NAPQI is toxic. In the liver, it kills cells and causes irreversible tissue damage. In severe cases, it can cause liver failure. This triggers a chain of reactions that can lead to death.
According to a literature review, liver failure caused by acetaminophen overdose causes death in approximately 28 percent of cases. Among those who have liver failure, 29 percent require a liver transplant. Those who survive an acetaminophen overdose without needing a liver transplant may experience long-term liver damage. In general, adults can take between milligrams mg and 1, mg of acetaminophen every 4 to 6 hours.
The chart below contains more detailed dosage information for adults based on the type of product and the amount of acetaminophen per dose. For children, the dose varies according to weight. If your child is under the age of 2, ask your doctor for the correct dose.
In general, children can take around 7 mg of acetaminophen per pound of their body weight every 6 hours. Call or poison control right away if you suspect you, your child, or someone you know took too much Tylenol. Early treatment is associated with lower mortality rates in both children and adults.
Treatment for a Tylenol or acetaminophen overdose depends on how much was taken and how much time has passed. If less than an hour has passed since the Tylenol was ingested, activated charcoal may be used to absorb the remaining acetaminophen from the gastrointestinal tract. When liver damage is likely, a drug called N-acetyl cysteine NAC may be given orally or intravenously. When used as directed, Tylenol is safe for most people.
However, you should speak to your healthcare provider before using Tylenol if you have any of the following conditions:. Tylenol may pose some risks to people who are pregnant or breastfeeding. Be sure to speak to your healthcare provider before taking a Tylenol product. Tylenol can interact with other medications. Some of our publications are aimed at helping you identify whether you or someone you know might have a mental health or psychosocial issue.
Many of these materials contain practical tips on how to manage certain mental health issues, or provide guidance for easy-to-do-at-home exercises or techniques that can help, such as breathing and relaxation exercises.
Most of these publications can be obtained for free. You can download them from this website or pick up your copy at our Treatment Center. If you are taking care of a person or people with a mental health condition or psychosocial issue, one of the best ways to understand the problems better and to increase your ability to provide adequate care and support, is to get some training in a mental health topic of your choice. TPO Cambodia regularly runs training courses in a wide range of mental health topics, open to the public.
Course can also be tailored to your specific needs. Getting Help —The Important First Step … It can be difficult to take the first step in getting help, but when you, or someone you know, is struggling with a mental health issue, or has something on their mind and it all just seems too much, reaching out for help and talking to someone can really help. Talk About It It can be very hard to get by on your own.
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In extremely rare cases, according to the FDA, recommended doses of ibuprofen and acetaminophen can provoke a skin reaction that can kill. But the FDA says acetaminophen carries a special risk. About a quarter of Americans routinely take more over-the-counter pain relief pills of all kinds than they are supposed to, surveys show.
That behavior is " particularly troublesome " for acetaminophen, an FDA report said, because the drug's narrow safety margin places " a large fraction of users close to a toxic dose in the ordinary course of use. The FDA sets the maximum recommended daily dose of acetaminophen at 4 grams, or eight extra strength acetaminophen tablets. That maximum applies to both over-the-counter and prescription drugs with acetaminophen.
Taken over several days, as little as 25 percent above the maximum daily dose — or just two additional extra strength pills a day — has been reported to cause liver damage , according to the agency. Taken all at once, a little less than four times the maximum daily dose can cause death. A comparable figure doesn't exist for ibuprofen, because so few people have died from overdosing on that drug. About as many Americans take ibuprofen as take acetaminophen, according to consumer surveys from the mids.
Centers for Disease Control and Prevention and the American Association of Poison Control Centers collect data on the number of deaths associated with each drug, but the figures are incomplete, making comparisons subject to question. McNeil contends the databases do not contain the information needed to draw conclusions about the relative risks of different medicines. The company and some epidemiologists maintain that these data sets undercount deaths resulting from chronic use of naproxen, ibuprofen and similar pain relievers.
More on the numbers can be found here. Still, the data show that acetaminophen is linked to more deaths than any other over-the-counter pain reliever. From to , annual acetaminophen-related deaths amounted to about twice the number attributed to all other over-the-counter pain relievers combined, according to the poison control data.
In , only 15 deaths were reported for the entire class of pain relievers, both prescription and over-the-counter, that includes ibuprofen, data from the CDC shows. That same year, people died from acetaminophen toxicity, according to CDC data. More than half — — died from accidental overdoses. The rest overdosed deliberately or their intent was unclear. For the decade through , the data shows, 1, people died from inadvertently taking too much of the drug.
Acetaminophen overdose sends as many as 78, Americans to the emergency room annually and results in 33, hospitalizations a year, federal data shows. Behind these statistics are families upended and traumatized and, in the worst cases, shattered by loss. Just before Christmas , year-old Davy Baumle came down with a sore throat.
But instead of getting better, Davy became listless. On Christmas Day, he threw up blood. His father took him to a local emergency room wrapped in a fuzzy brown blanket. A few days later, the boy was declared brain dead. At trial, they testified they never gave Davy more than the recommended dose, 4 grams per day, or eight tablespoons.
An expert for the company testified that lab work suggested the boy had ingested more, 6 to 10 grams, over several days. The difference amounted to as little as 4 tablespoons a day, but the company prevailed, persuading the jury that the Baumles had not used Tylenol precisely as specified.
David Baumle said he would never have given his son the drug if he knew it was potentially lethal. Tylenol was born in , when the family-owned McNeil Laboratories introduced a liquid for children called Tylenol Elixir. McNeil named the product based on letters in the chemical term for acetaminophen, N-ace tyl -p-aminoph enol. Unlike companies that develop prescription drugs, McNeil has no patent on acetaminophen, and so no right to sell it exclusively.
