Acetaminophen is Popular, but Dangerous

Up until recently, acetaminophen has been one of those seemingly harmless, over-the-counter (OTC) pain killers, which most consumers purchase without a second thought. The problem, according to researchers and certain Food and Drug Administration (FDA) committees, is that many people are purchasing acetaminophen more than they realize, and taking larger doses than they should. The result is that users are accidentally over dosing on the drug, and are damaging their livers at the same time. In numbers, about 100 people die from overdose (accidental or otherwise), and hundreds more experience acute liver failure each year.

"Acetaminophen differs from other non-opioid analgesics, like aspirin, because it only seems to affect the central nervous system, and doesn't possess anti-inflammatory properties."

Because acetaminophen is the most common pain killer in the U.S., and is used in more than 200 products (most popularly Tylenol), it's tough to avoid. Add to this the fact that it is not clearly stated as an ingredient on many products (certain medications list it as APAP), and it becomes easy to understand the concern. This week, an expert panel joint meeting between the Drug Safety and Risk Management Advisory Committee, the FDA's Nonprescription Drugs Advisory Committee, and the Anesthetic and Life Support Drugs Advisory Committee discussed the issue. Afterward, they announced 10 recommendations for the FDA's regulation of acetaminophen. Among them are included:

• No more prescription pain killers that contain acetaminophen, such as Vicodin and Percocet
• Continue allowing OTC combination formulas (solutions that claim to ease multiple symptoms) that contain acetaminophen
• Lower the maximum dosage of OTC pain killers that contain acetaminophen

Although the FDA often adopts recommendations like these, they are not legally required to do so. The physician community had a mixed reaction to the recommendations. While liver specialists are quite happy with the decisions, some in the field of pain management question the continued allowance of OTC acetaminophen when medications like Vicodin would be eliminated. "The inconsistency is that they don't address the over the counter combination products -- the 'all-in-one' combinations of cough, 'congestion' and 'fever' products that have acetaminophen, and only reveal the amount of acetaminophen in really small print on the back," said Dr. Timothy Collins of the Pain and Palliative Care Clinic at Duke University Medical Center. "These products are the ones that have given me concern with my own patients, because many patients are not aware that their 'cold, cough and fever' product has acetaminophen in it, and take it along with their pain medications." A specific concern of some experts is that the changes for acetaminophen will drive consumers to use alternatives like aspirin and ibuprofen, which they feel come with larger health risks, like ulcers, bleeding, kidney disease, and high blood pressure. Acetaminophen - a non-opioid analgesic - works by altering the way the body senses pain. Non-opioid analgesics inhibit an enzyme called cyclooxygenase (COX), which helps to convert fatty acids into prostaglandins. One function of the prostaglandins is to produce pain, inflammation, and fever. By blocking COX and prostaglandin production, non-opioid analgesics reduce pain and fever in the central and peripheral nervous systems. However, acetaminophen differs from other non-opioid analgesics, like aspirin, because it only seems to affect the central nervous system, and doesn't possess anti-inflammatory properties.

Go Natural!

Rather than depend on any chemical pain killers, it might be a good idea to seek out natural alternatives for your comfort. The following is a short list of some substances that might help reduce physical pain:

• Boswellia - Boswellia contains boswellic acids, which decrease the production of inflammatory compounds, and can ease pain and swelling.

• Curcumin - This is found in the herb turmeric, and blocks inflammatory proteins while helping the body fight inflammation. Consuming it with pineapple can help absorption.

• Devil's Claw - Devil's claw can help to ease arthritis and back pain with irioid glycosides, which offer analgesic and anti-inflammatory properties.

• Omega-3 Fatty Acids - Ingested through fish, nuts, and plant oils, these fats are broken down into anti-inflammatory compounds.

• White Willow Bark - This fever reducer also blocks the production of inflammatory prostaglandins. It contains salicin, as does aspirin, but is gentler on the stomach.

If you continue to purchase and use acetaminophen, be sure to know exactly how much you are taking. Be especially careful of giving the drug to children. Remember: A quick fix to every minor headache is not necessarily worth the serious issues it might lead to down the road.

Sources:

http://abcnews.go.com/Health/PainManagement/story?id=7955370&page=1

http://abcnews.go.com/Health/PainManagement/story?id=7971964&page=1

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a681004.html

http://tuftsjournal.tufts.edu/2008/04/professor/01/

http://www.steadyhealth.com/articles/Top_10_Natural_Painkillers_a892.html

http://www.care2.com/greenliving/natural-painkillers.html

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