Tag Archives: acetaminophen

More evidence that aspirin and ibuprofen don’t help with back pain

Scientists have shown that despite popular belief, aspirin and ibuprofen (also known as acetaminophen or paracetamol) don’t help with back pain at all.

Image credits: Derrick Coetzee

Over-the-counter pills are quite popular, but do they really help? Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are taken for many reasons, from common colds to hangovers or muscle aches. But they don’t always help, despite what many people think. A new study has found that in the case of back pain at least, they do little more than a placebo.

It’s not that they don’t do anything… it’s just that they don’t do anything for most people. The doctors report that for every patient reporting a clinically significant decrease in pain after two weeks on an NSAID, another six didn’t. This builds on previous studies, including a Cochrane review conducted in 2015 which found that ibuprofen is little more than a placebo for acute back pain.

Researchers from the George Institute for Global Health in Australia analyzed data from 35 peer-reviewed studies which included 6,065 patients with spinal pain. They found that despite being the most taken pills for back pain, paracetamol and its variants do basically nothing to ease the pain.

“When this result is taken together with those from recent reviews on paracetamol and opioids, it is now clear that the three most widely used, and guideline-recommended medicines for spinal pain do not provide clinically important effects over placebo,” they write in their paper.

Even stronger drugs, opiates such as codeine or OxyContin provide only modest short-term relief for those with chronic back pain, according to research published inJAMA Internal Medicine in 2016.

While this might seem like pretty grim news, it’s actually good news. For most people, back pain is a temporary, passing issue, but the people who struggle with chronic issues deserve better treatment.

Team researcher Manuela Ferreira advises in The Guardian:

“We are not arguing that no pain relief should be used, but people using these types should be aware the benefits are small and that their side effects can be harmful, and that discussing with their doctors the benefit of other treatments including exercise may be worthwhile.”

Also, it’s quite shocking to see that such a common problem was mistreated by so many people for so many years.

Journal Reference: Gustavo C Machado, Chris G Maher, Paulo H Ferreira, Richard O Da — Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis. Ann Rheum Dis doi:10.1136/annrheumdis-2016-210597

Acetaminophen affects the ability to detect errors

Acetaminophen, commonly sold as Tylenol or Paracetamol may affect our ability to solve errors, a new study has found. The impairment is minor, but noticeable.

Acetaminophen is one of the most common drugs, usually taken for mild pains and fever. But recently, more and more studies are starting to point out the negative effects of the drug. The latest in the string of side effects was pointed out by Canadian researchers, who report that people taking the drug are less likely to observe errors.

“It looks like acetaminophen makes it harder to recognize an error, which may have implications for cognitive control in daily life,” said Dan Randles, a researcher at the University of Toronto. “This is the first study to address this question, so we need more work and ideally with tasks more closely related to normal daily behavior.”

For the study, published in the journal Social Cognitive and Affective Neuroscience, they recuited 62 people for a double-blind, randomized study with half the participants receiving 1,000 milligrams of acetaminophen, the normal maximum dose, and the rest given a placebo. They were then hooked up to an electroencephalogram and given a target-detection task called Go or No Go, hitting a button when an “F” appeared on a screen but not hitting the button if an “E” appeared on the screen. Not only did the acetaminophen group hit the button more often when an “E” appeared, but they also missed more “F” screens, suggesting that the drugs has an effec that goes beyond just numbing the pain.

“An obvious question is if people aren’t detecting these errors, are they also making errors more often when taking acetaminophen,” Randles asks.

Acute overdoses of acetaminophen can cause liver damage and might even be fatal. The toxicity associated with Paracetamol and Tlenol is the foremost cause of acute liver failure in the Western world, and accounts for most drug overdoses in the United States, the United Kingdom, Australia and New Zealand.According to the FDA, in the United States there were “56,000 emergency room visits, 26,000 hospitalizations, and 458 deaths per year related to acetaminophen-associated overdoses during the 1990.

Prenatal exposure to paracetamol (acetaminophen) linked to asthma

Researchers have made a stronger case for the negative effects of paracetamol on pregnant women. It was already documented that prenatal paracetamol consumption is associated with asthma; now, a team has shown that this is not because the underlying condition for which the drug was taken.

