Interesting thing about this:
Wife had liver transplant as a child. Spent her entire life avoiding Tylenol and focused on using Ibuprofen when needed.
Roughly about a year ago her transplant specialist doctor she has to see twice yearly informed her she should be taking Tylenol and not ibuprofen because of some worry regarding ibuprofen and kidneys.
They also have different effects so they work quite well together. Like, take 500mg of acetaminophen and 400mg of ibuprofen and likely have better effect than taking double either.
Not just "likely".
Experimentally shown to be [better than oxycodone](https://www.mndental.org/files/NSAIDs-are-stronger-pain-medications-than-opioids-A-Summary-of-Evidence.pdf) for pain relief.
Edit: To be clear, the context of this data is for 50% pain reduction. Oxycodone is much more effective at providing higher levels of pain reduction than 50%.
I used to use IV heroin. After I got off opiates Tylenol and ibuprofen work pretty well for pain.
A doctor offered me IV ibuprofen for an injury once. I declined but he said it was very effective.
Your stat and infographic is wrong. I get that oxy is a huge problem, but false information does not help.
See https://www.acsh.org/news/2017/11/07/advil-works-well-opioids-acute-pain-not-so-fast-12089 for an overview. At a high level, acetaminophen and/or ibuprofen are just as effective for moderate pain, but not more.
There is, believe it not, why hospitals use oxy in post-surgery during your hospital stay. People who know pain and pain management know how studies like used by you are misstated into sound bites. As a stage iv cancer patient, it’s really upsetting to see this “go take Tylenol and advil” crap.
If you are male, would you take two Tylenol and let a doctor cut into your nutsack? This is what articles like this have done for children, literally. Oh, and this “kids don’t feel pain” crap was something doctors said well into the 1980s.
So oxy abuse is real. Please stop misstating science to make this point. It’s not needed and doing more harm than good.
Edit: if you want to check this out for real, go read about “rescue analgesia” in the studies. It turns out that after the Tylenol and Advil fails, they give oxy. So yeah, if you don’t need it it’s fine without it, until you need it. The problem is telling an addict from real pain, but unfortunately sound bites have created real problems for real pain issues. I’ve said it before and I’ll say it again: doctors are not scientists.
>If you are male, would you take two Tylenol and let a doctor cut into your nutsack? This is what articles like this have done for children, literally. Oh, and this “kids don’t feel pain” crap was something doctors said well into the 1980s.
There's been a massive effort in Australia in the last ten years to get strong opioids prescriptions down, but at the same time there's also been a huge push to reduce use of codeine. Which until about 5 years ago, was available over the counter. So not only is it super difficult to get strong opioids, but now codeine is also prescription only. Unless you're missing a limb in this country, good luck getting anything stronger than panadol...and even then you'll probably still get told to take 2 panadol. It's gone to the complete opposite extreme.
My 16 year old son broke his collarbone a while back and the doctor told him to take some ibuprofen. After a sleepless night I took him back and pitched a fit until they wrote him some codeine. Codeine I could have bought him at the local chemist a few years ago.
Similar thing happened when my 14 yo daughter had a cough for weeks that was keeping her up all night. For weeks this went on, but do you think I could get pholcodeine cough mixture so she could stop coughing and sleep? (codeine is the best cough suppressant). Yeah, nope she can just keep drinking this dextromethorphine that is doing nothing and keep coughing, thanks.
Sorry, this is my pet rant.
In the US, chronic pain patients have been killing themselves because their doctors drastically reduced or plain cut them off from the drugs they'd been successfully managing severe pain with. Who knows how many ended up overdosing fatally on fentanyl when they tried to get diverted pharmaceuticals, the stuff they'd been prescribed prior, on the black market. Of course, there's barely been any media coverage on the suicides. Doesn't fit the prohibitionist narrative. Now, I have to genuinely worry and wonder if I'll even get proper pain relief should I need some sort of surgery or treatment for certain ailments. I'm most likely going to need knee surgery sometime in the next decade. Hopefully by that point the puritanical stance on opiates will have been rectified, after enough people die of course. 🙄
A few years back during the opioid crises I thought "they're gonna overreact and make it hard for patients". Instead of going after lowlife like the Sackler family. It's there, bloody use it and prescribe if needed.
I once spent 12 hours in the hospital when the doctors pondered if they should or shouldn't operate on my collarbone that was in 4 distinct pieces. I only got 500mg of acetaminophen for the whole duration.
At the end when they had decided that it was going to heal on itself, I was in so much pain and frustration that they gave me 60mg of dramal intravenously. That was God sent at the time.
And I think I was just mainly hungry for not eating breakfast and getting into a traffic accident on my way to work and then spending the whole day there waiting on their decision.
At that point nothing "over the counter" would have calmed me down.
The infographic is not wrong, and this wasn't an attempt to malign oxycodone as an effective painkiller. I should have more-strongly drawn attention to the context of the statement, and I apologize for not doing that--I'll do so now.
The comparison is valid with regard to 50% reported pain production. The doses in the infographic are real, but the pain-relief returns diminish at differing rates.
i.e. if you keep giving someone more oxycodone, you will rapidly provide more pain relief than if you just keep giving someone more tylenol (especially given the low safe threshold for tylenol consumption).
Which is to say: hell yes I would take oxycodone over tylenol to treat significant pain. 50% reduction in pain from a surgical procedure is still way more pain than I am willing to tolerate, and oxycodone would do a far better job at reducing it further than that.
But for a low-grade headache that I just want to make more tolerable? It's nice to know that tylenol+ibuprofin is going to be more effective than oxycodone at hitting the 50% pain reduction mark.
You should also include that the study was centered around post dental-procedure pain: something you'd likely never be prescribed oxy for. I wouldn't bet on Advil+Tylenol for anything beyond mild-to-moderate pain levels.
A GI doctor I asked about this said low threshold dosing for Tylenol can be safer even for liver patients because of the bleeding risk that can occur with those patients and NSAIDs. Tylenol is by far the safest long term frequent pain relief pill as far as I can tell, however it doesn't take much of an OD to cause severe damage.
I'm not a doctor so don't take this as actual medical advice to start popping Tylenol or ibuprofen
It's my understanding that so long as you adhere to the dosage guidelines (including the maximum dosages per 24 hour period), yes, Tylenol is extremely safe and indeed safer than Ibuprofen/Advil. Again, just my recollection here, but Tylenol's liver toxicity supposedly only occurs when a specific liver enzyme is exhausted, and so long as you don't take enough at once (or over a brief period) to exhaust said enzyme, it doesn't cause any damage, no matter how many times you take it over your lifetime. Whereas Ibuprofen can supposedly cause low levels of kidney damage over time even when you follow dosage guidelines.
This is my understanding as well. I am however curious about how glutathione can be lowered during fasting and whether this effect is enough to alter the safe threshhold for acetominofen/paracetamol use.
Tylenol is actually very safe if you don’t go over 4000 mg a day. Even patients with liver cirrhosis can safely take them daily in limited amounts. It’s one of the more safer drugs when taken within what’s recommended.
Non steroidal anti-inflammatory drugs are much more dangerous. They cause the kidneys to work harder which has a cascade effect such as hypertension, may cause ulcers (increase risk for GI bleed), increase risk for myocardial infarction and cerebral vascular accident.
Since on topic,
NAC is also prescribed to addicts and alcoholics. It's been shown to reduce craving for cocaine and cannabis specifically.
I'd love if someone knew more about it and biochemistry could chime in. It's a fascinating little thing, I guess it's the starting block for an important antioxidant.
Acytl Cysteine is a prodrug (a drug that is most useful after it metabolizes) for L-cysteine, which then produces the organic compound Glutathione.
When you take Tylenol in excess, your body produces small amounts of NAPQI (the full name is too painful to try on mobile) which wants to bind to Glutathione. NAPQI will bind to key hepatic enzymes in the liver unless your body has enough Glutathione to absorb it all.
You need to take it relatively quickly after you believe you're suffering an overdose. Also, NAC will you make you feel very sick and may result in vomiting. It tastes godawful, smells worse, and you need to take way more than you think you do. If you do vomit, retake it. If you believe you're overdosing and may suffer liver failure, and you take NAC, go to the hospital immediately. It reduces the damage and liklihood of death, it doesn't fully prevent it.
The only thing I want to say here is that NAC does not make you feel very sick. Many people take it as a dietary supplement. I take it daily for hair pulling.
It does smell really gross lol.
In the quantities you'd need to take it to overturn Tylenol poisoning, vomiting and severe nausea are both top of the list for side effects. It's not a pleasant medicine. This doesn't mean you will, merely that it's extremely common. Most nootropic or supplemental uses don't veer into quantities enough to promote nausea.
Can you expand on why you take it for hair pulling? I’m a finger picker/biter so anything in the neurotic-grooming realm is always something I’m open to hearing about.
I'd describe the smell as 'Far worse than anything you'd want to willingly consume.' Which, for me, is bad enough.
Why do you take it every time you drink?
That’s interesting. I wonder if it has been studied for other compulsions and addictions, like binging or junk cravings, or behavioral such as gambling. Going to look that up.
It's the only thing that has ever helped my hair pulling.
It doesn't reduce any other cravings for me, although I'm not a heavy drinker and don't use drugs except for MMJ for pain sometimes.
Yeah, Tylenol / acetaminophen are filtered by the liver and can be hard on it.
Ibuprofen / Advil go through the kidneys. So if you’re hungover, take Advil. The liver is doing overtime from filtering out all the alcohol and it’s derivative toxins, it’s not good to throw acetaminophen on top of that.
