did he tell me that? Yes, he did.  Can tylenol be hepatoxic? Yes, it can.  Did my doctor tell me it would not be to me at lower recommended dosing?  Yes, he did. Is my liver being closely monitored?  Yes, it is.  Can aleve cause kidney failure in some patients? Yes, it can.  Is liver failure fun? No.  Is it twice the fun having double organ failure....no again. I've seen that with my mother and again with my father....not good.

I tried to make it clear with my wording that I was talking about my own experience. And ended it by suggesting that her doctor has her information and knows her case best.

It is our responsibillity to make sure our treating physicians have accurate information on us.  It is also our responsibility to educate ourselves on our conditions.  Coming here, for me has been part of that process.  So has learning to filter information.

I do try to make sure that my answers are as honest a reflection of my tx experience as possible.  I also realize that I probably am being a bit hypersensitive by answering in this manner, but I don't want kimbaalee or any other poster to think I would give false information.  

Also, gotta add that my doctor is an awesome, knowledgable, caring man and to suggest that he would base his recommendation to me based on drug seeking behavoir of others......arghhhhhh.

I have to admit, the rib makes me cranky sometimes. But again, that's been my experience.  Others may vary.  
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412873_tn?1329178055
oops....that would be the riba that makes me cranky--not my rib   ;)
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Avatar_m_tn
No one is suggesting to abuse Tylenol with other OTC/rx drugs and/or alcohol and that is why one should always run all drugs by their liver specialist. This does not mean however that we should not take Tylenol as directed by our liver specialists.

But speaking of abuse, your suggestion then is to prescribe a low-dose narcotic to a population that arguably has  a very high percentage of former drug addicts during a treatment regimen where one of the known side effects is relapse to former narcotic use?

-- Jim
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Avatar_f_tn
I'm very impressed by your response.

And just for the record, my ribs do make me cranky now and then. :)

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Avatar_f_tn
Yes Izzy, very well spoken.  

I have degenerative bone disease in 3 lumber vertebra from a skiing accident. Spinal fusion at 20 years old.  I now have degenerative bone disease.  Quite painful at times, can be incapacitating and no surgery can fix this problem.  I have been told that 3 times.  I live with chronic pain and OTC help.  

Car wreck caused cervical disc trauma to my neck. Bryan disc prosthesis for cervical disc replacement was recommended and I was scheduled for surgery but elected not to go through with it.  Again, chronic pain.  

There may come a time when I will have to use narcotics to control my pain and let me say tx has exhasberated every single broken down area in my body but for now I'm glad we can use Tylenol as recommended by our hepatologists.

Trin
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Avatar_f_tn
Some scary stuff gets posted on this site.  Some days, after reading here, I feel like everything I do, everything I eat, every medicine I take is going to make me instantly drop dead.

I think it's pretty well known that we would ALL be better off if we didn't have to take any medications - that would be a perfect world with perfectly functioning bodies.  Well, we don't live in a perfect world and we don't have perfectly functioning bodies (which is why we're here on this site).

I discussed pain meds in detail with my doc and he said Tylenol is okay.  Of course, I'm taking a dose that's appropriate for me.  I'd rather not take it but there have been days that I just can't work through the pain and I need relief.  I am not afraid of Tylenol.

I also took Cipro at about week 8 of my TX for a UTI.  I knew it was not "good" for my liver but an ongoing UTI would have been worse.  Cipro did have it's own set of side effects that I didn't appreciate but it got rid of the nasty UTI and I was thankful for that.  I am not afraid of Cipro.
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412873_tn?1329178055
Thanks to you both =)  

I got a smile from your "scary stuff" comment above, Trinity.  I am taking Microbiology right now... and have to admit, sometimes I think it's amazing we all survive on a daily basis.  Definately washing my hands better these days, lol!!

Just hearing you list your injuries makes my neck and back hurt...I think you are wise to stay with the tylenol and OTC as long as you can.  While there is always an appropriate time for the stronger narcotic drugs....they are just that...strong narcotic drugs and can very easily lead down a slippery slope even when used responsibility, especially long term.  

So, I quess, like Meakea......I am not afraid of Tylenol.  Of for that matter, ibuprofen, since that is where this conversation started, lol!!  (as long as my doc agrees)
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oh heck, I'm not offended at all by what you said, or the way you said it...

nor do I think that no one should never take tylenol, I just think the more you read on it, the less and less friendly it appears from a liver point of view.
BTW, I'm the LAST person in here who wants to be or see anyone on a narcotic...I pleaded for years for alternatives that would work...and finally tried some..to the detrement of my liver I've now learned

Like I said, HCV liver patients can have greatly diminished capacity to process drugs...and many are older and on various meds...making them far less safe than one might think.

seeing as how I had to make a choice for LONG term pain management, not an occasional pain, I asked my hepatologist, my GP and my neurologist in 07 what would be the safest way for me to go NOW....they all said the same thing...the plain narcotic, minus any added item such as tylenol, acetomenophen, aspiriin, would be the safest choice.

Now, maybe a transplant doctor is figuring with a new liver someone could tolerate the OTC additives...but that does not mean that my 3 doctors knew nothing either....
what it means, is that you have to ask the question like it really matters to you...
what's going to be THE SAFEST choice for my liver..."if this was your liver what would you do?" (if this was your son who would you have do the surgery?" That's how I phrase my inquiries....
and they all said the narcotic.  So who is right here?