Paracetamol, also known as acetaminophen and often sold under the name Tylenol, is one of the most commonly consumed drugs in the world. A mild analgesic, does not have significant anti-inflammatory activity and in fact, we don’t really know exactly why it works. Recently though, more and more studies have begun to show that it can have some very nasty effects – including liver failure, if taken in too large quantities.

Now, a team of Norwegian researchers confirmed what many physicians already suspected – pregnant mothers should avoid taking paracetamol, if possible. Co-author of the study, Maria Magnus, commented:

“Uncovering potential adverse effects is of public health importance, as paracetamol is the most commonly used painkiller among pregnant women and infants.”

Using data from the Norwegian Mother and Child Cohort Study, researchers in Norway and England compared this association over 114,500 children. They examined the asthma outcomes, as well as the three most common triggers for paracetamol use in pregnancy: pain, fever, and influenza.

They found that if mothers consumed paracetamol during their pregnancy, the likelihood of asthma was much higher – especially if they took it more than once. Furthermore, asthma rates weren’t correlated with either one of the three affections.

This seems to cement what previous studies found, that asthma is indeed caused by the drug and not by the underlying conditions.


Tylenol and infant usage

Judging by the emails we get, lots of our readers take Tylenol on a (mostly) regular basis, and lots of you are worried about its effects. As I already discussed how to take it responsibly in a previous post, now I’ll talk about using it with infants.


Tylenol (which is also paracetamol or acetaminophen depending on your country) is one of the most common drugs in the entire world – basically your go to over-the-counter analgesic (pain reliever) and antipyretic (fever reducer). However, when you know that Paracetamol intoxication is the foremost cause of acute liver failure in the Western world, and accounts for most drug overdoses in the United States, the United Kingdom, Australia and New Zealand (to name just a few), most people wouldn’t even consider giving it to their infants; is this an overreaction?

The maximum dosage for adults is 4000 mg – but you should never even go near that dosage. If you require that much pain relief, then you probably should visit your physician so he could prescribe something more suiting. The common dose for adults is 500-1000 mg. The absolute maximum for infants is 2500 mg / day – but again, you shouldn’t even go near this value; there have been reported cases of acute liver failure at doses of around 2000 mg. Ideally, you wouldn’t go over 500 mg / day – and you should always check with your physician before administering anything to your infant, and most doctors will never prescribe over 1000 mg / day. However, again, these are the maximum values.

Recommended values for children, as reported by the NHS for infants are:

  • 3 months to 6 months: 2.5ml of infant paracetamol suspension, given up to four times per day
  • 6 months to 24 months: 5ml of infant paracetamol suspension, given up to four times a day
  • 2 years to 4 years: 7.5ml of infant paracetamol suspension, given up to four times a day

Infant Tylenol suspension contains 120mg of paracetamol for every 5ml of suspension, so you get 60, 120 and 180 mg respectively per dose, 240, 480 and 720 mg per day. Parents and/or caretakers are advised to use the dosing spoon provided with the medicine or a syringe to ensure that the correct amount of medicine is given to children. Most doctors also recommend shaking the bottle before giving it to your child.


Also, since Tylenol is very demanding of the liver, it is usually not prescribed with drugs with a similar effect on the organ.

Health ABC: Everything you wanted to know about acetaminophen

Paracetamol or acetaminophen (going by trade names such as Tylenol, Panadol, Efferalgan, and many more) is one of the most common and effective drugs out there. You’ve almost certainly took it at some point in your life, your parents have, your friends have, I don’t think I know more than a few people who never have. But I was surprised to see that many people don’t really know what they’re taking, so I wanted to clear the waters a little bit.

What acetaminophen is

acetaminophen 3

The substance falls into two categories: it is a mild analgesic (calms pain) and antipyretic (reduces fever). Interestingly enough, the exact mechanisms of action is not entirely known; for its work as an analgesic, it works by increasing the pain threshold – basically by making you take more pain before you feel it. As an antipyretic, it works on the heat-regulating center of the brain, basically telling the brain to reduce the body’s temperature; it works on people of all ages, though it is not as effective on children.


The onset of analgesia is approximately 11 minutes after oral administration of paracetamol, and its half life is 1-4 hours. In combination with other analgesics, it can be used in the management of more severe pain such as post-surgical pain and providing palliative care in advanced cancer patients.

It was approved by the FDA all the way back in 1951, and since then, it hasn’t really changed that much. It’s also available without a prescription in virtually any country.