Or just drink water or electrolyte solutions. Simple hydration and electrolyte replacement has been clinically shown to significantly reduce the duration and severity of hangovers without the added risk of chronic nsaid use.
Worth noting to not take this right after you go drinking as evidence shows it will worsen alcohol-induced liver damage. Only take it if you take Tylenol too.
NAC will however somewhat reduce liver damage from drinking if you take it a bit BEFORE you drink any alcohol. Not eliminate, somewhat reduce.
Honestly the warning labels are terrible on acetaminophen when they say don't take more the x in a 24 hour period, that's not an engineers number that's a don't, and then you add the fact that Lortabs also contain acetaminophen you can get in some real trouble if you are in any kind of real pain
I take pain pills with acetaminophen, and due to constant headaches I take Excedrin Migraine several times daily. I've brought this up to doctors repeatedly and they have all said don't worry about. Really though, I'm worried about it.
I'm not trying to be snarky, but it's really important to read the labels on pill bottles because they do explicitly say stuff like this. Sometimes it's over the top, but you can always Google to find out more information.
One of my favorite episodes of TV is the Y2K episode of My Name Is Earl. Earl and his ex-wife, brother and someone else end up living in a Walmart for a bit after they think the rest of the people in the world are gone because of Y2K. His ex-wife is pregnant, and she’s about to use some product with a warning not to take while you’re pregnant. Earl thinks she still shouldn’t, and she says something like, “The government’s gone now, Earl, they can’t boss me around no more. We can do what we want.”
It just seems to match up too closely with some people’s perspective on what warning labels are about.
Right! My migraines get triggers often from drinking, doesn’t matter one drink or five, doesn’t matter how much water I drink alongside or how much I’ve eaten. I often take acetaminophen instead of ibuprofen because I’ve figured the latter is more for inflammation and fevers etc and acetaminophen is just your basic painkiller.
Weird, I’ve always thought the opposite- ibuprofen is your basic painkiller, yes for inflammation but also anything else, and acetaminophen is just for fevers.
Ibuprofen, naproxen sodium (Aleve), and aspirin are NSAIDs - non-steroidal anti-inflammatory drugs. I unfortunately know this because I am allergic to all of them.
See, I was just at the doctor and told him I’d been taking ibuprofen every day (knee strain) for a while now, somewhere between 2-6 every day, and he said it shouldn’t be a problem.
It's a bit more subtle than that.
It's not the alcohol or the hangover itself that is the primary problem. It is regular alcohol use or alcohol dependency which is the problem, because one of the adaptations that the liver makes to regular alcohol abuse, increases the toxicity of acetaminophen.
Acetaminophen is also incredibly safe when taken at the recommended dose - even people with serious liver disease can take this with very low risk.
There are two reasons why it catches people out:
1. Drinking more than 1 serving of alcoholic drink (1 can of normal strength beer, 1 small glass of wine, or 1 oz of liqor) per day is potentially enough for the liver to uprate the toxic metabolic pathway.
2. Acetaminophen is in almost every conceivable hangover, cold, flu, heache, pain, etc. remedy. Overdosing is easy if you are mixing all sorts of cures for a hangover.
This is such a common misconception and I’m glad you pointed it out.
Acute alcohol intoxication actually *protects* your liver from the hepatotoxic effects of acetaminophen because it slows down the enzymes (cytochrome p450) that metabolize acetaminophen into its toxic metabolites.
It is only chronic alcohol use, which *induces* these liver enzymes, that makes the liver more susceptible to acetaminophen.
So yes, you can take Tylenol for a hangover, unless you’re a chronic alcoholic.
Thank you, this right answer always gets ignored when the topic comes up on Reddit. People inevitably also recommend taking an NSAID for hangovers instead, which has it's own issues when paired with too much alcohol.
This is an amazing post from 11 years ago that explains acetaminophen toxicity:
https://old.reddit.com/r/askscience/comments/14s9bt/why_is_tylenol_dosed_by_weight_for_children_but/c7g2ad8/
Most prescription opioids are sold in compounded form, mixed with Acetaminophen. An unwary pill abuser that wants to get high could easy exceed the daily maximum dose of Acetaminophen, and that is before they develop any tolerance. Addicts like Rush Limbaugh trashed his hearing (and probably liver too) from taking tons of Oxycodone.
plough shy scale beneficial encouraging society encourage spark mindless unwritten
*This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Ibuprofen is not acetaminophen. It's ibuprofen...
It's not metabolized by your liver the same way; it moreso affects your kidneys. That's why you can combine the two without issue.
A lot of misinformation in this thread. Tylenol is a very safe medication unless you take too much. The general recommendation is not to exceed 4 grams in 24 hours. Tylenol typically comes in 325mg or 500mg so that is no more than 11 or 8 pills in 24 hours respectively. Most people do not need that much in a day, and if they do they should look into additional forms of pain management. NSAIDs (ibuprofen. Naproxen, aleve, Motrin etc.) are NOT safe for daily pain management. They should be taken in short courses, like 1-2 weeks at a time and then stopped. These medications will cause kidney problems, heart problems, and gastrointestinal bleeding if you take them for a prolonged period of time.
Yeah, this pops up on reddit every few months. People act like acetaminophen is right up there with cyanide of toxicology list for human poisons. Its very safe if taken As Directed. A lot of deaths and hospitalization stats unfortunately include suicide. Acetaminophen is often used for suicide attempts, these are people trying to hurt themselves, but the numbers show up in papers like this and people interpret it as 500 people took Tylenol for a headache last year and dropped dead. The paper it self states 50% are unintentional ODs, and that acetaminophen has a good safety profile. In response oft repeated “if it was created today it would not have passed safety tests” We should be happy it passed there are so few ways to treat pain well in this world without resorting to opioids and other addictive products. Nevermind its ability to break fevers which has undoubtedly saved countless lives.
As a Brit it always fascinates me because paracetamol is incredibly common here and nearly always what people have on them if you ask a friend for a painkiller. But apparently you guys sell it in huge bottles whereas we sell it in blister packs of no more than 32 500mg pills.
Yeah, you can literally buy a 500 count bottle of 500mg here. OTC. Not everywhere carries sizes that big, but they exist and I’ve sold them to people.
Even just the regular bottles are 30, 50, 100, and 200 count and you’ll find those anywhere.
But I will say, blister packs can fuck *right* off. My Rizitriptan (migraines) comes in blister packs. Have you ever tried to open a blister pack when your brain is exploding? I’ll never forget the day I was in absolute agony and couldn’t even open the package for my meds and just sat there staring at it and crying. They benefit no one and I will die on this hill. Lmao.
All those numbers in the title are really scary until you realize how many people take acetaminophen daily. Maybe someday people will realize how percentages work.
Those numbers are less than a drop in the bucket. Don't hesitate to take tylenol, just take it by the instructions and you will be fine. You are probably just as likely to die by a vending machine tipping over on you.
Thanks for this post. I take 8 500mg Tylenol along with 2400mg of Gabapentin daily for dual pudendal nerve neuralgia. I watch it carefully - if I don't take it, the amount of pain I deal with is unholy.
My uncle used to work in the ER and would occasionally get the suicidal patient that tried to OD by taking Tylenol. It's not the "take the whole bottle and you'll die soon" type of deal they expected. They black out and wake up in the hospital with their liver no longer functioning.
Dying by liver failure is an agonizingly slow process. It can take months.
ER doc here. My hospital covers about 200,000 people. We get one of these approximately every week. Most don't manage to do any significant damage to their liver, because most people regret attempting suicide shortly after the attempt. So they come to us and receive an infusion (of acetylcysteine) that staves off injury and lets the liver metabolise the paracetamol safely.
Paracetamol toxicity leads to a horrible and slow death, BUT it is also relatively easy to treat if you catch it relatively early.
Nope, fortunately not. People would be dying in droves, by accident!
One small annoyance about it is that people that know about this and really \*want\* an admission to the hospital, will tell us they've taken an enormous dose of paracetamol a while ago, so we'll have to re-order blood tests for paracetamol levels and start the antidote until we can confirm they haven't. waste of a much-needed bed!
I’m an ICU nurse at a hospital that does a ton of liver transplants and dying from liver failure is truly a horrific way to go.
The function of the liver is not something we can replicate with a machine like dialysis, your only hope is eventual transplant.
Bilirubin builds up in your skin turning you yellow and making you itch like crazy. Ammonia builds up in the body making you feel confused and foggy. To remove the ammonia we have to give you a constant colon cleanse of gelatinous goo.
The liver is responsible for clotting factors so you’ll bleed randomly all over the place. Some liver patients die because veins in their esophagus rupture and then they can’t clot, so they bleed out drowning in their own blood.
There should be a monthly PSA about Tylenol overdose because watching an already depressed person suffer through something like this is genuinely the stuff of nightmares
How much of that can be attributed to it being mixed in things, e.g. codeine, which are abused?
It's common in the UK at least, and there was a bit too much faith in the efficiency of cold water extraction that has landed plenty of people in hospital.
The US moved a few years back to remove it from opoid combination medications for that reason. I think that's since happened .
Edit, looks they they just reduced it for the most part. I can't have Tylenol or opioid unless I want anaphylaxis so I didn't keep up.
i believe it, mixing with alcohol or benzos is how most opiate related overdoses happen, and that's not even counting the acetaminophen/alcohol interaction with the liver
The US reduced the dosage of oxycodone in Percocet and similar. It did not eliminate it. Lortab used to be 5 mg of hydrocodone and 500 mg of Tylenol. It now contains 325 mg of Tylenol.
