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Headache or Liver transplant. What is your preference? Tylenol and the FDA.

July 2, 2009

What’s wrong with Tylenol? Take too much and you could end up with a liver transplant, if  your “plan” will pay for it.

The FDA has issued Tylenol aka acetaminophen a black penalty box warning.  That means take this warning seriously.

How can such a commonly taken, over the counter medication be just now labeled as unsafe? It has been known for years now that  taking 4 grams daily without alcohol can cause a rise in liver transaminases. That  danger is increased causing more damage to the liver when used in daily dosages higher than 7 grams and especially if taken with several alcohol drinks, think certain cold remedies.  The evidence of 264 liver transplants required due to acetaminophen related liver failure is one significant study prompting the FDA to enact the black box warning. Acetaminophen is the most common drug causing acute liver failure in children in the US and the UK. The only acute treatment for acute acetaminophen toxicity is acetylcystine.

So what is the take home message….if you do not want to risk liver failure and liver transplant for your survival then be careful of the amount of acetaminophen you take. Take the black box warning on acetaminophen very seriously. Make CAM alternative choices.  For instance, ginger is described as the universal medicine in ayurvedic therapies. Highly recommended for headache and migraine therapy.

Side Effect Profiles of Antinausea Medications (excerpt from The Sweet Smell of Success)
There are numerous other rare but potentially serious adverse drug reactions which have earned black box warnings attributed to  many different classes (antibiotic, antidepressants, antipsychotics) of drugs including antinausea medications. These adverse drug reactions range from mild confusion, dysphoria, headache, phlebitis, tics, torticolis, serotonin syndrome, neuroleptic malignant syndrome, and alpha blockade alterations in blood pressure to potential life-threatening cardiac rhythm disturbances.

Succinylcholine is a neuromuscular blocker used to faciliate endotracheal intubation. There is an FDA black box warning on succinylcholine because co-existing conditions such as certain muscles disorders in children place them at increased  risk of malignant hyperthermia.

Droperidol is the subject of a black box warning by the FDA (Habib and Gan, 2003). This controversial warning describes the rational for patients to have a normal Q-T interval documented by ECG prior to intravenous administration of droperidol. The risk of the malignant ventricular dysrhythmias, called torsades de pointes, associated with droperidol is also known to occur with several of the new selective blocking agents of the serotonin 5-HT3 receptor antagonists. This drug is commonly used by anesthesiologists.

Perhaps ginger oil Z. officinale could be considered an alternative for droperidol, even though one investigation failed to show antinausea benefit when droperidol was compared with powdered ginger root (Visalyuputra et al., 1998). The essential oil of ginger used topically at the time of surgery works great to prevent nausea. I apply to my anesthesia patients every day.

The King of Pop loved Propofol and that will be the subject of another post. It is a very good drug and very safe drug in the hands of an anesthesiologist. So is acetaminophen.


James Geiger MD

the oilMD

One Comment leave one →
  1. July 19, 2009 9:31 pm

    This post was picked up on Google Health News July 2nd 2009. The actual number of liver transplants is 265 not 264. Just wanted to see if anybody actually read the abstract and called me on it. Nobody has yet.

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