Acetaminophen: Miracle Drug or Liver Toxin?

Acetaminophen: Miracle Drug or Liver Toxin?

Today we are reading reports that the Food and Drug Administration (FDA) “assembled 37 experts to recommend ways to reduce deadly overdoses with acetaminophen, which is the leading cause of liver failure in the US and sends 56,000 people to the emergency room annually.”

As a physician who specializes in Pain Medicine for the last 20 years, I routinely order blood work to measure liver function studies at least once/year in those who are taking acetaminophen on a regular basis.

In my experience, everyone I have seen who has liver damage due to taking too much acetaminophen has either intentionally overdosed on acetaminophen or taken large doses of acetaminophen with pre-existing liver disease from other causes, such as Hepatitis C or alcoholic liver disease.

For those with pre-existing liver disease due to Hepatitis C, long term alcohol abuse, or other causes, I would recommend that they avoid acetaminophen completely. In my experience, acetaminophen will certainly “pour gasoline on the fire” of any pre-existing liver disease.

As the news reports correctly point out, acetaminophen is contained in many non-prescription medications (such as cold remedies, pain medications) as well as prescription medications (such as Vicodin, Lortab, Lorcet, Percodan, & Percocet).

Some people with severe pain conditions take more than the recommended maximum dosage of acetaminophen (two 500mg tablets up to 4 times daily) in order to get relief from their pain without going to a doctor or having to take prescription medications. I would certainly recommend against this.

BOTTOM LINE

If you have liver disease from other causes, such as Hepatitis C, regular alcohol use, or other causes, avoid regular use of significant amounts of acetaminophen and get blood work to track changes in liver function studies.

If you do not have liver disease, occasional use of acetaminophen is safe as long as you’ve never had an allergic reaction.

If you take acetaminophen on a regular basis, either alone or as an ingredient contained in other medications, speak with your healthcare provider about getting blood work to measure you liver function studies.

If your liver function studies are normal, then there is no evidence that your current intake of acetaminophen is doing harm. If they are elevated, then discuss this with your healthcare provider. Consider stopping acetaminophen & alcohol, and ask your healthcare provider about further investigation into other possible causes of liver disease, including other medications that can cause liver enzyme elevations.