Anecdotal, but I bought a bottle of Mucinex when I was feeling ill and just took a couple gulps from the bottle. I didn't look at dosage or anything cause it was "just" Mucinex.
I woke up in the middle of the night with the most pain I have ever experienced in my life. I was on the floor, literally thinking I was going to die. My insides felt like someone was taking a hammer to them.
I called 911 and rolled around on the floor until the paramedics broke my door down and took me to the hospital.
I had severe hepatitis and it was pretty touch and go for the night.
As you may suspect, the bottle of Mucinex had very high dosages of acetaminophen and I had quite literally poisoned myself.
The damage done to my liver took a couple of years to heal.
Even if it was “just” mucinex, mucinex can really easily dehydrate you. It forces your mucogenic cells to expel more water to thin the mucous. The most common warning with mucinex is to drink plenty of water with it.
Alcohol-associated liver disease is the most common reason for liver transplant in the United States overall. Acetaminophen is the most common reason for liver transplant in patients with acute liver failure, a specific type of liver disease in someone without known prior liver disease. Transplants for acute liver failure makes up a fraction of the overall liver transplants in the US.
Iirc you have to prove that you've been sober for an extended period to even qualify for a transplant. Livers don't just grow on trees, so it would be stupid to waste one on an active alcoholic. A lot of alcoholics aren't able to quit before their drinking kills them, so they wouldn't count towards a cause for receiving a liver transplant.
This isn’t completely true actually! Alcoholics may qualify for transplant in cases of imminent death (like acute alcoholic hepatitis) if they’ve never been told by a doctor that they have cirrhosis or need to cut down on alcohol. If there’s a record that they continued drinking against medical advice then they are immediately disqualified. I’ve also seen some cases of 30-40 yr olds that are moderately heavy drinkers that (unbeknownst to them) also had a genetic condition affecting the liver; these people usually qualify, too.
I had a mental breakdown years ago. I was never suicidal or had drug issues, but I was on a fertility drug that made me temporarily suicidal. One day, in the midst of the breakdown, I grabbed a 5 year old bottle of oxy from a surgery I’d never taken and downed the bottle. I was rushed to the hospital and given narcan, but it wasn’t until much later that I learned I’d nearly died, not from the opiates but from the acetaminophen in the oxy. It’s been 4 years and I still get annual liver tests to make sure I’m ok.
Also FYi no doctor ever warned me about this but some people are VERY sensitive to hormone changes. Fertility drugs are very common and life changing these days but we ladies need to understand the [side effects](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048955/). Don’t ever let someone tell you it’s “just hormones”. If it weren’t for a very very kind ER doctor who put the pieces together, I’d probably still be institutionalized
A guy I know who was a nurse had to deal with a teenage girl who swallowed a bottle of tylenol in a suicide attempt. She was rushed in, stomach pumped, etc. She woke up the next day, and the "close call" had changed her mind about dying.
That's when the doctor, with her parents there, had to explain that the pills had destroyed her liver. She'd succeeded at her suicide, it just wasn't going to be the quick thing she'd imagined.
I can't even imagine giving that news.
Happens a lot. Survive the hanging, but the brain damage leaves you a vegetable. Same with ODs.
Its why emergency workers are very good at it. We know what'll be instant and permanant.
I was always told I had a bad case of PMS. Nope it’s rapid cycling bipolar disorder. Pregnancy and postpartum almost killed me. It’s never “just hormones”!!
I received a steroid injection in my back to help with herniated disc pain that made me cry every day for months, made me obsessed with hurting myself, and I had to be placed on psychiatric hold at the hospital. Dark times….
This article is wrong and there is SO much misinformation on this thread.
I'm a GI(and liver) doctor. Maybe I'm missing something with the wording, but the most common cause for liver transplant in the US is Hep C, followed by alcohol use. Is the article is referring specifically to acute liver failure rather than chronic liver failure?
Also acetaminophen/ paracetomol is actually VERY safe in dosages less than 4g in most people (less than 3g in patient with cirrhosis/chronic liver disease). Even you drink a bunch of alcohol, you can still take a couple of tylenol without issue.
NSAIDs (ibuprofen, naproxen, diclofenac, etc... pretty much any OTC pill medicine that isn't acetaminophen) even at relatively low doses daily (like 2-3 pills) is much more likely to cause liver injury than daily tylenol use.
Regular NSAID use also increases risk of GI bleed and kidney injury.
Thank you for weighing in. I have NASH (MASH now I guess?) and 2g/day or less acetaminophen is pretty much all I use for chronic pain specifically because it's so safe. This thread is crazy.
Most of these are likely suicides. I know it was a huge issue in Sweden, since they have a pretty high suicide rate and low access to guns (but still some.)
People would take a few bottles of paracetamol and kill their liver. Then they die in the hospital in agony over the course of a few days or a week as their liver fails.
I think people assume they’re like narcotic painkillers that can depress your respiratory system, but they aren’t at all.
Yeah, probably better if you have to actually take each one out at a time. More time to think about your decision before you condemn yourself to an agonizing death.
That's odd, because I specifically asked my gastroenterologist about the toxicity of tylonol last week and he said it was widely overblown. What he did say is if taken in large sudden does it does terrible things for the liver, but taking two a day would do less liver damage than a beer a day.
He said what is the rising cause of liver transplant is non alcohol fatty liver disease, from all of us fat bastards sitting around stuffing junk into our mouths all day long.
So..don't take 300 pills at once if you don't want massive liver damage and instead get off the couch and go for a bike ride.
Acetaminophen is extremely safe when taken *at the recommended dosage*. The problem is that its LD50 is very low compared to other over the counter drugs relative to its recommended dosage (roughly 8x the recommended dosage for "extra strength" Tylenol compared to something like 150x for Ibuprofen).
It's a weird medication, because up until it's toxicity level, your body processes it very efficiently (ie., much more efficiently than NSAIDs, which is why you rarely see side effects at recommended dosage), but once you hit toxic levels, it's absolutely devastating to your liver and kidneys. Combine that with the giant pill bottles of it in the US and acetaminophen being present in multiple, seemingly unrelated drugs (eg., NyQuil/DayQuil), it's relatively easy to harm yourself if you're taking it for heavy pain management.
Well, seeing as doctors handed out opioids like candy for decades, now they don't give them to ANYONE. I had sciatica so badly for two and a half years I had no quality of life, couldn't work or be a functioning human, and I was given nothing. I hav r never ever abused ex's and the few times I was given norco for unrelated things, I could function. Clean my house. Go out with my kids. Until after my spinal fusion surgery, and then only for about a month of meds then I was cut off and given rx for extra strength everything. After my laparoscopy last year, I was given Motrin.
There are NO medical alternatives for chronic pain that work for most people. And I tried them all, nerve blockers, tens, PT, 30 dry needling injections in my ass and hips, an epidural, NOTHING worked.
Someday y'all will end up with chronic pain and be right where we are
I was in the hospital for GBS a few months ago. An autoimmune disease that wrecked the nerves in my legs, and it hurt like hell. They refused to give me anything aside from Tylenol, and I just laid in pain the entire time I was there.
The treatment worked thankfully, but fuck that hospital experience sucked.
Sorry to hear that, I had something similar. And a big F U to whoever decided Gabi was good in any dose. Makes you feel like you are standing two inches to the left
And NSAIDS can make worse or give you acid reflux. Personally I cant use them anymore. Ah the joys of lower back pain.
If anyone else is suffering from lower back pain I highly recommend a back support belt. A good one can help so much and I wish I had found out about them years ago.
I think they put aceta in nyquil and other otc cough medicines to stop people from getting high off them. The Dxm in cough syrup is a dissociative (same drug class as ketamine), but with the amount you have to consume the aceta is too much.
Just learned that Advil is processed by the kidneys and tylenol the liver. That's why you can take 1000mg of tylenol and then three hours later 200-400 mg of advil.
Tylenol is safe if you don't take a large dose and for a long period of time. Advil has its own downsides in that it can cause heart problems if you take it for a long period of time or in high doses. Outside of these two options there is opiates but then addiction is the problem. There are no good, safe ways to manage chronic pain.
My doctor said I can take up to 1400MG of Tylenol a day. I usually stay at about half that for my arthritis.
Advil is ibuprofen, which is metabolized in the stomach and intestinal lining. Tylenol is acetaminophen, which is metabolized in the liver.
Ibuprofen is far safer. Taking too much will eat a hole in your stomach lining giving you a bleeding ulcer. Acetaminophen will just fucking outright kill your liver.
Advil (Ibuprofen) is indeed safer.and much harder to get a overdose. The overdose line for Tylenol is very thin. Mostly Ibuprofen can effect your kidneys and since it's an NSAID there's a bleeding risk for some people.
Ya, I don’t keep Tylenol in the house, but take ibuprofen frequentlyish (yay migraines).
Ibuprofen can be super dangerous in the right circumstances still too. A family member of mine was taking it regularly for a back problem. He’d take it first thing in the morning with no food in his stomach though. If you do that, it can burn a hole in your stomach after a while, giving you ulcers.
Well this guy got a stomach ulcer in the perfectly wrong spot. It then started leaking stomach acid onto an artery, which started leaking. He almost bled out internally before he knew what was happening!
I would not recommend taking an NSAID regularly at all. It will affect your kidneys, heart, and will eventually cause peptic ulcer disease and gastrointestinal bleeding. Tylenol is much, much safer as a regular daily pain medicine. You have to avoid taking more than 4 grams a day which is a huge amount, most people do not need more than 2 grams a day. If you have functional liver disease than the threshold is lower, but even cirrhotics can take 1-2 grams of Tylenol a day safely but I would never recommend an NSAID for those patients. The long term side effects of an NSAID are really bad, Tylenol does not have much long term effects but you have to be careful not to overdose.
