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Acetaminophen: Is it Really Your Safest Option?

November 6th, 2015

By Tori Bumgardner, PharmD Student Cedarville University

Acetaminophen has long been a popular over-the-counter product used to treat pain and fever in both adults and children (1). It is recommended to women as the preferred pain medication while pregnant. The FDA has been approved for dosing in individuals of all ages, from infants to adults, who may be suffering from pain or fevers (2). While it is known that acetaminophen causes liver damage to people who take it at high doses for an extended period of time, recent studies have investigated the possibility that it can lead to dangerous levels of toxins in the body, potentially increasing the risk of attention deficit hyperactive disorder (ADHD) and even autism (3,4). The buildup occurs when one of the metabolites of acetaminophen, N-acetyl-p-benzoquinone imine (NAPQI), inhibits the detoxification of reactive oxygen species (ROS) in the body (5). When ROS builds up, inflammation can occur, giving it the potential to cause ADHD or autism. Additionally, a meta-analysis was conducted looking at the correlation between use of acetaminophen during pregnancy and occurrence of asthma in offspring (6). The study found that mothers who used acetaminophen while pregnant increased the risk of their child developing asthma. This blog post will review the recent evidence on the dangers associated with pre-natal exposure to acetaminophen.

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

A study from 2014 examined the relationship between mothers who took acetaminophen during pregnancy and the subsequent occurrence of ADHD in their children (4). In this study, 1714 European children were followed for 11 years and their mothers were surveyed when the children were newborn, 1, 3.5, 7, and 11 years old. For the newborn interview, information on the mothers’ pregnancy was collected. The other interviews were focused on the child, paying special attention to cognitive development, behavior, and physical activity. In the final interview, at age 11, the children also completed and interview that asked about topics like behavior, emotions, and self-esteem. The investigators examined the relationships between different drugs that were taken during pregnancy with the results of the strengths and difficulties questionnaire that were completed throughout the study. Interestingly, it was found that the group who used acetaminophen showed higher difficulties and lower social scores. The findings of this study indicate that acetaminophen use during pregnancy is correlated with higher rates of ADHD in children. Limitations to the study included a low follow-up rate, lack of generalization since the study was specific to European women and their children, and a possibility of selection bias if both parents were already predisposed to ADHD. Authors concede that additional research should be done to determine the actual risks associated with exposing children to acetaminophen at young ages. Other data found that children whose mothers used acetaminophen while pregnant had a higher incidence of behavior problems and hyperkinetic disorders (HKDs) like ADHD during a follow up when the children were seven years old (7). Due to the safety concern in allowing pregnant women to continue taking acetaminophen, since research seems to suggest its harm, the FDA has begun looking into the issue (8).

Though research is not yet conclusive, they encourage women to talk to their healthcare providers before taking anything.While it is always a good recommendation to talk to a doctor first, what does that leave women to use when they are in pain, but don’t have time to see or call the doctor, and are left with no options to provide relief? There are certainly alternatives available that don’t include drugs and can help relieve pain caused by headaches and aching in other parts of the body. Sometimes headaches are caused by stress and can be helped by practicing relaxation through deep-breathing, yoga, or any other technique that is convenient and will divert their mind off stress-inducing stimulation (9). A regular sleeping schedule is also important and exercise can help to relieve headaches, so taking a nap or a walk are both ways to relieve stress and pain without taking medication. Pain in other parts of the body may be troublesome, but a gentle massage or an external, topical pain relief product can be used to help establish comfort.

The data is still uncertain on the magnitude of risk with acetaminophen use in pregnant women, it is best to err on the side of caution and avoid use if possible. At the end of the day, the question that is left is one of risk versus benefit. Since nothing is conclusive about the danger that acetaminophen may have on babies, is it ultimately worth the risk to use it as a quick fix for a couple of hours free of pain?

