by Calvin Anderson, PharmD student
Acetaminophen, commonly known as Tylenol, is one of several analgesics available over-the-counter and is found to help alleviate symptoms such as headaches and fevers. Other available over-the-counter analgesics include ibuprofen, naproxen, and aspirin, which have different methods of action for treating pain. Acetaminophen is the most commonly used analgesic for pain relief in patients, and often people use it as needed without properly measuring how much they are taking; this can have severe consequences that people need to be aware of.1 Overdosing on acetaminophen can eventually lead to acute liver failure, which is a serious, potentially life-threatening condition that occurs when large parts of the liver become damaged beyond repair.2 According to a news article published in US news titled “Tylenol-Induced Liver Failure Presents Own Set of Problems: Study,” a recent study showed overdose survivors of acetaminophen-induced liver failure have considerably worse mental and physical health as compared to other patients suffering from liver failure induced by other causes. This article caught my attention because it directly correlated with self-care exclusion criteria regarding proper use of acetaminophen, which states that acetaminophen is potentially toxic to the liver in doses over 4 grams per day.3
The researchers who conducted this study found that patients who over-dosed on acetaminophen were reported to have more days of poor health and reduced physical activity due to pain, anxiety and depression experienced more so than other liver failure patients. They collected data from more than 280 patients diagnosed with liver failure between 1998 and 2010, and followed them for two years. The results were reported in Liver Transplantation, and were released this past July. According to the research, adult survivors of acute liver failure have reduced quality of life as compared to those of similar age and gender in the general population. An article called “Tylenol Safety: Is there Reason to Worry?”4 mentions that acetaminophen is the most commonly used medication for pain and fever in children, and there have been numerous reports of acute liver failure in children under eighteen years of age caused by ingesting too much acetaminophen. Prescribers and pharmacists alike must let their patients know about the risks of acetaminophen before allowing them to use it, especially for those patients already suffering from a liver condition, or those who chronically consume alcohol (more than 4 drinks per day.)3
It can be concluded from this study that there does exist an association between acetaminophen over-dose and quality of life among liver-failure patients. However, one thing I noticed about this article is that it failed to explain why the quality of life was worse in patients with acetaminophen-induced liver failure, as it did not establish a substantial cause-and-effect relationship. I would like to know why this is because the article did not address this issue. After properly ensuring that it is fine for the patient to take, I would still recommend acetaminophen as it is intended for the treatment of headaches, fevers, and pain. We as pharmacists must stress to our patients the potential risks of acetaminophen and be extra careful in our recommendations. One question I pose to my colleagues is: What are some effective ways we can bring to our patient’s attention the potential risks of Tylenol without scaring them?
1.) Johnson, Kimball. Liver Failure. Digestive Disorders Health Center http://www.webmd.com/digestive-disorders/digestive-diseases-liver-failure. Published July 11, 2012. Accessed November 5, 2013.
2.) Slack A, Wendon J. Acute liver failure. Clinical Medicine [serial online]. June 2011;11(3):254-258. Available from: Academic Search Complete, Ipswich, MA. Accessed November 29, 2013.
3.) Huckleberry Y, Rollins C. Analgesics. In: Krinsky D, ed. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. Washington DC: American Pharmacists Association; 67-72.
4.) Tylenol Safety: Is There Reason To Worry? Child Health Alert [serial online]. September 2006;24:1-2. Available from: Academic Search Complete, Ipswich, MA. Accessed November 5, 2013.