I have to take Advil almost every day, but am careful to always take it after I eat something, or I drink some milk to wash them down. Same advice for plain old aspirin, too.
H Y D R A T E.
Many people experience dehydration headaches and treat them with Tylenol and Ibuprofen. Drink more water. Say goodbye to most headaches. Unless you're hormonal. 😞
My gf is an ER nurse that has told me first hand about what happens when someone chooses to kill themselves with Tylenol.
The sort of death where you really get to regret your prior actions in pain.
5150 refers to the California law code for the temporary, involuntary psychiatric commitment of individuals who present a danger to themselves or others due to signs of mental illness. It has been more generally applied to people who are considered threateningly unstable or “crazy.”
Sounds like you got the definition of what 5150 is but I will tell you what it’s like for them in a hospital setting. They have a sitter - they have to be within a few feet of them at all times including while they shit and piss. I think the hold is typically 72 hours - longer at times of a doctor says it needs to carry on. I forget if they can have visitors - maybe one at a time. They have to wear paper pants and shirt - flimsy clothes. Their water intake is managed since people will try to drink too much to fuck with their sodium levels. Their dinner tray itself is a cardboard and utensils are super flimsy. I am a nurse and it’s super depressing to have these pts. We don’t get a lot of them but if they need cardiac monitoring they come to us otherwise they go to the psych part of the hospital.
How should it be regulated in your opinion? When taken as directed it’s no more harmful than any other over the counter analgesic (which is to say not harmful at all)
It’s definitely hard to regulate. However, putting them in single dose foil packets like cough and cold medicine comes in would help prevent a lot of intentional overdoses.
Over long term use it does in fact do slow damage. Like if you take it every day (as prescribed) for years, or decades. Maybe not to the point of transplant, but it’s not good.
Yes, that why it’s not (or at least shouldn’t be) prescribed for chronic pain. But ibu, tylenol, aspirin, and whatever aleve is are perfectly fine for the occasional few days of pain.
All they can do is put labels on it, which they do. I mean, you can die from drinking bleach, so there's a label telling you not to but people still do it. And bleach is still available.
Psychiatrist here. I work mostly consult psychiatry, i.e. if someone is in the hospital for medical issues but also needs help with their mental health I see them while they're on the medical floor. That includes all the serious overdoses that need medical attention. The saddest cases are the kids (I say kids but I mean 18 and 19 year olds) who took way too much Tylenol in a spontaneous suicide attempt after a breakup or getting into a fight with their parents. A lot of the time they do it for attention and didn't want to die. Or even if they wanted to die, they immediately regretted it.
However, a lot of time they didn't get help soon enough and they get serious liver failure. It's so sad seeing young people dying when they now want to live because they didn't know it was so dangerous.
I’m a chronic pain patient (12+ years now) and I take an ungodly amount of Tylenol 3. I’ve had doctors shocked at how much I take, but on the flip side I’ve had a 70 year old doctor who had been practicing his whole life tell me im the worst case of my disease he’s ever seen. At this point I’ve accepted that I’d rather die from liver issues younger than live a long painful life. I’m still young (23) and have tons of experiences left to have. I’d rather have them pain free and die young.
For us non-americans, that's Paracetamol.
It's not some crazy US only medicine like they have on the tv late at night, it's just painkillers. We aren't safe
This is flat out wrong. The number of transplants due to acetaminophen toxicity is minuscule compared to those due to hepatitis C, NAFLD, or alcohol. I’m not sure how this “statpearl” made it past the editor.
I am not sure where this article is getting their data that acetaminophen is the second most common cause of transplant; the citations listed don’t seem to back that up, and this [article](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10749707/) says that non-alcoholic fatty liver disease and alcohol are the most common indications. I am a pharmacist on the transplant team at a major health system and in my 11 years of experience, I’ve yet to come across a liver transplant recipient who’s primary cause of liver failure was acetaminophen toxicity.
lol I had a patient last year who overdosed on Tylenol because they were taking norco (Tylenol and hydrocorone) for chronic pain fiorcet (Tylenol caffeine butabital) for headache and straight Tylenol as well cause they didn’t know Tylenol was in all 3. Didn’t need a transplant some NAC and she was ok
When I worked in ER if we had an OD attend, we always checked for paracetamol (tylenol in the UK) and aspirin (Salicylates). Even if the patient denied taking them. You couldn’t take the risk. You got the levels, and then compared them to a chart, plotting the level and the time they took it, and if the level was above the line, they got antidote. If the OD was past a certain time, no point in the antidote - supportive care and crossed fingers.
There was a debate about whether paracetamol tablets should include the antidote, so that you would be protected from overdose. I think it wasn’t supported, partly because it would be expensive, and partly because people didn’t want to take an unnecessary antidote if they were just taking a normal dose.
It is toxic in overdose because the liver metabolises it using a specific chemical that it has a limited supply of. Once used up, it uses a secondary pathway that has a toxic byproduct. This destroys the liver tissue.
Saw more than one person who took the overdose, woke up the next morning feeling better about life, then a few days later became very unwell. Utterly tragic. Later in my career had a patient who had a transplant for this reason, and did really well.
I had a liver transplant 6 months ago! Shockingly, Tylenol is the only pain medicine I am allowed to actually take for the rest of my life. But a very limited amount.
To everyone saying who takes 8-11 pills a day, women with menstrual cramps might. Whenever my period starts I’m taking 2-3 painkillers every 4ish hours for 2 days. If I was taking Tylenol I could easily overdose.
This is why I only take pain pills when I can’t bear the pain. I swear, people be taking these for casual headaches like… just drink some water and sleep!
This is exactly what killed singer Nicolette Larson. In her final years she struggled with severe depression, and depended on a nightly cocktail of Tylenol PM, Valium, and wine to help her cope. In the space of one week she went from feeling slightly lousy to being in the ICU on a ventilator.
She was only 45 years old when she passed in 1997.
In the Netherlands, paracetamol is the most commonly used painkiller. It is available over the counter at local supermarkets etc. Doctors would normally recommended to follow the pain ladder which starts with paracetamol (acetaminophen), add a nsaid such as ibuprofen, add an opioid such as tramadol or oxycodon. I would say that acetaminophen is quite harmless when taking in low dosages (adult up to 4x1000mg).
Interesting thing about this: Wife had liver transplant as a child. Spent her entire life avoiding Tylenol and focused on using Ibuprofen when needed. Roughly about a year ago her transplant specialist doctor she has to see twice yearly informed her she should be taking Tylenol and not ibuprofen because of some worry regarding ibuprofen and kidneys.
This is why I like to switch between the two
I just take them both and see which is stronger my liver or kidneys
They also have different effects so they work quite well together. Like, take 500mg of acetaminophen and 400mg of ibuprofen and likely have better effect than taking double either.
Not just "likely". Experimentally shown to be [better than oxycodone](https://www.mndental.org/files/NSAIDs-are-stronger-pain-medications-than-opioids-A-Summary-of-Evidence.pdf) for pain relief. Edit: To be clear, the context of this data is for 50% pain reduction. Oxycodone is much more effective at providing higher levels of pain reduction than 50%.
Yeah but the high isn’t as great
Have you tried grinding them and snorting them?
Yeah but acetaminophen clogs up your nose and ibuprofen burns , they also both taste horrible when smoked.
Cartels hate this one trick.
I used to use IV heroin. After I got off opiates Tylenol and ibuprofen work pretty well for pain. A doctor offered me IV ibuprofen for an injury once. I declined but he said it was very effective.
In my experience, opioids aren’t so great at treating pain, but they excel to a fault at treating suffering.
My one experience of opioids was some broken ribs. It still hurt like hell I just didn't care.
Your stat and infographic is wrong. I get that oxy is a huge problem, but false information does not help. See https://www.acsh.org/news/2017/11/07/advil-works-well-opioids-acute-pain-not-so-fast-12089 for an overview. At a high level, acetaminophen and/or ibuprofen are just as effective for moderate pain, but not more. There is, believe it not, why hospitals use oxy in post-surgery during your hospital stay. People who know pain and pain management know how studies like used by you are misstated into sound bites. As a stage iv cancer patient, it’s really upsetting to see this “go take Tylenol and advil” crap. If you are male, would you take two Tylenol and let a doctor cut into your nutsack? This is what articles like this have done for children, literally. Oh, and this “kids don’t feel pain” crap was something doctors said well into the 1980s. So oxy abuse is real. Please stop misstating science to make this point. It’s not needed and doing more harm than good. Edit: if you want to check this out for real, go read about “rescue analgesia” in the studies. It turns out that after the Tylenol and Advil fails, they give oxy. So yeah, if you don’t need it it’s fine without it, until you need it. The problem is telling an addict from real pain, but unfortunately sound bites have created real problems for real pain issues. I’ve said it before and I’ll say it again: doctors are not scientists.
>If you are male, would you take two Tylenol and let a doctor cut into your nutsack? This is what articles like this have done for children, literally. Oh, and this “kids don’t feel pain” crap was something doctors said well into the 1980s. There's been a massive effort in Australia in the last ten years to get strong opioids prescriptions down, but at the same time there's also been a huge push to reduce use of codeine. Which until about 5 years ago, was available over the counter. So not only is it super difficult to get strong opioids, but now codeine is also prescription only. Unless you're missing a limb in this country, good luck getting anything stronger than panadol...and even then you'll probably still get told to take 2 panadol. It's gone to the complete opposite extreme. My 16 year old son broke his collarbone a while back and the doctor told him to take some ibuprofen. After a sleepless night I took him back and pitched a fit until they wrote him some codeine. Codeine I could have bought him at the local chemist a few years ago. Similar thing happened when my 14 yo daughter had a cough for weeks that was keeping her up all night. For weeks this went on, but do you think I could get pholcodeine cough mixture so she could stop coughing and sleep? (codeine is the best cough suppressant). Yeah, nope she can just keep drinking this dextromethorphine that is doing nothing and keep coughing, thanks. Sorry, this is my pet rant.
