PRESCRIPTIONS
Resist urge to take extra Tylenol
By Landis Lum
Do you believe that just because drugs such as Tylenol and Advil are available without a prescription you can safely gulp down more pills if your pain persists or your kid's fever remains high?
Well, you should know that the Journal of Pediatrics in January 1998 found nearly 50 young people with severe liver damage after ingesting two or more doses of Tylenol (acetaminophen) at higher-than-recommended doses. Half these keiki died, and three required liver transplantation. Their parents may have run out of the pediatric preparations and substituted an adult preparation, misread instructions or given more Tylenol because fever persisted.
Fever, especially in an infant, can sometimes be a signal of serious illness and should be discussed with your physician. However, fever actually helps the immune system fight infection and will not continue to go higher and cause brain damage if you don't treat it. Therefore, don't treat fever unless there is another reason for Tylenol or Advil (ibuprofen), such as pain, discomfort, headache or a chronic heart, lung or blood condition.
Tylenol is safer than anti-inflammatory drugs such as Advil, Aleve, and Feldene because the latter can cause dangerous bleeding ulcers, especially if taken daily for more than a few weeks or months, or after even shorter periods if a person is debilitated, elderly or has chronic heart or kidney problems. Anti-inflammatories may worsen heart failure or kidney problems. Don't take anti-inflammatories if you're on blood thinners such as coumadin or warfarin, or on steroids such as prednisone; in such situations, use Tylenol.
Alcoholics and those with severe liver disease should never exceed four extra-strength (or six regular strength) Tylenols (2,000 milligrams total) a day; this can precipitate massive liver damage and death. This same amount of Tylenol can increase warfarin activity, so get extra coagulation tests if you're on warfarin and are taking 2,000 milligrams of Tylenol a day for more than 48 hours.
If you don't have liver disease or drink excessive alcohol and your pain is still bothersome, you can take up to two Extra Strength Tylenol (acetaminophen) pills three to four times a day (or three regular strength pills three to four times a day), but drink a FULL glass of water with each dose to prevent liver toxicity.
For people with arthritis or joint pains, try capsaicin cream, which is made from the active ingredient in Tabasco sauce. The burning feeling which is a side effect of capsaicin is less common with the 0.025 percent cream, which must be applied as often as three or four times daily. Maximal improvement may take a month.
What about herbs? Because herbs or supplements are not regulated by the FDA, you can never be sure of their purity, dose or safety. However, the Cochrane database of systematic reviews concluded that there was good evidence that glucosamine is both effective and safe in treating degenerative or osteoarthritis, although long-term effectiveness and toxicity remains unclear. They also reviewed studies of herbs, including so-called avocado/soybean unsaponifiables (ASU), a concoction composed of unsaponifiable (please don't ask what this means) fractions of one-third avocado oil and two-thirds soybean oil. They concluded that, unlike other herbal therapies, ASU effectively reduced osteoarthritis pain.
So be akamai and never take more than the recommended amount of drugs — even if you still have pain or fever!
Dr. Landis Lum is a family practice physician with Kaiser Permanente and an associate clinical professor of family and community medicine at the University of Hawai'i's John A. Burns School of Medicine. This column is not intended to provide medical advice; you should consult your doctor.