Remember I worked with accident and stroke victims?? I saw some pitiful cases of chronic pain...and for years no one really helped patients..they were too worried about their liscenses..and this has not gotten much better.
I once asked a doctor why...if he knew how toxic acetominophen is was it still being pushed....and he said "because we are monitored constantly for how many scripts we write"....and I asked him why do you give it so freely  to the elderly then...."because we know they are dying, we aren't worried about addiction anymore and don't suffer the same scutiny when prescribing for them."

I don't know about anyone else's liver...but if I was in stage 5 or waiting for a transplant,
and some doctor was still giving me tylenol....I'd say that doctor had not done his homework at all. I'd say more, but it would not sound very nice.

Jim, I see your point, and it is scary stuff...but lets remember medicine continued to practice nonsterile procedures for 50 years after germs were proven, they continued to bleed people for 100 years, and they continue in many erroneous practices today.

When I was 14 I read Freud's Unabrided Abnormal Psychology 20 volume work, in which he extoled the virtues of fileting the faces of women open to cure hysertia, scooping out their adennoids and leaving them permanently dyfigured was his cure for anxiety....
and YET still to this day people call Freud a genius.

And there are doctor's practicing today that make about as much sense as Sigmund did.
.
My question is, why is everyone SO eager to believe what their doctors say hook line and sinker?  I tend to listen respectfully...but then go search for myself. As a result I diagnosed my last 5 diseases long before a doctor would see or confirm them.

Do we not realize that 9/10 of everything once believed true in medicine has now been proven to be false???
  As we learn more, even more current "medical facts" will prove erroneous that we think are true.  
So we need to scrutinize all these new man made molecules that we blithly place in our bodies each day.
We know about mercury, we know about lead...
but why is it we really don't ever research for ourselves the drugs we are told are safe to take?  How many in here have??  
I for one have....I started 41 years ago....when I was 18 years old researching what meds were offered me, and refused many then and since on the basis of their liver toxicity.
Knowing now, that I had this dread disease in that interim, I guess it's a good thing I did refuse as much as I did or I most likely would not be here.

mb


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233616_tn?1312790796
heres a good overview that gives some of the research sources..

written for the layman:

http://www.lef.org/protocols/appendix/otc_toxicity_01.htm

of couse going to pubmed and searching "tylenol liver toxicity" together will also be a real eye opener
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Avatar_f_tn
"Freud's Unabrided Abnormal Psychology 20 volume work, in which he extoled the virtues of fileting the faces of women open to cure hysertia, scooping out their adennoids and leaving them permanently dyfigured was his cure for anxiety....
and YET still to this day people call Freud a genius. "

I'm scared again.  I may have to consider therapy.
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412873_tn?1329178055
You know, I think I just assume that everyone takes this stuff pretty seriously and does the research, but I guess not everyone does.  

I'm too strong minded to do anything anyone tells me until I understand why.  (and by strong minded, I mean stubborn to a fault.)

Very timely information about Freud....just today I was debating whether or not to up my anti-d.  I think I'll just go slice my face open instead, lol!!  Not really, I think Freud was (mostly)  a whack.

Trinity:  you are cracking me up
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Avatar_m_tn
You  have yet to post one reputable study/opinion by a liver specialist supporting your positions. Posting an article for  support from a commercial nutritional web site with no attributed author -- I mean, come on, you really know better.

Hey, it's OK if you have opinions, but please try and be more careful to present your thoughts in this regard as opinions that are in opposition to almost every liver specialist in the world. At least that puts things in context and then people can do their own research. This is contrary to your current presentations  that a newcomer here might accept as current accepted fact within the medical community. And, no, most of the liver specialists who recommend here are not transplant specialists.

-- Jim
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Avatar_m_tn
I happen to agree with you.
And the liver specialists at my center prescribed Tylenol for pre-transplant patients. I think those patients had compromised liver function, It's just a guess but it does seem rather likely since they were, after all, awaiting liver transplants.
BTW, why does it always take up so much space? blah blah blah blah blah blah blah
Mike
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Avatar_m_tn
Your comment of NSAIDS  thinning the stomach wall is bunk, NSAIDS prohibit prostaglandin synthesis they do not thin the stomach wall. The protective mucus covering of the stomach is produced by prostaglandin synthesis, when you inhibit this from taking NSAIDS this protective mucus coating is gone, or greatly diminished. Once it is gone then the patient is at a high risk of developing bleeding ulcers, or gastritis. You also related acites (ascites) and a thin stomach wall? This is also bunk and it is obvious that you have a poor medical knowledge of the patho behind liver failure, acites (ascites) and stomach bleeding from NSAIDS. Acites (ascites) is caused by a greatly increased capillary hydrostatic pressure and a low collodial osmotic pressure. The increased capillary hydrostatic pressure is present in all end stage liver patients due to portal hypertension caused by scarring of the liver. Likewise they all have low collodial osmotic pressure due to a very low serum albumin level due to their liver failure. When you combine the two together you get acites (ascites). You should be very cautious when making medical statements, or giving medical advice. You never know when a medical professional may be reading and call you out on your lack of knowledge regarding the subject matter.
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Avatar_m_tn
I find this last post interesting .(.insignificant because of it responding to a post three years ago)...but nonetheless interesting... i
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