 

References:

  1. Medline Plus: Trusted Health Information for You Web site. https://www.nlm.nih.gov/medlineplus/druginfo/meds/a681004.html. Published 08-15-2014. Updated 2014. Accessed October 16, 2015.
  2. DailyMed (package inserts). National Institutes of Health; National Library of Medicine.  http://dailymed.nlm.nih.gov/dailymed/ (accessed October 26, 2015).
  3. Jennifer Margulis PD. Could A common painkiller cause brain inflammation — and even autism — in children? http://reset.me/story/could-a-common-painkiller-cause-brain-inflammation-and-even-autism-in-children/. Published 09-08-2015. Updated 2015. Accessed 10-16-2015.
  4. Thompson JMD, Waldie KE, Wall CR, Murphy R, Mitchell EA, the ABC study group. Associations between Acetaminophen Use during Pregnancy and ADHD Symptoms Measured at Ages 7 and 11 Years. Hashimoto K, ed. PLoS ONE. 2014;9(9):e108210. doi:10.1371/journal.pone.0108210.
  5. Shaw W. Evidence that increased acetaminophen use in genetically vulnerable children appears to be a major cause of the epidemics of autism, attention deficit with hyperactivity, and asthma. Journal of Restorative Medicine. 2013;2:1. Accessed October 26, 2015. doi: 10.14200/jrm.2013.2.0101.
  6. Cheelo M, Lodge CJ, Dharmage SC, et al. Paracetamol exposure in pregnancy and early childhood and development of childhood asthma: A systematic review and meta-analysis. Arch Dis Child. 2015;100(1):81.
  7. Liew Z, Ritz B, Rebordosa C, Lee P,Olsen J. Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatrics. 2014;168(4):313-320.
  8. FDA drug safety communication: FDA has reviewed possible risks of pain medicine use during pregnancy. U.S. Food and Drug Administration Web site. http://www.fda.gov/Drugs/DrugSafety/ucm429117.htm. Published 01-09-2015. Updated 2015. Accessed October 16, 2015.
  9. Krinsky D, Ferreri S, Hemstreet B, et al. Headache. In: Young L, ed. Handbook of nonprescription drugs: An interactive approach to self-care. 18th ed. Washington, DC: American Pharmacists Association; 2015:65-83-95. Accessed 10-16-2015.

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18 Responses to “Acetaminophen: Is it Really Your Safest Option?”

  1. Emily Bruce Says:

    This article is so interesting! I find it crazy that using acetaminophen during pregnancy can lead to your baby having asthma. I believe the OB/GYN will give a specific list to each expectant mother and acetaminophen is one of the medications that it states they can take. The other thing I found interesting was that giving the children acetaminophen could lead to ADHD. The doctors actually tell parents to give their children acetaminophen before or right after receiving vaccines. Now seeing this information will make me think twice before giving my child acetaminophen or taking it during pregnancy.

  2. Lia G Hickinbotham Says:

    This is quite an interesting study. I am very curious about the additional research that is going to be done. It would also be good to see if there are any additional issues past the age of 11 (such as during puberty and through adult-hood) to see if there are any symptom changes that occur as they grow older.

  3. Nicholas Rudy Says:

    Great article! I wonder if Acetaminophen could be linked to any other disorders besides ADHD and Autism? I think it’s intriguing that a drug deemed the “hallmark” of safety fro OTC analgesics could actually be harmful. I’d like to see more in depth research on this topic!

  4. Micah Bernard Says:

    Interesting article, Tori!
    I’d be interested to know the results of further studies into this topic. It’s alarming that the pain medication many consider one of the safest could have such serious adverse effects! I’m curious – does dose and frequency of use of acetaminophen have any impact on how severe the effects are? Would a woman who only used acetaminophen sporadically in low doses have the same risks as a pregnant woman who used it more frequently and in higher doses?

  5. Katie Distel Says:

    This is a very interesting piece!
    It seemed that most of the research is directed toward the effect of APAP taken during pregnancy but I wonder if there is a similar effect when given to an infant or toddler. I do find it interesting that they only assessed the children up to ages 7 or 11. Kids are naturally full of energy and, depending on temperament and parenting, have varying degrees of self-control. It seems that much of what is diagnosed as ADHD these days is truly just a lack of self-control. It will be interesting to see these studies duplicated and expanded. Perhaps they can see if there is any effect that continues into teens and adulthood.

  6. David J Fisher Says:

    Interesting article!
    It’s scary when a medication we so freely recommend is determined to be dangerous to the patient. This will definitely make me do more research before I recommend acetaminophen to a pregnant woman. I’m curious with the buildup of ROS do the children suffer any other medical conditions given that ROS damage the plasma membrane.

  7. Dominic Yeboah Says:

    I really want to know the sponsors of this research or how it was funded.From my little knowledge about drugs since been in pharmacy school there is always side effect on anything we take into our bodies.That been said there can be a lot of side effects on anything including water we drink if its more than the body require. Anything can be poison depending on the dose.

