I have been repeatedly warned by my PM, surgeons, internist about the potential detrimental effects of tylenol (acetaminophen) on the liver and kidneys, ESPECIALLY when used on a daily basis. The fact that I am a chronic pain patient.... chronic being the operative word....means I will most likely be taking opiate based pain meds containing acetaminophen for many years or until death. I have been taking this stuff on a regular basis in one form or another for over 10 years now.
The docs warn first, never to exceed the max dose on a daily basis, and secondly to try and MINIMIZE the amount on a daily basis as I will be taking it until death...... The PM said that it will "shred your liver" and create serious problems for your kidneys if not careful.
I am sure that you are like me, you want to keep your liver and kidneys intact. After some reading, talks with docs, etc. my core pain meds were set-up to minimize acetaminophen in these meds. My around the clock pain med is compounded hydrocodone, which means it is made at a compounding pharmacy in capsule form where there is no acetaminophen added. It is an eight hour capsule. The reason I don't use any of the long acting oxy products is these tend to make me very irritable and impatient, so I don't take them for the benefit of wife and kids.
Back to my meds.: For BT meds, I am given generic norco 10/325. Since I frequently break these in half, I am only taking 5/162.5 .... meaning I am only taking a very small dose of acetaminophen (162.5 mg) at a time.
I must admit that I do have elevated liver enzymes and some kidney problems, so I have a particular interest in ensuring that I minimize acetaminophen intake.
Prior to writing this, I did a search for "tylenol safety" and found some very interesting info. You may want to do the same. One case described was of a young man who was taking tylenol for a couple of weeks, for a wrist injury, became very sick, was hospitalized and died. Cause of death: acetaminophen poisoning. The fact that it is found in several hundred products should alert us to carefully check the ingredients list to ensure we are not taking an excessive amount (cold meds, pain relievers, sinus meds, etc.)
I have two basic things I tell people about meds when they are going to see a PM doc for the first time for chronic pain: Ask him/her about the amount of acetaminophen in the meds they are proposing; and secondly, what is potential risks of LONG TERM taking of the amount proposed. Arm yourself first by doing some research on-line.
I must tell you that all the studies that I have read explain that adding acetaminophen to a narcotic pain med enhances that pain relieving quality.... it is called adjuvant. When extra relief is needed I usually turn to advil/ibuprophen, and then I am careful not to take too much as it tears my stomach up.
Also, at least annually if not more often, I have blood work done to evaluate my liver enzymes and kidney function.
CB,just wondering why,when actually having the compounded hydro created to not include tylenol,why you are on something WITH tylenol?it just seems kind of odd.considering the fact that you stated you actually are having out of range labs already,you really should not be taking ANY tylenol based meds period,really.there is roxicodone or oxy IR that do not actually contain any tylenol that would be much safer for you to be taking at this point.
the thing about labs is they do not go out out of range til the actual real damage gets to a certain point,you are there already with out of range labs,thats not a good thing for your liver.this IS confirmed damage.i am a bit curious about what your doc stated about the liver actually 'shredding' because of tylenol usuage?thats really something i had not ever heard before.the liver cells do die,but the liver will generally become hard,but not actually shredded.
the 'safe' limit for the occasional tylenol user is at 4000mgs per day,but when used on a dailyor chronic basis thet safe level actually goes down to only 3000mgs.and like you mentioned above it also is very hard on the kidneys too.the liver just needs time to replenish the gluthethione it needs to actually metabolize tylenol and other meds that also will deplete that as well.once the body/liver cannot keep up,thats when the cell damage occurs.you are just in a rather dangerous type of situation CB with any continued usage of tylenol.
