Question about acetaminophen consumption...

So... This isn't the normal idiotic question asking "how much acetaminophen can i take in one day?" or "how much can i take at one time?". This question is more of a personal matter that applies to myself specifically and my own abuse of opiates w/ acetaminophen. I'm well aware that the recommended dosage for acetaminophen is to not exceed 4 grams daily and to not exceed 1 gram at a time...

In order to ask my question and get an intelligent answer, I assume you need more info on my dosing habits. So allow me to inform... I have been taking opiates and have developed an addiction over the past 3 - 4 years which stemmed from a massive bout of severe depression that only opiates seemed to save me from on a daily basis. Over the past year, I have slacked off quite a bit and returned to daily cannabis use but i still would take decent doses of lortab and percocet maybe 3 times a week. Now, I'm back on the wagon again and I'm using hydrocodone semi-daily. I have a decent tolerance (30 - 50mg dose to get high) so I normally perform a CWE to rid myself of the acetaminophen. So, over the past two months, I have relocated and I can't perform a CWE without starting a massive argument that I don't wish to deal with. So, I just ingest the tylenol and say fuck it. I'm not taking CRAZY amounts, but I am starting to get worried. I'm not taking it every single day for the last month or so, but i am taking it at least 4 days a week and those 4 days are consecutively. I eat about 2.6 - 3.2 grams of tylenol at once, just once daily... late at night most of the time as it helps me sleep normally after a couple years of opiate abuse. I occasionally wake up and eat one or two more pills, keeping my daily tylenol consumption right at 4 grams or just over in the 4.2 - 4.5 range, but not every time. Most of the time I wait a full 24 hours before my dose of 2.6 - 3.2 grams again. Like I said, it's pretty much the same time every night. Sometimes, I even wait 36 hours between my dose, just to add a little safety into the equation...

So, my question is, will this type of dosing bring about cumulative liver damage and possibly liver failure after a while? I'm aware that I'm taking quite a dose of acetaminophen at once semi-daily and I have heard from numerous sources that that type of dosing in itself is a serious danger. I'm aware that I have probably been pushing my body's boundaries and I just would appreciate some intelligent feedback from some of you who may have encountered the same type of problem or something similar, or just have a general knowledge of acetaminophen abuse. Thanks in advance for any knowledgeable replies <3

 

As long as there's no current alcohol use, probably not. (Alcohol, besides being liver-toxic in itself, is partly metabolized by an enzyme that converts acetaminophen into its toxic metabolite. Chronic alcohol use tends to make the body make more of these enzymes responsible for alcohol's metabolism, so there's more of the toxic metabolite.) There could be some clinical signs of liver damage, such as elevated liver enzymes, but liver failure is quite unlikely as long as you don't start ingesting a lot more. Even at the recommended daily maximum, acetaminophen can cause elevated liver enzymes. They also say you shouldn't use it at the daily maximum dose for more than 2 weeks (I think that's the timeframe), but obviously a lot of people do. Honestly, I would be more concerned about the effects of chronic acetaminophen use on the kidneys. Although not as toxic to the kidneys as NSAIDs, it's definitely not too good for them in the long term.

 

Yeah, I forgot to mention that I don't drink. Not excessively anyway. I try to refrain from alcohol use altogether but most of my friends are drunks so it gets rather tedious trying to fend off the constant "hey man, drink a fucking beer!" attacks that i receive when i do go out with them. But i never have more than two beers maybe 3 times a month, which i consider being pretty damn cautious as opposed to some people.

So, you're saying I don't have to worry so much about my liver as I do my kidneys?? So, it's not damage to my liver perse, but possibly my kidneys... that still qualifies as damage to my body, so I guess that is one form of the intellectual answer I was looking for, I guess I figured something was getting damaged one way or another...

 

This is absolutely, 100% not true. It may be true in case of a one time bolus, but chronically abusing acetaminophen and opioids is hepatotoxic. Over 4g a day will result in permanent scarring over a three week period. In a young person, it's mostly reversible.

Drugs are excreted through the kidneys, and while it isn't good, your liver is a major concern and will likely show some enlargement on an ultrasound.

I work in an area where opioid abuse is rampant and I can guess where your LFTs stand. Don't listen to people who either want to scare you straight or lack medical knowledge. You HAVE to either cook out the Tylenol or take it without, because you're going to be very sick in a year or less.

The entire reason Big Pharma puts that stuff in is to knock off druggies quickly. Don't become a statistic.

 

Well, what I got from his post was that he was mostly not going over 4 grams per day. (With the highest amount mentioned being 4.5, which is not everyday). It's a very important detail because--as I'm sure you know--the difference between a therapeutic dose of Tylenol and a toxic dose is not very large. If he was regularly going over 6 grams, for instance, I would doubt it much more that he could continue on that way. Even 4 grams per day (an allowable therapeutic dose) can result in elevated LFTs and some enlargement and fibrosis over time. I never said his liver wasn't being damaged. It most certainly is. But liver failure? (Which is what my "probably not" referred to.) Unlikely. That's why I brought up the point about the kidneys because APAP is harmful to both, but the kidneys are less resilient than the liver.

Also, the reason "big pharma" puts APAP in combination with opiate analgesics is because the analgesic effect is greater with both in combination than either alone.