Negative side effects, overdoses


If you take the recommended doses, the negative side effects are mild to non-existent. It doesn’t cause gastric issues, and unlike aspirin, it can be taken by patients with coagulation problems. Comparative studies have shown that its effects are slightly weaker than those of ibuprofen, but the side effects are much milder. While ibuprofen, even in regular doses, can cause diarrhea, vomiting and abdominal pain – paracetamol causes none of these issues.

However, the substance is hepatotoxic – it’s toxic for your lives. For that purpose, people who are chronic drinkers or suffer from other liver issues should be careful when taking the drug. Also, the overdose can be very dangerous.

Paracetamol hepatotoxicity is, by far, the most common cause of acute liver failure in both the United States and the United Kingdom – probably in most developed countries as well, but I couldn’t find any data on the issue. The initial signs may be vague or absent, but untreated overdose can lead to liver failure in a matter of days. There are tablets available (brand name differs) which mix acetaminophen an antidote (methionine), to protect the liver in case of an overdose. You shouldn’t take more than 1,000 mg per single dose and up to 4,000 mg per day for adults.


Paracetamol has been with us for more than half a century – and it will probably be around for even longer – because it works! In recommended doses, it has little to no side effects and it’s suitable for a huge number of diseases and conditions (especially milder ones), but overdoses are extremely dangerous. You should always consult with a physician (or at least a pharmacist) before giving it to a child, but adults without any liver problems can take it without any concerns – as long as they don’t go over the recommended dose.

Get Responsible Pain Relief When Taking Acetaminophen

The dangers of prescription drugs

A while ago I wrote a post on the dangers of prescription drugs; the next day, I woke up to see many concerned emails regarding responsible medication, self medication, and other related topics. I tried my best to reply to each and every one of them, but I figured since this is such a big concern to you (and for good reason!), the topic really deserves an article.


So, for those of you who haven’t read the previous article, here’s the summary: In 2010, prescription drug overdoses killed 23,000 Americans (pretty much all of them due to overdoses). This raised a big question mark – how can approved drugs be so dangerous? Well… the thing is… they are, so it’s up to as to be prepared. If you are taking such drugs, be sure not to stray a single step from your doctor’s recommendation! More is not better, not in this case. Also, we have the internet now, this is 2013. You can literally google up any drug and just see what it does, what are the side effects associated, what an overdose can cause, etc. Of course, be selective about what information you pick up, and bare in mind that google is not a substitute for a physician!

A word on acetaminophen (paracetamol)


Acetaminophen orparacetamol is a widely used over-the-counter analgesic (pain reliever) and antipyretic (fever reducer). The first name goes in the US (the iconic drug here being Tylenol), while the second one is used in Europe and mostly, in the rest of the world. Pretty much everybody has taken this drug, no matter where you are – and really, it’s ok. It’s a good drug, it’s remained virtually unchanged for decades because it works. Simple as that. In contrast to aspirin, it doesn’t work as a blood thinner, and thus may be used in patients where coagulation is a concern, and it does not cause gastric irritation. The main problem however is overdose.

Paracetamol hepatotoxicity is, by far, the most common cause of acute liver failure in both the United States and the United Kingdom (probably other areas as well, but we don’t have any data). Paracetamol overdose results in more calls to poison control centers in the US than overdose of any other pharmacological substance, and this is mostly because people don’t take it responsible – there, I’ve said it. Just because it’s a simple drug, one that’s virtually everywhere and just because it does a lot of good doesn’t mean you should take too much. How much is too much? I can’t really say, because it depends on so many factors, but your local pharmacist will be more than willing to share that information with you. If you’re just on the edge, or not sure if it’s too much, or just want to play it on the safe side, there are tablets combine paracetamol with an antidote (methionine), to protect the liver in case of an overdose.











Also, be sure to note that more drugs contain this substance, and it’s really important that you only take one drug containing acetaminophen (paracetamol) at a time! For example, aside for Tylenol, Vicodin, Percocet, Midol, NyQuil and Excedrin all contain the substance (as do more drugs, depending on the country – there are literally hundreds of drugs with this substance); be sure not to take more than one of these at the same time!

So talk to your physician and your pharmacist, don’t self medicate, and stay as informed as possible – those are probably the best pieces of advice I can give you.