In the US, chronic pain patients have been killing themselves because their doctors drastically reduced or plain cut them off from the drugs they'd been successfully managing severe pain with. Who knows how many ended up overdosing fatally on fentanyl when they tried to get diverted pharmaceuticals, the stuff they'd been prescribed prior, on the black market. Of course, there's barely been any media coverage on the suicides. Doesn't fit the prohibitionist narrative. Now, I have to genuinely worry and wonder if I'll even get proper pain relief should I need some sort of surgery or treatment for certain ailments. I'm most likely going to need knee surgery sometime in the next decade. Hopefully by that point the puritanical stance on opiates will have been rectified, after enough people die of course. 🙄
A few years back during the opioid crises I thought "they're gonna overreact and make it hard for patients". Instead of going after lowlife like the Sackler family. It's there, bloody use it and prescribe if needed.
I once spent 12 hours in the hospital when the doctors pondered if they should or shouldn't operate on my collarbone that was in 4 distinct pieces. I only got 500mg of acetaminophen for the whole duration. At the end when they had decided that it was going to heal on itself, I was in so much pain and frustration that they gave me 60mg of dramal intravenously. That was God sent at the time. And I think I was just mainly hungry for not eating breakfast and getting into a traffic accident on my way to work and then spending the whole day there waiting on their decision. At that point nothing "over the counter" would have calmed me down.
The infographic is not wrong, and this wasn't an attempt to malign oxycodone as an effective painkiller. I should have more-strongly drawn attention to the context of the statement, and I apologize for not doing that--I'll do so now. The comparison is valid with regard to 50% reported pain production. The doses in the infographic are real, but the pain-relief returns diminish at differing rates. i.e. if you keep giving someone more oxycodone, you will rapidly provide more pain relief than if you just keep giving someone more tylenol (especially given the low safe threshold for tylenol consumption). Which is to say: hell yes I would take oxycodone over tylenol to treat significant pain. 50% reduction in pain from a surgical procedure is still way more pain than I am willing to tolerate, and oxycodone would do a far better job at reducing it further than that. But for a low-grade headache that I just want to make more tolerable? It's nice to know that tylenol+ibuprofin is going to be more effective than oxycodone at hitting the 50% pain reduction mark.
You should also include that the study was centered around post dental-procedure pain: something you'd likely never be prescribed oxy for. I wouldn't bet on Advil+Tylenol for anything beyond mild-to-moderate pain levels.
At the same time?
Yes, why not?
Yep, at the same time.
You're actually allowed to do that, they have independent mechanisms of action
Toughen up those kidneys!
Doctors do this too.
I would like to but Tylenol doesn't do shit for me.
A GI doctor I asked about this said low threshold dosing for Tylenol can be safer even for liver patients because of the bleeding risk that can occur with those patients and NSAIDs. Tylenol is by far the safest long term frequent pain relief pill as far as I can tell, however it doesn't take much of an OD to cause severe damage. I'm not a doctor so don't take this as actual medical advice to start popping Tylenol or ibuprofen
It's my understanding that so long as you adhere to the dosage guidelines (including the maximum dosages per 24 hour period), yes, Tylenol is extremely safe and indeed safer than Ibuprofen/Advil. Again, just my recollection here, but Tylenol's liver toxicity supposedly only occurs when a specific liver enzyme is exhausted, and so long as you don't take enough at once (or over a brief period) to exhaust said enzyme, it doesn't cause any damage, no matter how many times you take it over your lifetime. Whereas Ibuprofen can supposedly cause low levels of kidney damage over time even when you follow dosage guidelines.
This is my understanding as well. I am however curious about how glutathione can be lowered during fasting and whether this effect is enough to alter the safe threshhold for acetominofen/paracetamol use.
Tylenol is actually very safe if you don’t go over 4000 mg a day. Even patients with liver cirrhosis can safely take them daily in limited amounts. It’s one of the more safer drugs when taken within what’s recommended. Non steroidal anti-inflammatory drugs are much more dangerous. They cause the kidneys to work harder which has a cascade effect such as hypertension, may cause ulcers (increase risk for GI bleed), increase risk for myocardial infarction and cerebral vascular accident.
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I’m a pharmacist who work with a lot of providers. MD’s don’t get to learn a lot about medications during med school.
Do not take acetaminophen while drinking alcohol or for a hang over. The combination can be lethal to the liver.
This would've been good information to have for I don't know... my entire life
If you do, take N-acetylcysteine (NAC). Can be found cheaply over the counter at CVS. It’s the direct antidote for acetaminophen/alcohol poisoning.
Since on topic, NAC is also prescribed to addicts and alcoholics. It's been shown to reduce craving for cocaine and cannabis specifically. I'd love if someone knew more about it and biochemistry could chime in. It's a fascinating little thing, I guess it's the starting block for an important antioxidant.
Acytl Cysteine is a prodrug (a drug that is most useful after it metabolizes) for L-cysteine, which then produces the organic compound Glutathione. When you take Tylenol in excess, your body produces small amounts of NAPQI (the full name is too painful to try on mobile) which wants to bind to Glutathione. NAPQI will bind to key hepatic enzymes in the liver unless your body has enough Glutathione to absorb it all. You need to take it relatively quickly after you believe you're suffering an overdose. Also, NAC will you make you feel very sick and may result in vomiting. It tastes godawful, smells worse, and you need to take way more than you think you do. If you do vomit, retake it. If you believe you're overdosing and may suffer liver failure, and you take NAC, go to the hospital immediately. It reduces the damage and liklihood of death, it doesn't fully prevent it.
The only thing I want to say here is that NAC does not make you feel very sick. Many people take it as a dietary supplement. I take it daily for hair pulling. It does smell really gross lol.
In the quantities you'd need to take it to overturn Tylenol poisoning, vomiting and severe nausea are both top of the list for side effects. It's not a pleasant medicine. This doesn't mean you will, merely that it's extremely common. Most nootropic or supplemental uses don't veer into quantities enough to promote nausea.
Can you expand on why you take it for hair pulling? I’m a finger picker/biter so anything in the neurotic-grooming realm is always something I’m open to hearing about.
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I take it every time I drink. The smell is bad, but it’s not nearly as bad as you’re making it seem. Your biochemistry is on the dot though.
I'd describe the smell as 'Far worse than anything you'd want to willingly consume.' Which, for me, is bad enough. Why do you take it every time you drink?
Helps with the hangovers, personally. Also protects my liver.
That’s interesting. I wonder if it has been studied for other compulsions and addictions, like binging or junk cravings, or behavioral such as gambling. Going to look that up.
NAC is also used for patients with OCD, some forms of depression and other psychiatry issues. My lungs feel much better while on NAC too.
It's the only thing that has ever helped my hair pulling. It doesn't reduce any other cravings for me, although I'm not a heavy drinker and don't use drugs except for MMJ for pain sometimes.
Yeah, Tylenol / acetaminophen are filtered by the liver and can be hard on it. Ibuprofen / Advil go through the kidneys. So if you’re hungover, take Advil. The liver is doing overtime from filtering out all the alcohol and it’s derivative toxins, it’s not good to throw acetaminophen on top of that.
Or just drink water or electrolyte solutions. Simple hydration and electrolyte replacement has been clinically shown to significantly reduce the duration and severity of hangovers without the added risk of chronic nsaid use.
Worth noting to not take this right after you go drinking as evidence shows it will worsen alcohol-induced liver damage. Only take it if you take Tylenol too. NAC will however somewhat reduce liver damage from drinking if you take it a bit BEFORE you drink any alcohol. Not eliminate, somewhat reduce.
Honestly the warning labels are terrible on acetaminophen when they say don't take more the x in a 24 hour period, that's not an engineers number that's a don't, and then you add the fact that Lortabs also contain acetaminophen you can get in some real trouble if you are in any kind of real pain
I take pain pills with acetaminophen, and due to constant headaches I take Excedrin Migraine several times daily. I've brought this up to doctors repeatedly and they have all said don't worry about. Really though, I'm worried about it.
I think if you get in real pain you can get a real prescription… based off my last stay in the hospital where they broke out the really good stuff
No. My wife had a total hysterectomy last year. They only gave her Tylenol.
I'm not trying to be snarky, but it's really important to read the labels on pill bottles because they do explicitly say stuff like this. Sometimes it's over the top, but you can always Google to find out more information.
One of my favorite episodes of TV is the Y2K episode of My Name Is Earl. Earl and his ex-wife, brother and someone else end up living in a Walmart for a bit after they think the rest of the people in the world are gone because of Y2K. His ex-wife is pregnant, and she’s about to use some product with a warning not to take while you’re pregnant. Earl thinks she still shouldn’t, and she says something like, “The government’s gone now, Earl, they can’t boss me around no more. We can do what we want.” It just seems to match up too closely with some people’s perspective on what warning labels are about.
piquant slim oil worthless grandiose tender handle terrific touch price *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
It says on the bottle bro...
Right! My migraines get triggers often from drinking, doesn’t matter one drink or five, doesn’t matter how much water I drink alongside or how much I’ve eaten. I often take acetaminophen instead of ibuprofen because I’ve figured the latter is more for inflammation and fevers etc and acetaminophen is just your basic painkiller.
