Tylenol found to dull the brain and make people less likely to notice errors

a reply to: PeterMcFly

Tylenol (or paracetamol as it is called here) does not cause automatic death in someone with liver damage. It IS toxic to the liver and can exacerbate any liver damage, true, but saying 'be prepared for them to die' is very misleading.

Long term paracetamol use will eventually cause liver damage. Liver failure is the primary cause of death in overdose with this drug (and is a bloody horriable and painful death). If it were to be introduced today it would likely not be licensed as an over the counter medication due to the toxicity and would be prescription only.

That being said is a very effective simple analgesic which increases the efficiency of many other pain killers, particularly opiate based ones. IV paracetamol is one of the main analgesics of choice in post-op care due to its effectiveness. It is also superb in controlling fevers. However it does need to be used as advised. People with pre-existing liver problems or who have excessive alcohol intake need to restrict/avoid its use.

Virtually all drugs have damaging effects if taken in excess. For example there are a few here who advocate aspirin, however this has a very detrimental effect on blood clotting, so us not advised following trauma/injury. NSAIDS like ibuprofen cause severe stomach ulcers in prolonged use.

BTW I used to work as a registered nurse and my girlfriend (who agrees with this) holds a MSc in pain management.

a reply to: PaddyInf

BTW I used to work as a registered nurse and my girlfriend (who agrees with this) holds a MSc in pain management.

Funny, spouse had acute liver failure and I remember the ER doc saying this to me face to face. He did not look to be the "joking" kind of doc, nor does I think he was bull#ting me for the pleasure...

Who to believe, Johnson & Johnson that will try obviously to sweep under the carpet the info, our sympathetic registered nurse and girlfriend, or the ER doc that saved my spouse???

a reply to: PeterMcFly

So your experience of this is an ER doc telling you this while your spouse was ill? I get the feeling that you may have read a bit more into this than was intended.

Tylenol is hepatoxic, true. It does exacerbate liver damage and increases the chance of death in very severe cases of acute liver failure. Stating that someone who has any liver damage will automatically pop their clogs after taking 2 of them however is just not true.

a reply to: PaddyInf

I hope that you understand that you base your argumentation on an appeal to authority:

BTW I used to work as a registered nurse and my girlfriend (who agrees with this) holds a MSc in pain management.

Problematic because my args are also based on such appeal to authority:

Funny, spouse had acute liver failure and I remember the ER doc saying this to me face to face. He did not look to be the "joking" kind of doc, nor does I think he was bull#ting me for the pleasure...

It is not impossible the doc was wrong or lying, but in the world I live, a nurse, as registered as she want, is subordinate to a doctor, of coarse many nurse wish and act like they are the boss and know anything, but when thing get serious, I have alway saw them retake their place when remembered about their pay grade...

It does exacerbate liver damage and increases the chance of death in very severe cases of acute liver failure.

Strange, I think it was basically what I was saying that in case of accute liver failure (they are ALWAY very severe), so if a person suffer from a "very severe" accute liver failure (NOT CAUSED BY TYLENOL), where chance of death according to King's College Criteria are already very high, presence of Tylenol signify an "increased" chance of death, but let not play words and call it a death sentence!

originally posted by: PeterMcFly
a reply to: PaddyInf

I hope that you understand that you base your argumentation on an appeal to authority:

Actually, you generally see people with end-stage hepatic disease being given acetaminophen for fever and headache, and being told to avoid NSAIDS like the plague, due to the kidney failure that accompanies liver failure.

A systematic review of methodologically sound short-term studies suggested that the use of therapeutic dosing of acetaminophen in patients with chronic alcoholism has not been associated with liver injury, but no studies of longer-term therapy have been performed.15 Thus, less than 4 g/d of acetaminophen appears safe for short-term dosing in patients with mild to moderate alcohol intake, but most hepatologists (written communication, expert opinion: see end of article for list of sources) advocate for lower dosing at 2 g or less per day, given the small margin for error in a nonstudy population. Data do not exist for long-term acetaminophen use in patients with active alcohol use. Multiple hepatologists agree that 2 g or less per day of acetaminophen would be recommended for these patients (written communication, expert opinion).

to wit:

There are many similar studies, your key to enlightenment might be something like "analgesic choice liver failure" or the like.

more -

The half-life of acetaminophen is prolonged in patients with chronic liver disease. However, a study by Benson showed that repeated maximal dosing did not lead to accumulation in patients with chronic stable liver disease (CSLD).18 In that study, 20 patients with CSLD were given 4 grams per day of acetaminophen for 13 days without signs of toxicity. When compared to normal patients, Forrest et al demonstrated similar levels of cysteine and mercapturic acid conjugates, suggesting intact detoxification of NAPQI.19

and a very nice paper about the subject: (big pdf)

Recent reviews have concluded that paracetamol is a safe
and effective first line agent in almost all patients
regardless of liver disease aetiology. Although the need for
dose reduction in the healthy population seems largely
unnecessary, it may be warranted in certain severe or decompensated
hepatic disease states, particularly if patients
are malnourished, are not eating or have a dry weight less
than 50 kg.

