You know, there has been so much hype about Narcan and the need for regular people to have access to it to help those who have overdosed on heroin and fentanyl. I just shake my head. I pity those who have become addicted to these substances, but it’s not something I can put any effort into preparing for. There are other hazards my family and I are far more likely to encounter. One of those is acetaminophen overdose.
At this point in time, one of the most common unintentional over-the-counter drug overdoses in the US concerns acetaminophen. Tylenol. It happens to regular people that are just trying to relieve normal aches and pains like headaches or arthritis and perhaps manage a head cold at the same time. It happens to people who don’t want to resort to going to a doctor or getting a prescription for something more effective, so they increase the amount they take. In the future, acetaminophen use may rise due to supplies of a person’s normal pain relievers being exhausted while at the same time people are doing more manual labor. When taking it easy and resting may not be an option because it takes all we’ve got to survive.
Already in this country, 19% of adults report using acetaminophen at least once per week.[1] And acetaminophen overdose has surpassed viral hepatitis as the leading cause of acute liver failure in the US.[2] We’d be well-advised to understand how to prevent and prepare for unintentional overdoses of this most commonly used medicine.
About a decade ago, researchers decided to evaluate how well the general public understands acetaminophen formulations and safe dosages. The volunteers in this hypothetical study were gathered among patients in physician waiting rooms. They had no hearing or vision difficulties.
The results were a little disturbing. It was found that nearly 25% of patients would exceed the recommended dosages, with 5% taking enough to potentially cause serious harm. The most alarming finding, however, was the nearly half of the patients would overdose by “double-dipping”—using two different medications that each contained acetaminophen in the formula.[3] It was also revealed that exceeding the safe dosage levels was more likely to occur with high dosage formulations, i.e. 1000 mg and 650 mg tablets were more likely to be involved with dosing errors than 325 mg tablets. And unsurprisingly, patients with lower literacy skills were also more likely to unintentionally overdose.[4]
Part of the problem lies in the fact that with NSAID pain relievers, a lot more have to be taken to reach toxic levels. Not so with acetaminophen, where 4000 mg (the maximum recommended daily dose for most people) is deemed safe, but 5000 mg may cause problems. The other issue is that acetaminophen is incorporated into so many other medications. Cold and flu medications often contain acetaminophen. So do Midol, Excedrin, and Vanquish. And then there are all the prescription medications that also contain varying amounts of acetaminophen. There is a link below to a chart that lists some of the most common. If you are in doubt, just look at the bottle. Acetaminophen will be listed if it is an ingredient.
So how can we prepare to treat accidental poisonings?
Activated charcoal and milk thistle are two supplements for managing overdoses. Activated charcoal is employed in hospitals all over the world. It is only effective for removing poisons that have not yet passed into the bloodstream, so within 2-3 hours of ingestion. The recommended dosage is 1 gram per kilogram of body weight, about 10-25 grams for children and 50-100 grams for adults. Begin with activated charcoal if within the timeframe for using it.
Wait at least two hours before beginning with milk thistle. The two cannot be taken together because they would cancel each other out. Milk thistle works to remove toxins that have already made it to the liver. N-acetyl-cysteine is also used to treat acetaminophen and other overdoses and may be used later than activated charcoal. However, I couldn’t locate any dosage recommendations for treating overdoses, unfortunately. It is available in capsule form through Amazon.
[1] Wolf MS, King J, Jacobson K, Di Francesco L, Bailey SC, Mullen R, McCarthy D, Serper M, Davis TC, Parker RM. Risk of unintentional overdose with non-prescription acetaminophen products. Journal of General Internal Medicine, 2012 Dec;27(12):1587-93, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509295/ (accessed 11 April 2023).
[2] Ibid.
[3] Ibid.
[4] Ibid.
I was in a CVS store picking up a prescription two or three years ago. At the pharmacy counter was a rubber mat with an advertisement for Narcan, no doubt from its manufacturer. It said something like "Carry Narcan for a friend." Curious, I asked the pharmacy tech how much it cost. She responded, "$165.00."
ReplyDeleteI said, "Instead of carrying it for a friend, it sounds like someone just needs new friends."
She agreed.
Sounds like another one of those failed advertising campaigns. Right up there with "I cuss, you cuss, we all cuss for asparagus."
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