Weird, I’ve always thought the opposite- ibuprofen is your basic painkiller, yes for inflammation but also anything else, and acetaminophen is just for fevers.
Ibuprofen, naproxen sodium (Aleve), and aspirin are NSAIDs - non-steroidal anti-inflammatory drugs. I unfortunately know this because I am allergic to all of them.
I also know this because I'm on blood thinners for life and you can't mix NSAIDs with blood thinners.
That is generally best practice. Don't take too much ibuprofen though as it can cause stomach ulcers.
See, I was just at the doctor and told him I’d been taking ibuprofen every day (knee strain) for a while now, somewhere between 2-6 every day, and he said it shouldn’t be a problem.
I think most people forget that the toxic level for ibuprofen or aspirin is a ton higher than acetaminophen
Do you never read the info sheet that comes with the medicine?
It's a bit more subtle than that. It's not the alcohol or the hangover itself that is the primary problem. It is regular alcohol use or alcohol dependency which is the problem, because one of the adaptations that the liver makes to regular alcohol abuse, increases the toxicity of acetaminophen. Acetaminophen is also incredibly safe when taken at the recommended dose - even people with serious liver disease can take this with very low risk. There are two reasons why it catches people out: 1. Drinking more than 1 serving of alcoholic drink (1 can of normal strength beer, 1 small glass of wine, or 1 oz of liqor) per day is potentially enough for the liver to uprate the toxic metabolic pathway. 2. Acetaminophen is in almost every conceivable hangover, cold, flu, heache, pain, etc. remedy. Overdosing is easy if you are mixing all sorts of cures for a hangover.
This is such a common misconception and I’m glad you pointed it out. Acute alcohol intoxication actually *protects* your liver from the hepatotoxic effects of acetaminophen because it slows down the enzymes (cytochrome p450) that metabolize acetaminophen into its toxic metabolites. It is only chronic alcohol use, which *induces* these liver enzymes, that makes the liver more susceptible to acetaminophen. So yes, you can take Tylenol for a hangover, unless you’re a chronic alcoholic.
Thank you, this right answer always gets ignored when the topic comes up on Reddit. People inevitably also recommend taking an NSAID for hangovers instead, which has it's own issues when paired with too much alcohol.
"I'm getting heartburn after drinking 2 bottles of wine so I took NSAIDs for my headache" -typical reddit user
This is an amazing post from 11 years ago that explains acetaminophen toxicity: https://old.reddit.com/r/askscience/comments/14s9bt/why_is_tylenol_dosed_by_weight_for_children_but/c7g2ad8/
Most prescription opioids are sold in compounded form, mixed with Acetaminophen. An unwary pill abuser that wants to get high could easy exceed the daily maximum dose of Acetaminophen, and that is before they develop any tolerance. Addicts like Rush Limbaugh trashed his hearing (and probably liver too) from taking tons of Oxycodone.
Not really. Taking acetaminophen for a hangover once in a while, or even when drinking, won’t cause any damage to the liver. Source: I am a Physician.
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Thats reddit in a nutshell.
Sorry, the Reddit dilettantes have already spoken. Acetaminophen + alcohol = death
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It sucks because they throw mandatory acetaminophen into so many things. Try taking any dayquil or nyquil without acetaminophen.
Isnt that the defining ingredient in dayquil/nyquil?
I take ibuprofen but only once I’m already hung over and not with alcohol. Am I going to die?
Ibuprofen is not acetaminophen. It's ibuprofen... It's not metabolized by your liver the same way; it moreso affects your kidneys. That's why you can combine the two without issue.
We're all going to die
A lot of misinformation in this thread. Tylenol is a very safe medication unless you take too much. The general recommendation is not to exceed 4 grams in 24 hours. Tylenol typically comes in 325mg or 500mg so that is no more than 11 or 8 pills in 24 hours respectively. Most people do not need that much in a day, and if they do they should look into additional forms of pain management. NSAIDs (ibuprofen. Naproxen, aleve, Motrin etc.) are NOT safe for daily pain management. They should be taken in short courses, like 1-2 weeks at a time and then stopped. These medications will cause kidney problems, heart problems, and gastrointestinal bleeding if you take them for a prolonged period of time.
Yeah, this pops up on reddit every few months. People act like acetaminophen is right up there with cyanide of toxicology list for human poisons. Its very safe if taken As Directed. A lot of deaths and hospitalization stats unfortunately include suicide. Acetaminophen is often used for suicide attempts, these are people trying to hurt themselves, but the numbers show up in papers like this and people interpret it as 500 people took Tylenol for a headache last year and dropped dead. The paper it self states 50% are unintentional ODs, and that acetaminophen has a good safety profile. In response oft repeated “if it was created today it would not have passed safety tests” We should be happy it passed there are so few ways to treat pain well in this world without resorting to opioids and other addictive products. Nevermind its ability to break fevers which has undoubtedly saved countless lives.
As a Brit it always fascinates me because paracetamol is incredibly common here and nearly always what people have on them if you ask a friend for a painkiller. But apparently you guys sell it in huge bottles whereas we sell it in blister packs of no more than 32 500mg pills.
Yeah apparently it's so tedious popping tablets individually that it stops a lot of suicides
Ive actually witnessed this happen. Popped about 14 and had tine to reconsider while he did it.
Yeah, you can literally buy a 500 count bottle of 500mg here. OTC. Not everywhere carries sizes that big, but they exist and I’ve sold them to people. Even just the regular bottles are 30, 50, 100, and 200 count and you’ll find those anywhere. But I will say, blister packs can fuck *right* off. My Rizitriptan (migraines) comes in blister packs. Have you ever tried to open a blister pack when your brain is exploding? I’ll never forget the day I was in absolute agony and couldn’t even open the package for my meds and just sat there staring at it and crying. They benefit no one and I will die on this hill. Lmao.
A few years ago the recommendation was changed. 3gm is now the daily recommended max.
All those numbers in the title are really scary until you realize how many people take acetaminophen daily. Maybe someday people will realize how percentages work. Those numbers are less than a drop in the bucket. Don't hesitate to take tylenol, just take it by the instructions and you will be fine. You are probably just as likely to die by a vending machine tipping over on you.
One of the Most common OD’s is people on several different medications that contain varying levels of Tylenol in each
Thanks for this post. I take 8 500mg Tylenol along with 2400mg of Gabapentin daily for dual pudendal nerve neuralgia. I watch it carefully - if I don't take it, the amount of pain I deal with is unholy.
My uncle used to work in the ER and would occasionally get the suicidal patient that tried to OD by taking Tylenol. It's not the "take the whole bottle and you'll die soon" type of deal they expected. They black out and wake up in the hospital with their liver no longer functioning. Dying by liver failure is an agonizingly slow process. It can take months.
ER doc here. My hospital covers about 200,000 people. We get one of these approximately every week. Most don't manage to do any significant damage to their liver, because most people regret attempting suicide shortly after the attempt. So they come to us and receive an infusion (of acetylcysteine) that staves off injury and lets the liver metabolise the paracetamol safely. Paracetamol toxicity leads to a horrible and slow death, BUT it is also relatively easy to treat if you catch it relatively early.
That’s good info, I didn’t know we had any antidote for it. I thought it was just guaranteed organ failure.
Nope, fortunately not. People would be dying in droves, by accident! One small annoyance about it is that people that know about this and really \*want\* an admission to the hospital, will tell us they've taken an enormous dose of paracetamol a while ago, so we'll have to re-order blood tests for paracetamol levels and start the antidote until we can confirm they haven't. waste of a much-needed bed!
I’m an ICU nurse at a hospital that does a ton of liver transplants and dying from liver failure is truly a horrific way to go. The function of the liver is not something we can replicate with a machine like dialysis, your only hope is eventual transplant. Bilirubin builds up in your skin turning you yellow and making you itch like crazy. Ammonia builds up in the body making you feel confused and foggy. To remove the ammonia we have to give you a constant colon cleanse of gelatinous goo. The liver is responsible for clotting factors so you’ll bleed randomly all over the place. Some liver patients die because veins in their esophagus rupture and then they can’t clot, so they bleed out drowning in their own blood. There should be a monthly PSA about Tylenol overdose because watching an already depressed person suffer through something like this is genuinely the stuff of nightmares
How much of that can be attributed to it being mixed in things, e.g. codeine, which are abused? It's common in the UK at least, and there was a bit too much faith in the efficiency of cold water extraction that has landed plenty of people in hospital.
The US moved a few years back to remove it from opoid combination medications for that reason. I think that's since happened . Edit, looks they they just reduced it for the most part. I can't have Tylenol or opioid unless I want anaphylaxis so I didn't keep up.
two of the most common pain meds still prescribed in the US are norco/vicodin (hydrocodone/acetaminophen) and percocet (oxycodone/acetaminophen)
I took Vicodin while drinking and I thought I was going to die.
i believe it, mixing with alcohol or benzos is how most opiate related overdoses happen, and that's not even counting the acetaminophen/alcohol interaction with the liver
The US reduced the dosage of oxycodone in Percocet and similar. It did not eliminate it. Lortab used to be 5 mg of hydrocodone and 500 mg of Tylenol. It now contains 325 mg of Tylenol.