 

I am quite aware of this. My question is more about how much damage the actual dose I'm taking is doing to my body and my daily acetaminophen dose is normally 3.2 grams at the most... The only thing is, I'm taking that all at once, for the most part. It variates tho, sometimes I may only take 2.6 at once and that is my daily dose for that day. But regardless of the variation, I never really go past 4 grams in one day. 4.5 grams in one day for me IS VERY RARE. And I never take more than 3.2 grams at one time.

Thank you, Aesthete, for thoroughly reading my post

 

???

Theraputic levels are 5-20. Toxicity starts at serum levels of 150. There's not a narrow range at all, compared to lithium or digoxin. MOST people who get acetaminophen poisoning were taking "small" amounts over a long time. A one time damaging dose would require about double the amount of what they recommend.

In OB and oncology, your NSAIDs are additional meds and your opioids are separate because of toxicity. It's not a good idea to mix pain meds. For chronic pain patients, more often a benzo or first generation anti-emetic* is used. Trust me - The ones with the NSAIDs already in them aren't just because it's convenient, because people with severe pain don't get those.

You're just googling stuff and giving bad info, which is very distressing, and yes, liver damage and often eventually failure of long term Tylenol users does occur. Kidneys regenerate less readily than the liver, but that's not his biggest concern here, or it wouldn't be mine.

 

I take Tylenol everyday.. But if I take 4oooMg I feel my body resisting it...

2-500mg good enough for afternoon, I probably dont exceed that very often.

 

If you are taking over 2000mg daily, you are putting yourself at a significant health risk. You are not supposed to take that stuff every day. I can't tell you whether or not you'll end up giving yourself liver cancer, but I can tell you you're significantly elevating your chances. I can't tell you if you'll ever need a liver transplant. What I can tell you is that the majority of people who experience acetaminophen poisoning were taking small doses each day. And if you go the ER, they will find the opioids. And it's a long and unpleasant road.

You really need to come clean with your doc and see about a methadone or suboxone treatment. Your habit is reduced to about $4 a day, and you don't have to tolerate this crap. And a doctor or nurse practitioner will HELP you or understand if you find a good one.

 

I swear to God I'm going to beat you to death.

 

It is a pretty narrow range. You just said double the recommended dose can cause toxicity. That's true. Ingesting eight grams in a day can cause acute liver failure. More likely that it won't, but it can certainly happen. A large number of poisonings do arise from accidental or too many small doses, which wouldn't be nearly as common if the difference between a therapeutic dose and a toxic one weren't so small. Part of the problem is APAP can be found in a lot of OTC products, and people don't always read labels to make sure they're not ingesting too much of it. Bottom line is if you are putting it in your body faster then your body can get rid of it, then you've got a problem, obviously. I can't say his liver won't eventually fail, but I'm stating it's unlikely that it will from taking doses of 2.6-4.5 grams per day four times a week. Certainly there are many opiate users who aren't nearly as careful with their acetaminophen intake.

 

Look, a narrow therapeutic/toxic range drug would be something like Digoxin.

Therapeutic range: 0.8-2.2mg/mL

Toxic: > 2.2mg/mL

Another example is Ethosuximide.

Therapeutic: 40 to 100 mcg/mL

Toxic level: >100 mcg/mL

Even ASPIRIN has a more narrow range than flippin' Tylenol, therapeutic being 50-250mg/mL and potentially toxic being 300.

(Source: Nurse's Pocket Drug Guide: 2011)

Tylenol has to be almost 8x a therapeutic dose to be immediately hepatotoxic. I don't know why you insist it has a narrow range, but that's just incorrect.

It does not matter how many times you say it. Most people who have acetaminophen-related liver dysfunction are taking "small" doses, less than 3000mg, daily.

When did I say his liver will fail? He will more than likely have damage and reduced function. Where are you getting your information from? Besides, if you are right and the therapeutic/toxic range IS super-narrow, he should be more worried.

Habitual users tend to have poor nutritional habits and weakened immune systems as is, even those who are just eating, so telling them to continue a habit that is liver-damaging is dangerous. Stop arguing and think logically about the good of the person instead of trying to be right. And that's all I have to say.

 

They SAY 4,000 mg. is the upper safe limit, but it varies for everyone. In rare cases, people have had severe liver damage from one or two APAP pills (again, very rare). Add alcohol, kava or another liver toxin into the mix and your APAP limit goes way down. History of liver/kidney disease? You should probably forget it altogether in that case.

Personally, I wouldn't dare take anywhere near 4,000 mg. everyday, but that's just me. A quick google search will reveal that it's not as safe as most people think. (one Harvard study sticks out in my mind).

 

I never told him he should continue his habit. I even brought up another reason to be concerned about the health effects of this habit (the kidneys). As for the narrowness of the toxic range, maybe someone could go a year using the drug at 2 g/day but suffer ill effects with just 2 extra-strength tablets more at 3. It may not be the narrowest range you can give examples of. And yes, of course, it is a good reason to curtail tylenol consumption and do CWEs.

 

i i were you i would find a way to do a CWE. if you get it scripted or can buy abunch at once i would just do one big CWE then keep liquid measurement so you can dose yourself that way.

 

^^^^ No shit, CWE is the livers pre filter and the reason I still have a liver that works.....

1. Crush

2. Add cold water, let sit in fridge and settle for 20 mins

3. Slowly filter through a coffee filter, discard white gunk

4. Put back in fridge to settle/cool for another 20 mins

5. Filter again, discard white gunk

<<<<< Done>>>>>

This will save your liver people, please if you have to do stuff with Tylenol in it do this for your future health.