Do you know the drug ingredient called, acetaminophen?

Acetaminophen is one of the most common ingredients in antipyretic analgesics for fever and pain. You may have heard the name acetaminophen recently, as it was introduced as a drug that can be used to counteract adverse reactions to the Covid vaccine.

Acetaminophen is widely available in the United States, and is reportedly found in hundreds of cold and cough medicines in the United States. But it is not entirely safe. In fact, acetaminophen is said to be one of the most frequently banned or restricted drugs because of its potential dangers, which makes it easy to misuse and it has also been linked to suicide and unintentional poisoning deaths!

In 2014, the U.S. Food and Drug Administration (FDA) recommended that all manufacturers stop marketing prescription drug combination products containing more than 325 milligrams (mg) of acetaminophen per tablet, capsule, or other dosage unit in order to prevent serious liver disease. All of these products have been discontinued and are no longer available, but there are a few manufacturers left that have not taken the necessary administrative steps.

Despite the placement of the FDA recommendations, a report updated in February of this year by the National Institutes of Health states that acetaminophen toxicity is the second most common cause of liver transplants worldwide and the most common cause of liver transplants in the United States, and is also responsible for 56,000 emergency room visits, 2,600 hospitalizations and 500 deaths in the United States annually, 50% of which are unintentional overdoses.

Unintentional overdose

It is estimated that more than 60 million Americans consume acetaminophen weekly, many of whom are unaware that acetaminophen is contained in compounded products. This is because acetaminophen is sold under many brand names and is an ingredient in a wide range of over-the-counter and prescription drugs. In fact, acetaminophen is reported to be found in about 600 different products.

Dr. Nima Majlesi, director of medical toxicology at Staten Island University Hospital in New York said that misuse of drugs such as Percocet, Vicodin, and Tylenol PM, and taking multiple acetaminophen-containing products without recognizing the risks of taking large daily doses, can lead to acute liver failure. When acetaminophen is taken in large doses, the liver cannot keep up with the breakdown of the drug, and toxic byproducts accumulate, causing liver cell damage!

Dr. Kevin Zacharoff, a chronic pain and substance-use expert, says that there is concern that not all physicians prescribing combination opioid/acetaminophen medications are ensuring that their patients do not take other acetaminophen medications. He added that most people who need liver transplants in the U.S. need them not because of IV drug abuse or anything else other than the fact that they were ‘poisoned’ in some way by too much acetaminophen.

Dr. Zacharoff is also concerned that even if a doctor tells a patient when he or she prescribes Percocet not to take other medications that contain acetaminophen, the patient may not know that Tylenol is another name for acetaminophen. They may also not know that the common cough medicine Robitussin contains acetaminophen, or that common allergy, sinus, and migraine medications also contain acetaminophen. This leads to people being unintentionally exposed to excessive amounts of the drug.

suicide

The inclusion of acetaminophen in over-the-counter medications means that the drug is readily available and can be a means of suicide.

A study published in 2019 in the journal Clinical Toxicology examined U.S. poison center data on 1.68 million cases of suspected suicide by self-poisoning between the ages of 10 and 25 between 2000 and 2018, and found that the incidence of serious medical problems after self-poisoning increased with age, ranging from 20% of suicide attempts among 10- to 12-year-olds to 28% among 22- to 25-year-olds. ‘Because medications are readily available at home, many families do not take precautions to keep them safe. Our findings suggest that this is a major problem,” said Dr. John Ackerman, co-author of the study and clinical psychologist and suicide prevention coordinator at Nationwide Children’s’ Suicide Prevention and Research Center.

A recent study by the Centers for Disease Control and Prevention found a 30% increase in suicide attempts due to acetaminophen toxicity among 10- to 19-year-olds in the United States between 2019 and 2021. The data reveal an even more alarming trend among younger children, with a 73% increase among 10- to 12-year-olds and a nearly 49% increase among 13- to 15-year-old youth.

emotional effects

Studies have shown that acetaminophen not only has a negative effect on the liver, but also affects emotions. A study by Baldwin Way, associate professor of psychology at Ohio State University, found that acetaminophen blunts both positive and negative emotions. They found that over-the-counter acetaminophen alleviates “pain and pleasure alike” and essentially attenuates the user’s ability to experience emotionally pleasurable sensations.

Also, Way and his colleagues found that acetaminophen is an “empathy killer”. Because empathy plays an important role in prosocial and antisocial behavior, acetaminophen-induced changes in empathy appear to have the potential for a wide range of social side effects. In a further 2019 study, Way and colleagues found that acetaminophen blunts “social distress” by decreasing activity in the anterior insula and anterior cingulate gyrus, brain regions associated with emotional recognition and motivation. They say that even positive empathy is blunted by drugs. When participants were given 1,000 mg of acetaminophen and then asked to read scenarios about others’ uplifting experiences, acetaminophen reduced personal pleasure and empathic feelings toward others, again suggesting that widespread use of acetaminophen may have a negative effect on prosocial behavior at the social level. Acetaminophen has also been found to cause “suppression of evaluation processing”. In other words, it is said that their ability to make decisions may change, slowing their reactions and causing them to miss mistakes that they would otherwise have noticed!

ADHD and ASD

Hundreds of “Tylenol lawsuits” have already been filed against retailers and manufacturers for selling products containing acetaminophen to pregnant women knowing that they could harm their developing fetuses. The lawsuit alleges that the use of acetaminophen during pregnancy can cause children to have autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD).

The U.S. Judicial Panel on Multidistrict Litigation (JPML) late last year appointed Senior U.S. District Judge Dennis Cote to oversee the growing number of family lawsuits, and Judge Cote has appointed a special judge to preside over all federal Tylenol autism and ADHD litigation in December 2023.

Mark Lanier, one of the attorneys appointed as lead counsel for the Tylenol Multidistrict Litigation (MDL), said, “At this point, I think there are a few hundred lawsuits filed. When all is said and done, I think there will be thousands to tens of thousands of lawsuits.”

Dr. Roberta Ness, the epidemiologist who helped demonstrate the link between baby powder and ovarian cancer, is also alarmed by the relationship between acetaminophen and ASD and ADHD. Ness, a woman’s health expert who works with Autism Justice and former dean of the University of Texas School of Public Health, told USA Today in November 2022:

“I’m not saying that acetaminophen is now the cause (of autism and ADHD). I’m saying that it’s a cause. This is our first opportunity to find an exposure that may be preventable and may be a cause.”

what we can do

If the FDA really wants to reduce the risk of chronic acetaminophen poisoning, it should eliminate all combination drugs (drugs that combine multiple medicinal ingredients into a single medication) and have patients take a pill for each medication they need. In this case, patients would take one pill for each ingredient in the drug, which would eliminate confusion and make the drug safer.” comments Dr. Majeresi on acetaminophen overdose.

I hope such a law will be established, but at this point I think we should all be properly informed about our medications. We tend to think that because it is an over-the-counter drug, it is safe, but do we have a correct understanding of its dosage?

I would also like you to understand, that it is essential to do your own research before purchasing medicine, and not just to rely on the manufacturer or retailer.