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Watch that acetaminophen dosage

Posted: September 27, 2013 9:38 a.m.
Updated: September 30, 2013 5:00 a.m.

Did you know that if you follow the first line of directions on a bottle of extra strength acetaminophen (the primary ingredient in Tylenol and its generic copies) you can actually exceed the safe amount you can take in 24 hours?

I’m usually very good about checking on the side effects and warnings of prescription medications. This has been especially important to me during the past month. On August 27, I was the victim in a car accident right in downtown Camden. I won’t go into specifics, but I got a nasty case of whiplash and have experienced neck, shoulder and back pain ever since. In the days after the accident, my doctor’s office arranged a prescription for me to take 800 mg of ibuprofen three times a day. I later received a prescription for a muscle relaxer.

Ten nights later, as I was climbing up on my bed, I suddenly experienced excruciating pain in my abdomen. Thinking it was something I ate, I waited it out -- something I now regret -- over that weekend. The following Monday, I saw my doctor who thought it might be appendicitis. A CT scan, however, turned up diverticulitis. That’s a very painful (believe me!) condition that occurs, according to WebMD, when pouches that have formed in the wall of the colon become inflamed or infected.

Our pretty solid suspicion is that the high dose of ibuprofen I was taking for the whiplash pain may have caused, but certainly aggravated, the diverticulitis.

The good news was that I already appeared to be getting past the very worst of it by the time I had the CT scan. I never developed a fever and any bouts of nausea were relatively mild.

My doctor prescribed both an antibiotic (which, ironically, upset my stomach) and an anti-fungal (which tastes nasty), and I ended up staying home for a week. However, I came off the ibuprofen and switched to acetaminophen.

My diverticulitis slowly but surely calmed down. I still have a few twinges here and there, but perhaps -- as WebMD suggests -- if I begin to increase my intake of high fiber (whole grains, fruits and vegetables), something I’ve never been very good at, and drink plenty of water (which I do better now than compared to several years ago), I might be able to keep from redeveloping that painful episode.

The only other problem I had with my medications during that time was the muscle relaxant. I had no troubles for the first week, but for some reason on the seventh night, it hit me like a ton of bricks and even made my feet and hands feel numb. I haven’t taken it again, since I can’t really function either at home or at work that way.

Furthermore, I’m allergic to medicines with codeine or that are sulfa-based and seem to have problems taking almost any other kind of “hard” pain reliever.

That’s left me with the acetaminophen. The first line of directions -- the one that everyone reads and follows -- says that the recommended dosage is two 500 mg gelcaps every six hours. So that’s what I did.

Then I read a series of rather mind-blowing articles on ProPublica is, according to its website, “an independent non-profit newsroom that produces investigative journalism in the public interest.” It was founded in 2007, started up in 2008 and is led by former “mainstream” news editors and managers. Its initial funding came from the Sandler Foundation and continues to be supported by philanthropists and donations from readers. ProPublica produces long, detailed, data-rich stories.

I learned about ProPublica after it won the Pulitzer prizes in 2010 and 2011 for, respectively, investigative journalism and national reporting.

While I was sick, ProPublica came out with a series of articles showing not only that high levels of acetaminophen can cause severe liver damage, even leading to death, but that the margin of safety is very narrow. That means it can be very easy -- ridiculously easy, in my opinion -- to overdose on acetaminophen and not even know it until it is too late. More than 1,500 Americans died during the last decade of acetaminophen poisoning.

I’ll let you read the articles for yourself, but the point I want to touch on here is the paradoxical labeling of at least the bottle of generic acetaminophen I currently have. As I mentioned, it recommends taking two 500 mg gelcaps every six hours.

But read the second line of the directions, and you see that it says not to take more than six gelcaps in 24 hours.

Hold on. Let’s see ... two gelcaps every six hours ... there are four six-hour periods in a 24-hour day ... two times four is eight. If I do that, I’m already hitting two more gelcaps than I should in that 24-hour period.

In fact, if you go back up the label to the warnings section, it clearly says, “Liver warning: This product contains acetaminophen. The maximum daily dosage of this product is 6 gelcaps (3,000 mg) in 24 hours. Severe liver damage may occur if you take: *more than 4,000 mg of acetaminophen in 24 hours *with other drugs containing acetaminophen [and there are a lot of them] *3 or more alcoholic drinks every day while using this product.”

Luckily, I don’t drink, but, obviously, you can’t take two gelcaps every six hours without going over the 3,000 mg limit.

Sure, the fourth dose is at the 24th hour, but I don’t want to take the chance. I have enough problems as it is without messing up my liver. I’m only taking them every eight hours.

Please read all your medication labels, even non-prescription ones. You can never be too careful.


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