PrepperMed 101: Acetaminophen and OTC Medication Safety

If they sell it over the counter (OTC, meaning without a prescription), a medication must be safe, right? You should just be able to stock and use OTC meds without much concern, right? Nope. OTC drugs are easier to select and use safely than prescription meds, sure.

That’s a trend, however, and not a guarantee.

We have to know what stingers might hide in the tails of the medicines we stock. OTC meds are no exception. Look at a great example of this: Acetaminophen.

We talk about this and more in this podcast recorded to accompany this article: 

Acetaminophen: An example of the stinger in the tail of an OTC drug

Acetaminphen (trade name Tylenol, among others) is a very common OTC painkiller because it’s very useful and safe when taken as directed. Take it as directed and it’s safe. Acetaminophen overdose is also a leading cause of liver failure. 

This is not one of those “oh, this could possibly happen sometime to someone.” It is the reason for about 20% of the liver transplants done in the USA every year (4). In addition, acetaminophen overdoses cause around 450 deaths annually.

Most groups, including Salty’s physician, say acetaminophen is a good choice for pain control taken at doses of 4 g/day (for adults) or less. A more cautious subset sticks with 3 g/day as the cap, 75 mg/kg/day for children. (1) (I make no recommendations at all; I’m not a physician.) 

All sources agree that higher doses lead a lot of people into liver failure. Often the liver will recover on its own once the drug is stopped. In other cases, people need liver transplants. Some of them die. You’d probably guess that a liver transplant is not going to be an option in the situations where our preps are needed. We’d better avoid the necessity.

Why do so many people get liver failure from acetaminophen?

There are three main contributing reasons people get into trouble with acetaminophen.

People don’t pay attention because they consider it must be safe if it’s sold over the counter. (This problem is what motivated me to write this post.)

Another problem is that the toxic dose is surprisingly close to the recommended dose. You have to take 10x or more above the recommended amount of many OTC drugs before problems become likely. However with acetaminophen, the liver starts suffering at less than twice the recommended dose. (This is usually a problem for FDA regulators for OTC drugs. I’m not sure what happened there.)

Lastly but not leastly, acetaminophen isn’t always obvious in the drug. It’s often uses in combination with other medications. Don’t think there’s no acetaminophen in it just because the name in big print on the label is not acetaminophen or Tylenol.

The combination of acetaminophen with opiate painkillers is very effective, allowing both to be used at lower doses than usual. (2) For example, Oxycodone is a common combo prescription drug. Acetominophen is also often used as part of OTC multi-symptom relief cold medications, or with caffeine to increase the anti-headache action.

It’s common for overdoses to arise when people take more than one acetaminophen-containing medication without knowing or thinking about their total acetaminophen dose. Some of the most common combo prescription medications with acetaminophen include Norco and Oxycodone.  Excedrin, Sudafed, NyQuil, and Dayquil are popular OTC varieties. Here’s a list with some others. 

What can preppers learn from the acetaminophen example?

1. Know the baggage of everything you stock in your prepper’s medicine chest. Every drug, even the OTC ones, have its risks and quirks.
2. Pay particular attention to combination medications. Read the label if you’re not sure what drugs are in a remedy. In fact, back up a bit and just read the label of every drug. Yeah, skim through the CYA lawyer-speak; but pay attention to the important bits.
3. I’m not staying don’t stock OTC meds, because some are great tools. You’re spiting yourself if you ignore meds because they’re not 100% safe. Don’t fool yourself: No chemical that affects how your body works is 100% safe. Understand, that most definitely includes the chemicals naturally produced in herbs. Every drug in sufficient concentration is a poison, for example. We just have to pay attention.

Some other considerations on OTC medication can be found here. 

References:

1) LiverTox: Clinical and Research Information on Drug-Induced Liver Toxicity. (2018). National Institutes of Health. https://livertox.nih.gov/Acetaminophen.htm.

2) Gatti A¹, Sabato E, Di Paolo AR, Mammucari M, Sabato AF. Oxycodone/paracetamol: a low-dose synergic combination useful in different types of pain.Clin Drug Investig. 2010;30 Suppl 2:3-14. doi: 10.2165/1158414-S0-000000000-00000.

3) Common medicines including acetaminophen. 2017. Acetaminophen Awareness Coalition. https://www.knowyourdose.org/common-medicines/

4) Yoon, E., Babar, A., Choudhary, M., Kutner, M., & Pyrsopoulos, N. (2016). Acetaminophen-Induced Hepatotoxicity: a Comprehensive Update. Journal of clinical and translational hepatology, 4(2), 131-42.

5) BruceBlaus [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons

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