Back to the subject, acetaminophen's effect on the mind and nervous system is way more complex than just dulling you out.

It's also an effective treatment for anxiety in some people, and it does so by making a very subtle change in the way you view events - you tend to stop using your "basic values" for decisions. It also reduces fear of death (!) and affects the way you view the possible future outcomes of actions. In what I'd call a negative way.

It's also effective against PTSD in some people because it stops you from having those 'circulating thoughts', so maybe if you've got an earworm, you just need a couple of extra strength tablets.

That to say, what it does to your behavior isn't intuitive or straightforward.

a reply to: Bedlam

We are talking here about ACUTE liver failure and NOT chronic liver problems. Your key to enlightenment might be on reading the difference.

Actually, you generally see people with end-stage hepatic disease being given acetaminophen for fever and headache, and being told to avoid NSAIDS like the plague

Hepatic failure/problem mean loss of coag. Tylenol is one of the few if not the only practical one that is not an antiplatelet.

originally posted by: PeterMcFly
a reply to: Bedlam

We are talking here about ACUTE liver failure and NOT chronic liver problems. Your key to enlightenment might be on reading the difference.

Yet, they give tylenol for fever and headache to patients with liver failure awaiting transplant. And they don't give NSAIDS, because when the liver is failing, your kidneys fail as well, it's called hepatorenal failure.

Hepatic failure/problem mean loss of coag. Tylenol is one of the few if not the only practical one that is not an antiplatelet.

Another reason FOR giving Tylenol.

Read the PDF I posted. It addresses most of what you're saying. As do thousands of other scholarly articles you can find.

eta:

another:

Paracetamol metabolism is altered during acute viral hepatitis.
It has been suggested that the 24 hour intake of paracetamol in patients
with acute liver disease should be restricted to around 2g/day4.

It's tough to pick out good cites about its use in acute liver failure because it's usually in articles about tylenol poisoning.

a reply to: Bedlam

Repeat/take two:

We are talking here about ACUTE liver failure and NOT chronic liver problems. Your key to enlightenment might be on reading the difference.

What I find strange is that you normally take the "crusade" to defend the orthodoxy of official medical knowledge, yet I clearly stated this come from a competent MD, not from me... go figure...

Please, spare me your bucket of bogus studies bought and paid by Johnson & Johnson. And on a more personal level, you never read the studies I sent you, then why I should bother reading yours?

FYI I am quite used to peoples treating me like a crank and laughing at my medical or diet recommendations, then later coming back and saying it have changed quality of life "immeasurably".

You like Tylenol, you believe it is safe for you when having acute or hyperacute liver failure. Then go ahead, next time your liver is in the process of shutting down, take a couple Tylenol to relieve the pain! One thing for sure is I will not give a damn about you! Hope you will have your multiples studies to cling on while experiencing liver failure...

a reply to: PeterMcFly

OK, I'll bite. I don't base it on an appeal to authority. I simply stated credentials to indicate that I am not coming from a position of complete medical ignorance. I stated my other halves qual as it relates to pain management in which she is a subject matter expert and she had some input in the post. Despite your rather out dated view of nursing, they do have a little bit of medical knowledge and learn to base their practice on evidence. This comes from several years of medical training resulting in a BSc. The main reason for needing this knowledge is that they work as a stupidity check for doctors, who make a lot more mistakes than most people think. They also learn to give credit to anyone involved in their work. It's a professional thing.

Your first post indicated that any patient who goes to hospital with liver damage is likely to be told that they should be prepared to die if they have had Tylenol.

Other posters have provided evidence based on trials, supporting evidence and experience from many unrelated sources. These indicate that this statement is wrong.

Your evidence appears to be the word if a single ER doctor who told you something once at a time of apparent stress.

From an objective standpoint, which would a reasonable person rather base a decision on?