  8. Abby Savino Says:

    This is very interesting! I find it a little scary that a medication that is often taken during pregnancy and taken as children could lead to ADHD. I think it would be interesting to follow the children more closely and see how extensive the ADHD is. Also to look at the amount they take and how that effects the severity of it. If you think about it Aspirin was used for everything in the 70’s and 80’s and then they realized the damage it can cause so I’m interested to see what the FDA has to say about the recent findings.

  9. Hannah Chittenden Says:

    Wow this article really took me by surprise. I never would have thought that the “go-to” pain medicine for those who are pregnant may not be such a good idea after all. With that being said, I also think further research should be done. Along with Micah, it would be interesting to see how dose would affect these children. But more so, how does the time period the acetaminophen was taken affect the kids? Would it be safer to take it during the 3rd trimester? Is it linked to these effects no matter what trimester the mother is in? What about breast feeding? Or if young kids take it once they are born, such as what Katie mentioned. While it is clear that research still needs to be done, this article is a great reminder that just because something is widely accepted, we must look critically at the medications we are recommending.

  10. Casey A Nelson Says:

    Tori, I found this to be an interesting read. I find it ironic that others are looking into Acetaminophen’s safety, even though we are taught it is a safe option. One aspect I enjoyed was how you mentioned the use of non-drug measures, as I believe it is important for us to be able to refer patients to these just as much as it is for us to understand the different drug options. Also, did the study mention the dosing of Acetaminophen they were using in this study?

  11. Morgan Says:

    Great article! I think that it is interesting that a drug that we learn in class to be a “go to” drug is having so many severe side effects that are just now surfacing. I wonder if any other disorders can also be linked to APAP consumption that we don’t know about yet. This just makes me think about how many other OTC medications have side effects that we still don’t know about?

  12. Caleb H VanDyke Says:

    I think that you did a great job presenting this information. The article really brought to light an important fact that we don’t always focus on…we don’t know everything about these “common” medications. Acetaminophen has been used for a while now for pain and we are still finding new ways it is interacting with the body. Gives a new emphasis and view on “non-pharmacological” therapy. Thanks for reminding us that sometimes medications may harm more than help. Great article and interested to see where the research takes the field of pharmacy!

  13. Sam Franklin Says:

    How do they think acetaminophen affects their predisposition to asthma? If anything, I’d expect it to do the opposite. Is it a rebound effect?

  14. freddie Says:

    Great article. If a conclusion has not been made yet and is still under investigation, then I believe non-pharmacological treatment should be the ultimate recommendation for pregnant women and have them self excluded from taken acetaminophen. Yes although all medication has their side effects which is inevitable but on the other hand, it is very necessary to prevent further health related issue that might be worse by self exclusion.

  15. Belinda Darkwah Says:

    Fascinating, simply, fascinating! I enjoyed every aspect of this article, but I do have some questions. What prompted the researchers to look specifically at acetaminophen during pregnancy? Did they exclude other factors that could cause an increase in ADHA?

    I also wonder if the reason for the increase in ADHD diagnosis is due to the fact that ADHD was not a disease diagnosed many years ago. A possible explanation could be that we now have the capability to diagnosis ADHD more efficiently. The caveat to this could be over diagnosis of ADHD. Overall, we need to take this into consideration when we counsel pregnant women on the use of pain relievers during pregnancy. Non-drug options are always the safer option for most patients.

  16. Akwasi O Appiah Says:

    Wow, learn something new everyday. This is a very educative article. I know about the adverse effects of high doses of acetaminophen such as hepatic damage but strangely enough, It is the only “safe’ pain medication pregnant women can take. Is there anything else that could be used instead of acetaminophen for pregnant women?

  17. Matt Madden Says:

    This was a great article Tori. I knew APAP had liver risks associated with it, but I never would have guessed that ADHD could be linked to it also. I noticed that this article seemed to be focused on European women. I assume it could be generalizable to American women also, but I think that would be an interesting topic to look into. Good job!

  18. Caleb S Tang Says:

    ADHD and autism diagnoses are sprouting out more often than ever in the past decade. Whether or not these were true diagnoses of the disorders isn’t clear in a lot of studies, I believe. I understand that more and more social/cognitive/mental-related problems are being added to the DSM every year. Every year, the population as a whole is becoming more aware that social disorders are actual biological disorders. Also I am curious of the connection between asthma and the social disorders. Is there a common biological pathway that intersects these very different symptoms?

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