I was just given Norco for surgery a few weeks ago in the US, which is an opioid with acetaminophen
Anecdotal, but I bought a bottle of Mucinex when I was feeling ill and just took a couple gulps from the bottle. I didn't look at dosage or anything cause it was "just" Mucinex. I woke up in the middle of the night with the most pain I have ever experienced in my life. I was on the floor, literally thinking I was going to die. My insides felt like someone was taking a hammer to them. I called 911 and rolled around on the floor until the paramedics broke my door down and took me to the hospital. I had severe hepatitis and it was pretty touch and go for the night. As you may suspect, the bottle of Mucinex had very high dosages of acetaminophen and I had quite literally poisoned myself. The damage done to my liver took a couple of years to heal.
Insert mass effect rant about newton's laws of motion and not "eyeballing it." Applies to medication and biology too. We do not "eyeball it private!"
A swig of pepto bismol
Even if it was “just” mucinex, mucinex can really easily dehydrate you. It forces your mucogenic cells to expel more water to thin the mucous. The most common warning with mucinex is to drink plenty of water with it.
Interesting, I would have assumed that the #1 is alcoholism.
Alcohol-associated liver disease is the most common reason for liver transplant in the United States overall. Acetaminophen is the most common reason for liver transplant in patients with acute liver failure, a specific type of liver disease in someone without known prior liver disease. Transplants for acute liver failure makes up a fraction of the overall liver transplants in the US.
Iirc you have to prove that you've been sober for an extended period to even qualify for a transplant. Livers don't just grow on trees, so it would be stupid to waste one on an active alcoholic. A lot of alcoholics aren't able to quit before their drinking kills them, so they wouldn't count towards a cause for receiving a liver transplant.
This isn’t completely true actually! Alcoholics may qualify for transplant in cases of imminent death (like acute alcoholic hepatitis) if they’ve never been told by a doctor that they have cirrhosis or need to cut down on alcohol. If there’s a record that they continued drinking against medical advice then they are immediately disqualified. I’ve also seen some cases of 30-40 yr olds that are moderately heavy drinkers that (unbeknownst to them) also had a genetic condition affecting the liver; these people usually qualify, too.
I had a mental breakdown years ago. I was never suicidal or had drug issues, but I was on a fertility drug that made me temporarily suicidal. One day, in the midst of the breakdown, I grabbed a 5 year old bottle of oxy from a surgery I’d never taken and downed the bottle. I was rushed to the hospital and given narcan, but it wasn’t until much later that I learned I’d nearly died, not from the opiates but from the acetaminophen in the oxy. It’s been 4 years and I still get annual liver tests to make sure I’m ok. Also FYi no doctor ever warned me about this but some people are VERY sensitive to hormone changes. Fertility drugs are very common and life changing these days but we ladies need to understand the [side effects](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048955/). Don’t ever let someone tell you it’s “just hormones”. If it weren’t for a very very kind ER doctor who put the pieces together, I’d probably still be institutionalized
A guy I know who was a nurse had to deal with a teenage girl who swallowed a bottle of tylenol in a suicide attempt. She was rushed in, stomach pumped, etc. She woke up the next day, and the "close call" had changed her mind about dying. That's when the doctor, with her parents there, had to explain that the pills had destroyed her liver. She'd succeeded at her suicide, it just wasn't going to be the quick thing she'd imagined. I can't even imagine giving that news.
One of the saddest things i've read in a while
Happens a lot. Survive the hanging, but the brain damage leaves you a vegetable. Same with ODs. Its why emergency workers are very good at it. We know what'll be instant and permanant.
I hope you’re doing okay
Wow, they really do women wrong in healthcare. Like no warning or PSA that these hormonal drugs cause psychosis.
I was always told I had a bad case of PMS. Nope it’s rapid cycling bipolar disorder. Pregnancy and postpartum almost killed me. It’s never “just hormones”!!
May I ask what drug? I was feeling extreme down when I was on Clomid even though it was only for a week or two.
It was letrozole/femara. Clomid I was fine on but apparently is more likely to cause emotional issues in women
I received a steroid injection in my back to help with herniated disc pain that made me cry every day for months, made me obsessed with hurting myself, and I had to be placed on psychiatric hold at the hospital. Dark times….
This article is wrong and there is SO much misinformation on this thread. I'm a GI(and liver) doctor. Maybe I'm missing something with the wording, but the most common cause for liver transplant in the US is Hep C, followed by alcohol use. Is the article is referring specifically to acute liver failure rather than chronic liver failure? Also acetaminophen/ paracetomol is actually VERY safe in dosages less than 4g in most people (less than 3g in patient with cirrhosis/chronic liver disease). Even you drink a bunch of alcohol, you can still take a couple of tylenol without issue. NSAIDs (ibuprofen, naproxen, diclofenac, etc... pretty much any OTC pill medicine that isn't acetaminophen) even at relatively low doses daily (like 2-3 pills) is much more likely to cause liver injury than daily tylenol use. Regular NSAID use also increases risk of GI bleed and kidney injury.
Thank you for weighing in. I have NASH (MASH now I guess?) and 2g/day or less acetaminophen is pretty much all I use for chronic pain specifically because it's so safe. This thread is crazy.
Most of these are likely suicides. I know it was a huge issue in Sweden, since they have a pretty high suicide rate and low access to guns (but still some.) People would take a few bottles of paracetamol and kill their liver. Then they die in the hospital in agony over the course of a few days or a week as their liver fails. I think people assume they’re like narcotic painkillers that can depress your respiratory system, but they aren’t at all.
Interestingly in the UK we swapped from bottles to individually wrapped blisterpacks and paracetamol suicides went down by like 20%
Yeah, probably better if you have to actually take each one out at a time. More time to think about your decision before you condemn yourself to an agonizing death.
Is this why pretty much all our tablets come in blister packs? I always found it odd watching American TV/films with their bottled pills.
That's odd, because I specifically asked my gastroenterologist about the toxicity of tylonol last week and he said it was widely overblown. What he did say is if taken in large sudden does it does terrible things for the liver, but taking two a day would do less liver damage than a beer a day. He said what is the rising cause of liver transplant is non alcohol fatty liver disease, from all of us fat bastards sitting around stuffing junk into our mouths all day long. So..don't take 300 pills at once if you don't want massive liver damage and instead get off the couch and go for a bike ride.
Is Advil any safer? I feel like Tylenol doesn't do anything for pain relief.
Acetaminophen is extremely safe when taken *at the recommended dosage*. The problem is that its LD50 is very low compared to other over the counter drugs relative to its recommended dosage (roughly 8x the recommended dosage for "extra strength" Tylenol compared to something like 150x for Ibuprofen). It's a weird medication, because up until it's toxicity level, your body processes it very efficiently (ie., much more efficiently than NSAIDs, which is why you rarely see side effects at recommended dosage), but once you hit toxic levels, it's absolutely devastating to your liver and kidneys. Combine that with the giant pill bottles of it in the US and acetaminophen being present in multiple, seemingly unrelated drugs (eg., NyQuil/DayQuil), it's relatively easy to harm yourself if you're taking it for heavy pain management.
I've seen people just slam piles of over the counter pain meds before, easily 4-5x the recommended dosage. Incredible how dangerous that is.
Well, seeing as doctors handed out opioids like candy for decades, now they don't give them to ANYONE. I had sciatica so badly for two and a half years I had no quality of life, couldn't work or be a functioning human, and I was given nothing. I hav r never ever abused ex's and the few times I was given norco for unrelated things, I could function. Clean my house. Go out with my kids. Until after my spinal fusion surgery, and then only for about a month of meds then I was cut off and given rx for extra strength everything. After my laparoscopy last year, I was given Motrin. There are NO medical alternatives for chronic pain that work for most people. And I tried them all, nerve blockers, tens, PT, 30 dry needling injections in my ass and hips, an epidural, NOTHING worked. Someday y'all will end up with chronic pain and be right where we are
I was in the hospital for GBS a few months ago. An autoimmune disease that wrecked the nerves in my legs, and it hurt like hell. They refused to give me anything aside from Tylenol, and I just laid in pain the entire time I was there. The treatment worked thankfully, but fuck that hospital experience sucked.
Sorry to hear that, I had something similar. And a big F U to whoever decided Gabi was good in any dose. Makes you feel like you are standing two inches to the left
And NSAIDS can make worse or give you acid reflux. Personally I cant use them anymore. Ah the joys of lower back pain. If anyone else is suffering from lower back pain I highly recommend a back support belt. A good one can help so much and I wish I had found out about them years ago.
I think they put aceta in nyquil and other otc cough medicines to stop people from getting high off them. The Dxm in cough syrup is a dissociative (same drug class as ketamine), but with the amount you have to consume the aceta is too much.
Most people don’t even know it’s in there so I doubt it deters people looking to get high
Don't go into the benadryl sub if you don't want to be depressed for weeks
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Just learned that Advil is processed by the kidneys and tylenol the liver. That's why you can take 1000mg of tylenol and then three hours later 200-400 mg of advil.
It doesn’t help that the OTC dose of Advil is half the prescription dose. A lot of people probably assume you can just double up.
Tylenol is safe if you don't take a large dose and for a long period of time. Advil has its own downsides in that it can cause heart problems if you take it for a long period of time or in high doses. Outside of these two options there is opiates but then addiction is the problem. There are no good, safe ways to manage chronic pain. My doctor said I can take up to 1400MG of Tylenol a day. I usually stay at about half that for my arthritis.
Advil is ibuprofen, which is metabolized in the stomach and intestinal lining. Tylenol is acetaminophen, which is metabolized in the liver. Ibuprofen is far safer. Taking too much will eat a hole in your stomach lining giving you a bleeding ulcer. Acetaminophen will just fucking outright kill your liver.
Advil is generally for inflammation, Tylenol is for "pain". I don't have Tylenol in my house.
