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Pain Reliever Top Liver Failure Cause

Acetaminophen is Safe at Recommended Dosages, Deadly When Abused
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Dec. 16, 2002 -- Acetaminophen is best known as the world's most popular remedy for easing life's aches and pains. Less publicized, perhaps, is its reputation as a popular drug of choice for ending life itself.

Although there is no medical data to suspect it poses danger at recommended amounts, the active ingredient in Tylenol is so toxic at high doses that a new study indicates that acetaminophen overdose has become the leading cause of sudden liver failure. For 30 years, hepatitis held that dubious distinction.

Researchers say that acetaminophen overdose led to nearly 40% of cases of acute liver failure among 308 patients over a three-year period. By comparison, about 13% of cases were caused by other drug reactions and 12% were the result of hepatitis types A and B.

What's more, one in three of these acetaminophen overdose cases was an apparent suicide attempt, finds the study, published in the Dec. 17 issue of Annals of Internal Medicine.

"Acetaminophen has been a suicide drug of choice ever since I started treating patients in the 1970s," says J. Ward Donovan, MD, FACMT, FACEP, medical toxicologist and emergency medicine specialist at Penn State Milton S. Hershey Medical Center. "The main reason it's so popular for that purpose is its availability and effectiveness. People can get it anywhere and use it without supervision in any amount they choose. And its biochemistry is such that is highly toxic at high doses."

In the Annals study, the latest to explore the dangers of abusing the world's most consumed medication, sudden liver failure typically occurred in those who took doses three times higher than the maximum recommended amount. Unlike other forms of liver failure, which can take years to manifest, acute liver failure typically occurs in a matter of days or weeks. It strikes about 2,000 Americans a year, many of whom die.

In this study, however, two-thirds of the patients were alive three weeks after requiring emergency treatment -- likely because they were treated at facilities specializing in liver disease. Of those, nearly 30% needed a liver transplant.

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