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Wednesday, December 9, 2009

Drugs demand respect: Including Tylenol

Sun Media's Mindelle Jacobs ended a column on the dangers of OxyContin saying, "A drug like OxyContin is markedly different than a drug like Tylenol 3." With those words Jacobs underlined how correct she had been when she wrote, " . . . people are unfortunately naive about the potential risks of such drugs." She could have as easily been referring to Tylenol 3 as OxyContin.

Yesterday McNeil Consumer Healthcare, a Johnson & Johnson company, announced it is lowering recommended maximum daily dose for Extra Strength Tylenol to reduce the risk of acetaminophen overdose. Other Tylenol products, such as Tylenol 3, will follow in 2012 with lowered recommended maximum daily doses.

Why the fuss? It has been reported that acetaminophen causes three times as many cases of acute liver failure (ALF) as all other drugs combined. It is the most common cause of acute liver failure in the United States, accounting for 39% of cases.

Most Tylenol overdosing cases are unintentional. People take multiple medications not realizing how many contain acetaminophen. (The active ingredient in Tylenol.) This accidental overdosing results in approximately 150 deaths annually in the U.S.

Here's a detailed list of some of the most commonly used drugs containing acetaminophen. Mix these drugs at your peril.


  • Actifed: Cold & Allergy, Sinus
  • Alka-Seltzer Plus: All Products
  • Anacin: Aspirin Free Formula
  • Benadryl: Allergy Sinus Headache; Severe Allergy & Sinus Headache
  • Comtrex: All Products
  • Contac: Severe Cold and Flu Maximum Strength Caplets, Non-Drowsy Caplets, Day & Night Cold & Flu
  • Coricidin: D Cold, Flu & Sinus Tablets, HBP Cold & Flu Tablets
  • Dimetapp: Non-Drowsy Flu Syrup
  • Dristan: Cold Multi-Symptom Formula
  • Drixoral: Allergy Sinus, Cold & Flu Excedrin®: All Products
  • Feverall: Suppositories
  • Goody’s Powders: All Products
  • Midol: Maximum Strength Menstrual Formula, Maximum Strength PMS Formula
  • NyQuil/DayQuil: Cold/Flu Relief Liquid and LiquiCaps
  • Pamprin: All Products
  • Percogesic: All Products
  • Robitussin: Cold, Multi-Symptom Cold & Flu, Multi-Symptom Honey Flu Liquid, Nighttime Honey Flu Liquid
  • Singlet: Tablets
  • Sinutab Sinus: Sinus Allergy Medication Maximum Strength Formula
  • Sudafed: Cold & Cough Liquid Caps, Cold & Sinus Liquid Caps, Severe Cold Caplets and Tablets, Sinus Caplets and Tablets
  • Tavist: Sinus Non-Drowsy Coated Caplets
  • TheraFlu: All Regular and Maximum Strength Caplets and Hot Liquid
  • Triaminic: Cold, Cough & Fever Liquid, Cough & Sore Throat Liquid, Cough & Sore Throat Softchews
  • Tylenol: Allergy Sinus Formula, Severe Allergy; Arthritis Pain Extended Relief; Cold Formula, Cold & Flu; Extra Strength Pain Reliever; Flu Formula; Maximum Strength Sore Throat Adult Liquid; PM Pain Reliever/Sleep Aid; Regular Strength; Sinus; Women’s Tylenol
  • Vanquish: Caplets
  • Vicks: Vicks 44M Cough, Cold & Flu Relief Liquid and Liquicap
  • Acetaminophen is the most commonly implicated drug in cases of acute liver failure (ALF), predominantly due to its widespread availability.

    This may all come as a surprise but acetaminophen is not the only painkiller with serious side effects. According to the Canadian Medical Society Journal, sixteen thousand deaths a year in the United States and 1900 a year in Canada may be caused by non-steroidal anti-inflammatory drugs (NSAIDs) inducing gastric perforations, obstructions and bleeds.

    Dr. Ike Iheanacho, editor of the Drug and Therapeutics Bulletin, says: "The latest evidence shows . . . for every 3,300 people you treated for a year (with daily aspirin), you’d get one extra incident of gastrointestinal bleeding, which can be fatal."

    Sun Media columnist Mindelle Jacobs ended her column: "A drug like OxyContin is markedly different than a drug like Tylenol 3." Quite right. According to Johns Hopkins: ". . . a narcotic pain reliever such as morphine, oxycodone, hydrocodone, or fentanyl . . . does not pose the health risks you face with NSAIDS (aspirin, Celebrex, ibuprofen) . . . studies show that (narcotic) abuse is rare among patients with chronic pain, and with newer, long-acting opioids that release controlled amounts of medication . . ."

    Why are people not more knowledgeable? One reason may be that reporters are not all that knowledgeable. When it comes to drugs, reporters seem to deal more in fear than fact.

    Increases in deaths from opioid drugs such as OxyContin may be linked to the volume of coverage such deaths receive in the news. According to a study from Children's Hospital Boston and the University of North Carolina (UNC), Chapel Hill.

    The study, "Breaking the News or Fueling the Epidemic? Temporal association between news media report volume and opioid-related mortality," found that spikes in media coverage often preceded an increase in deaths, suggesting that media coverage — even when negative — may have influenced opioid abuse.

    This is the first time research has assessed the relationship between opioid abuse and the national news, according to senior investigator John Brownstein, Ph.D., of the Children's Hospital Informatics Program (CHIP) and Children's Division of Emergency Medicine. Although anecdotal information about a link between news reports and drug use date back to the 1950s, when amphetamine abuse was a common news topic.
    The authors suggest that stories about drugs follow guidelines similar to what psychiatrists and professional journalism organizations recommend for stories about suicides; under those guidelines, specific details are withheld so as not to inspire copycat suicides.
    "Specifics on how one might get high and how it feels are probably things that should be mentioned with caution or even left out of the news," Brownstein adds. "This is setting the stage for research around responsibility in the news."
    A London Free Press / Sun Media Special Report informed readers what medications "contains higher levels of oxycodone" and went on to tell readers what they can do to bypass the time release mechanism built into the pills to force the immediate release of oxycodone.

    What the paper didn't tell its readers was:

    "What makes these (deaths from opiods) even more tragic is that overdoses involving opioids (drugs like heroin, morphine, Oxycontin, Vicodin) are usually slow killers. Victims can be revived without lasting effects if the antidote — a drug called naloxone (brand: Narcan) — is given early enough."

    —  source: Maia Szalavitz writing in the Huffington Post:

    When I worked at a newspaper, I used to argue the dangers of "shotgun drugstrore remedies" should be addressed in the paper. I got nowhere. Today I feel slightly vindicated.

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