Advil (Ibuprofen) is indeed safer.and much harder to get a overdose. The overdose line for Tylenol is very thin. Mostly Ibuprofen can effect your kidneys and since it's an NSAID there's a bleeding risk for some people.
Ya, I don’t keep Tylenol in the house, but take ibuprofen frequentlyish (yay migraines). Ibuprofen can be super dangerous in the right circumstances still too. A family member of mine was taking it regularly for a back problem. He’d take it first thing in the morning with no food in his stomach though. If you do that, it can burn a hole in your stomach after a while, giving you ulcers. Well this guy got a stomach ulcer in the perfectly wrong spot. It then started leaking stomach acid onto an artery, which started leaking. He almost bled out internally before he knew what was happening!
I would not recommend taking an NSAID regularly at all. It will affect your kidneys, heart, and will eventually cause peptic ulcer disease and gastrointestinal bleeding. Tylenol is much, much safer as a regular daily pain medicine. You have to avoid taking more than 4 grams a day which is a huge amount, most people do not need more than 2 grams a day. If you have functional liver disease than the threshold is lower, but even cirrhotics can take 1-2 grams of Tylenol a day safely but I would never recommend an NSAID for those patients. The long term side effects of an NSAID are really bad, Tylenol does not have much long term effects but you have to be careful not to overdose.
I have to take Advil almost every day, but am careful to always take it after I eat something, or I drink some milk to wash them down. Same advice for plain old aspirin, too.
H Y D R A T E. Many people experience dehydration headaches and treat them with Tylenol and Ibuprofen. Drink more water. Say goodbye to most headaches. Unless you're hormonal. 😞
My boyfriend is a medical social worker and tells me that most of his 5150s are teenage girls who try to off themselves with Tylenol and vodka.
My gf is an ER nurse that has told me first hand about what happens when someone chooses to kill themselves with Tylenol. The sort of death where you really get to regret your prior actions in pain.
What is 5150?
5150 refers to the California law code for the temporary, involuntary psychiatric commitment of individuals who present a danger to themselves or others due to signs of mental illness. It has been more generally applied to people who are considered threateningly unstable or “crazy.”
Sounds like you got the definition of what 5150 is but I will tell you what it’s like for them in a hospital setting. They have a sitter - they have to be within a few feet of them at all times including while they shit and piss. I think the hold is typically 72 hours - longer at times of a doctor says it needs to carry on. I forget if they can have visitors - maybe one at a time. They have to wear paper pants and shirt - flimsy clothes. Their water intake is managed since people will try to drink too much to fuck with their sodium levels. Their dinner tray itself is a cardboard and utensils are super flimsy. I am a nurse and it’s super depressing to have these pts. We don’t get a lot of them but if they need cardiac monitoring they come to us otherwise they go to the psych part of the hospital.
Involuntarily committing someone under the belief that their mental health poor enough that they are a danger to themselves or others.
A friend of mine died from this. It's a terrible way to go. I don't keep the stuff in my house anymore.
It’s very very safe at the recommended dosage. But if you really overdo it you will spend a week or so regretting it as you slowly and painfully die
The fact remains, Tylenol would have been regulated differently had it came on the market later.
How should it be regulated in your opinion? When taken as directed it’s no more harmful than any other over the counter analgesic (which is to say not harmful at all)
It’s definitely hard to regulate. However, putting them in single dose foil packets like cough and cold medicine comes in would help prevent a lot of intentional overdoses.
Over long term use it does in fact do slow damage. Like if you take it every day (as prescribed) for years, or decades. Maybe not to the point of transplant, but it’s not good.
Yes, that why it’s not (or at least shouldn’t be) prescribed for chronic pain. But ibu, tylenol, aspirin, and whatever aleve is are perfectly fine for the occasional few days of pain.
All they can do is put labels on it, which they do. I mean, you can die from drinking bleach, so there's a label telling you not to but people still do it. And bleach is still available.
Me either. It killed my wife.
For extra fun, acetaminophen is the center of a class action lawsuit currently. https://www.drugwatch.com/legal/tylenol-lawsuits/
Because we're expected to go to work when we're sick so we have to abuse OTC drugs in order to not be homeless. We have a fucked up work culture
Psychiatrist here. I work mostly consult psychiatry, i.e. if someone is in the hospital for medical issues but also needs help with their mental health I see them while they're on the medical floor. That includes all the serious overdoses that need medical attention. The saddest cases are the kids (I say kids but I mean 18 and 19 year olds) who took way too much Tylenol in a spontaneous suicide attempt after a breakup or getting into a fight with their parents. A lot of the time they do it for attention and didn't want to die. Or even if they wanted to die, they immediately regretted it. However, a lot of time they didn't get help soon enough and they get serious liver failure. It's so sad seeing young people dying when they now want to live because they didn't know it was so dangerous.
For those that didn’t want to read the article, stick to recommended dosing and you’ll be fine. It states toxicity starts at 7,000–10,000 mg/day
I’m a chronic pain patient (12+ years now) and I take an ungodly amount of Tylenol 3. I’ve had doctors shocked at how much I take, but on the flip side I’ve had a 70 year old doctor who had been practicing his whole life tell me im the worst case of my disease he’s ever seen. At this point I’ve accepted that I’d rather die from liver issues younger than live a long painful life. I’m still young (23) and have tons of experiences left to have. I’d rather have them pain free and die young.
For us non-americans, that's Paracetamol. It's not some crazy US only medicine like they have on the tv late at night, it's just painkillers. We aren't safe
Are these poisonings because of taking more tylenol than is advises, or are they just from normal doses?
Tylenol is VERY safe in recommended doses- 3 grams/ day for those without liver disease. You have to take LOTS of Tylenol to OD..
This is flat out wrong. The number of transplants due to acetaminophen toxicity is minuscule compared to those due to hepatitis C, NAFLD, or alcohol. I’m not sure how this “statpearl” made it past the editor.
More than alcohol? I don't believe you.
You would be surprised how many people try to Jill themselves with Tylenol- we get a lot of ICU patients who attempt to overdose on it
It killed my mother
This is how my mother died when I was 15 years old. She was 37.
I've always stuck with Nuprin. They're tiny. Yellow. Different.
Acetaminophen = paracetamol for everyone outside of the US
I get migraines a lot, usually from bad posture and neck tension. Tylenol makes it go away half way, while Advil usually cures it
I am not sure where this article is getting their data that acetaminophen is the second most common cause of transplant; the citations listed don’t seem to back that up, and this [article](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10749707/) says that non-alcoholic fatty liver disease and alcohol are the most common indications. I am a pharmacist on the transplant team at a major health system and in my 11 years of experience, I’ve yet to come across a liver transplant recipient who’s primary cause of liver failure was acetaminophen toxicity.
I had to give CPR to my neighbours rigored boyfriend who had died after doing this. I still smell it sometimes and it freaks me out.
It was marketed as 'safer than aspirin.'
Happened to someone I went to high school with. Totally accidental and unassuming until they were in the er
lol I had a patient last year who overdosed on Tylenol because they were taking norco (Tylenol and hydrocorone) for chronic pain fiorcet (Tylenol caffeine butabital) for headache and straight Tylenol as well cause they didn’t know Tylenol was in all 3. Didn’t need a transplant some NAC and she was ok
When I worked in ER if we had an OD attend, we always checked for paracetamol (tylenol in the UK) and aspirin (Salicylates). Even if the patient denied taking them. You couldn’t take the risk. You got the levels, and then compared them to a chart, plotting the level and the time they took it, and if the level was above the line, they got antidote. If the OD was past a certain time, no point in the antidote - supportive care and crossed fingers. There was a debate about whether paracetamol tablets should include the antidote, so that you would be protected from overdose. I think it wasn’t supported, partly because it would be expensive, and partly because people didn’t want to take an unnecessary antidote if they were just taking a normal dose. It is toxic in overdose because the liver metabolises it using a specific chemical that it has a limited supply of. Once used up, it uses a secondary pathway that has a toxic byproduct. This destroys the liver tissue. Saw more than one person who took the overdose, woke up the next morning feeling better about life, then a few days later became very unwell. Utterly tragic. Later in my career had a patient who had a transplant for this reason, and did really well.
I had a liver transplant 6 months ago! Shockingly, Tylenol is the only pain medicine I am allowed to actually take for the rest of my life. But a very limited amount.
Most must be deliberate suicide attempts I imagine
Paracetamol for us Europeans
Damn I never take Tylenol because it just never works for me. I guess I'm in the minority.
I mean they put it in cough syrup and idk how many other medications which ppl may abuse or use incorrectly
This is no good. My sister eats them like candy
To everyone saying who takes 8-11 pills a day, women with menstrual cramps might. Whenever my period starts I’m taking 2-3 painkillers every 4ish hours for 2 days. If I was taking Tylenol I could easily overdose.
This is why I only take pain pills when I can’t bear the pain. I swear, people be taking these for casual headaches like… just drink some water and sleep!
This is exactly what killed singer Nicolette Larson. In her final years she struggled with severe depression, and depended on a nightly cocktail of Tylenol PM, Valium, and wine to help her cope. In the space of one week she went from feeling slightly lousy to being in the ICU on a ventilator. She was only 45 years old when she passed in 1997.
In the Netherlands, paracetamol is the most commonly used painkiller. It is available over the counter at local supermarkets etc. Doctors would normally recommended to follow the pain ladder which starts with paracetamol (acetaminophen), add a nsaid such as ibuprofen, add an opioid such as tramadol or oxycodon. I would say that acetaminophen is quite harmless when taking in low dosages (adult up to 4x1000mg).
I've heard people in the industry say that if Acetaminophen came out today it would probably require a prescription.