Virtually every drug store stocks generic acetaminophen, usually on the same shelf as Tylenol. To sell Tylenol at a premium, the company had to persuade customers they were getting extra value. The company aimed its early sales pitches at doctors , according to a company history , working to persuade them to recommend Tylenol as a safer alternative to aspirin. But in what later became a business school case study , McNeil removed Tylenol from the market, offered refunds and eventually developed tamper-resistant pills.
By the end, it had transformed a disaster into a public relations coup. Hospitals do. In , marketing was the largest department in the company, employing about professionals, McEvoy said in a court deposition.
Instead, the company is part of the consumer division, along with shampoo, mouthwash and skin care products. Although the drug is available in cheaper generic forms, McNeil accounted for nearly half of all over-the-counter sales of acetaminophen, according to a McNeil presentation. Sales of acetaminophen by all companies have also grown.
In , more than 27 billion doses of acetaminophen were sold in the U. Between and , the company notified the FDA of plans to introduce 54 different kinds of packages, ranging from chewable tablets to coated pills, packed into bottles, pouches, cartons and blister packs.
The first reports of deaths from acetaminophen emerged in the late s. Researchers subsequently learned that when the drug is broken down in the liver, it produces a potentially toxic byproduct. In an overdose, the liver can no longer safely dispose of the byproduct and can fail in a matter of days, shriveling like a deflated balloon. The concerns with acetaminophen emerged at a time when the American system for drug oversight was undergoing a sea change. Congress had passed a law in requiring the FDA to institute more rigorous testing for new drugs and to review the safety and efficacy of those already on the market.
In , as part of the review of existing drugs, the FDA assembled a group of doctors and scientists to assess painkillers, including acetaminophen. Over five years, the panel held 50 meetings, heard from scores of witnesses, and scoured thousands of pages of research — much of it submitted by drug makers themselves.
Relatively few cases of acetaminophen poisoning had been documented in the United States. But an American study published in identified four acetaminophen-related deaths in one year in one city, Denver. The company then gave him funding to help develop the acetaminophen antidote. Committee members wanted to drive home the potentially devastating consequences of taking too much acetaminophen, said Ninfa Redmond, a toxicologist who served on the panel. For McNeil, the proposed liver warning put a lot at stake.
Just the year before, Tylenol had become the No. Almost a decade would pass without the FDA coming to any decision. While the label advised consumers to seek medical assistance if they overdosed, McNeil was able to sell its drug without warning that it could harm the liver. Redmond called such additional review unnecessary because the basic facts about the drug were well-established. The agency agreed a warning was necessary but said there was no need to specify that the drug could injure the liver.
As early as the s, an FDA panel had examined whether to put an alcohol warning on the acetaminophen label. According to a corporate memo from February , McNeil had test-marketed how consumers would interpret different versions of an alcohol warning.
No matter how the warning was phrased, consumers reacted negatively: Most respondents concluded that drinkers should reduce or discontinue using Tylenol, even at recommended levels. A senior McNeil official would later testify in a deposition that the issue was controversial and complex. Then, in August , a relatively obscure Swedish journal published a study on the dangers of drinking and taking acetaminophen. In just over half the cases, users substantially exceeded dosing limits.
However, there were 18 instances in which they took less than 6 grams a day, not much more than the 4 grams considered safe, Gates noted.
Although McNeil had been preparing for the possibility that the FDA would require an alcohol warning, it took years before the agency publicly grappled with the issue. In , the FDA convened an advisory panel to look at the risk of mixing alcohol and acetaminophen.
Such panels are made up of outside experts. While the FDA does not have to follow their recommendations, it usually does. McNeil argued against the warning , saying the scientific evidence did not justify it and that it would frighten customers into taking other pain relievers that the company claimed were riskier. But the panel found that an alcohol warning was warranted. Because it was a post drug, the agency could push for a warning with less red tape.
It moved to do so on the new product, raising the possibility that regular Tylenol would have no alcohol warning but that the time-release product would have one. After the FDA approved extended release Tylenol with an alcohol alert in , McNeil voluntarily added the warning to all Tylenol products.
Four years after McNeil acted, the FDA required all acetaminophen manufacturers to add an alcohol alert to their products. People who drank three or more alcoholic drinks every day were advised to consult their doctors and were warned that liver damage could occur.
Benedi, who worked as a special assistant to President George H. Bush, often drank two or three glasses of wine with dinner. On a Friday in February , just weeks after Bush left office, Benedi came down with the flu. Over the next several days, he said, he took Tylenol, never exceeding the maximum dose. Benedi said he was careful to read labels. At the time, nothing on his box of Extra Strength Tylenol warned about the risk of drinking or liver damage. Several nights later, he woke up, confused and incoherent.
His wife called an ambulance to rush him to a hospital near their home in the Virginia suburbs of Washington, D. By the time he arrived, Benedi had slipped into a coma. Tests showed his liver enzyme levels were high, a sign of organ damage. He had brain swelling, so doctors drilled a hole in his skull to relieve the pressure. After his third day in a coma, Benedi got a second chance at life. Benedi spent two months in the hospital, more than surgical staples holding his abdomen together in a raw wound that looked like the Mercedes-Benz symbol.
Almost two decades later, he still suffers from those few days of taking Tylenol. To keep his body from rejecting his transplanted liver, he had to take powerful medications that eventually destroyed his kidneys, requiring a kidney transplant.
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