What Every User of Acetaminophen Needs to Know

Most parents think of Tylenol as a wonder drug -- harmless, readily available, and a miraculous cure for teething fussiness, ear infection pain, fevers and other childhood maladies. But when an old friend's son died recently from tylenol poisoning, I did some research. Call me naive, but I was shocked by what I learned.

Apparently, Tylenol/Acetaminophen is toxic to the human body. It causes liver poisoning. The analgesic effects derive from the liver's attempt to fight the tylenol by releasing enzymes to break it down. A liver that is not healthy or that is overwhelmed by other toxins (such as alcohol), or that has not been sufficiently fueled by food intake, can become overwhelmed and fail, leaving the poison in the body to cause organ damage and death.

The danger is that there isn't much difference between a safe, effective dose, and a toxic dose. Just a doubling of the maximum daily dose can be enough to kill, warns Dr. Anne Larson of the University of Washington Medical Center. The other problem is that if you have no food in your stomach, or if you have alcohol in your system, or worse yet, both, (not relevant for your kids unless they're teenagers, but think about that tylenol you took for your hangover last month), the regular dosage can be toxic because of the overload to the liver.

Acetaminophen (the active ingredient in tylenol) accounts for 100,000 calls to poison control centers, 56,000 emergency room visits, 2,600 hospitalizations, and 450 deaths annually.

A study published in the Journal of the American Medical Association found that even at recommended doses, acetaminophen can cause organ damage. Out of 106 patients in the study, 39% who took acetaminophen showed increases in liver enzymes to more than three times the normal upper limit, indicating potential liver damage. Another 25% of the patients had enzyme levels at five times the normal level, while 7% of the patients' enzyme levels increased to eight times the normal level! Their enzyme levels continued to increase for up to four days after the acetaminophen was stopped, and their enzyme levels did not return to normal for as long as 11 days, researchers said.

"This study shows that even taking the amount on the package can be a problem for some people," said Dr. William M. Lee of the University of Texas Southwestern Medical School, who was not involved in the study.

In another new study, in the Archives Of Internal Medicine, one in 10 women who took acetaminophen over an 11-year period experienced a 30 percent decline in kidney filtration function. The study showed that the more acetaminophen pills taken during a lifetime, the higher the risk of detrimental effects, indicating that the organ damage from even routine doses is cumulative.

If you choose to use acetaminophen in your household, follow common sense precautions to prevent poisoning:

1. Be certain you give the correct dosage. If you have both children's and infant's Tylenol in your house, be aware that the dosage is different. A teaspoon-full instead of a dropper-full of the wrong one can be lethal. Keep them in separate places so you don't mix them up at night.

2. Don't mix medicines. Be aware that most cold medicines contain acetaminophen. If you also give tylenol you are double dosing your child and risking liver failure.

3. Be sure all medicines are in child-safe containers, including that packet in your purse.

4. Be sure to educate any babysitters about tylenol safety.

5. Communicate with your spouse, babysitter, etc about any medicines given, and write down the time so the next dosage isn't given too soon.

6. Once your kids are old enough to self-medicate, educate! Don't let them be cavalier with tylenol or any medication. Make sure they know to consume tylenol with food, and not if they have been drinking. (My own view is that if a teen has a hangover, they should suffer the consequences