believe me,i had to learn everything about the liver and kidneys when my son went into 'suprise' liver failure back in 99.since then i also found out that i too have liver and kidney disease as well.the really freaky part tho is despite some really horrid looking ultrasounds done on my liver and mostly my kidneys,my labs have still remained with the normal ranges.still.amazing really if you ever actually saw those nasty ultrasounds.you just really really have to try and get off any tylenol based meds at this point.there are other options.your particular damage is already showing itself and will only become worse if you stay on tylenol in any form.its like an alcoholic who has cirhosis,the damage is there and can regenerate itself pretty amazingly in some cases,but ONLY if the alcoholic stops taking in the thing that is causing the real damage for him,alcohol.you are kind of in that same boat unfortunetly,but with tylenol.any other meds you take that are also metabolized within your liver could also aggrevate this situation since it does also need the stored gluth to complete the metab process.you know what i mean?i really think you need to reasscess your current treatment plan/options.you just really need to be protecting the liver and kidneys as much as possible(espescially if this is going to be a long term type situation) or it could lead to something much worse.trust me,you do not want to go thru what my son had to.you do have safer options out there.i wish you the best and hope you can get off all tylenol based meds completely,believe me,you will be very glad you did,and your labs will most likely eventually come back within normal ranges again.while the liver can regenrate itself and is probably the most forgiving organ in our bodies,it can only do what you allow it to.what labs are currently out of range for you and how long have they been that way?marcia
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.
Good questions ... lengthy answer. First, the compounded hydrocodone is in the most restricted class of meds due to it being pure (I think it is CIII for feds and CI for our state). Norco, because the opiate ingredient is combined with another ingredients drops it down one class. My doc does not want to be giving me two scripts for the most restricted meds.
ALSO, compounded meds are more expensive. I take 30 mg. of compounded hydro every 8 hours. The generic norco costs me about $10 as it is mass produced; the compounded is hand made locally at the compounding pharmacy. So, cost is a factor.
Thirdly, the compounding pharmacies prepare these compounds for long acting meds 8 hours. The norco is given for BT pain, so it is to be fast acting and of short duration. Compounding would not be feasible.
Regarding the roxicodone or oxy IR you mentioned, I cannot take these. I am highly sensitive to some meds, why so, who knows. I have tried many, many short and long acting, patches, etc., but find the most stable relief WITH THE FEWEST SIDE EFFECTS with the hydro. I realize it is not the strongest, but fortunately my doc goes through a process where he puts me on something else after I go through a number of increases in the hydro, such as duragesic, methadone, etc. This allows me to return to the hydro at much lower doses. As I said, the duragesic and methadone presented problems/side effects, so I only stay on them long enough to reduce the dependence on the hydro, so that when returning to it, it may be more effective at lower doses. It is a good system for me, but as just about everyone says at one point or another in these threads....EVERYONE IS DIFFERENT AND WHAT WORKS FOR ONE DOES NOT WORK FOR ANOTHER AND VICE VERSA. Its all trial and error. I have been dealing with this for alot of years.
By the way the docs did not say, NO tylenol, they suggested we keep it at an absolute minimum. This is the vest combination/balance to accomplish satisfactory pain relief with fewest side effects. I also frequently check my liver enzymes... no detrimental effects so far and I take ACE inhibitors which provide some measure of protection to the kidneys.
I think his use of the term "shredded" was to emphasize "damage", I don't know if it actually becomes shredded, in fact I doubt that.
feelbad wrote "the thing about labs is they do not go out out of range til the actual real damage gets to a certain point,you are there already with out of range labs,thats not a good thing for your liver.this IS confirmed damage.".... I don't know what you mean/referring to here???
Ref. the liver issues, as mentioned, I have this and the kidneys frequently tested. Actually, my other conditions and the 10 other meds I take are more problematic on the liver/kidney than the small tylenol in the breakthru meds.
Sarcoidosis (potato size glandular masses in and out of lungs and through the body), hypertension, heart disease, diabetes, esophagitis, malrotation of the gut, fibromyalgia, restless leg syndrome, chronic sinusitis, arthritis, DDD, spondiolosis, spondiololosis, spondylolothesis, sleep apnea, and a number of others.
So, to summarize my situation, I am take the pain med that is tolerable and beneficial with the least side effect after trying a host of them over 10 plus years, trying to minimize the negative impact on liver and kidneys, all while trying to keep my other more serious, through less painful health condition under control. Needless to say, I wish it would be better, but it is the best I can do considering my financial situation (disabled pension), being homebound, unable to drive, in constant pain, with 2 of 4 children still at home, while keeping a fairly positive outlook on life, by the grace of God.
Thanks for your questions. Sorry about the lengthy response, but as you did, I have spent hundreds, if not thousands of hours reading books and materials on my illnesses and meds, as well as seeking the advice of my regular docs, and two good friends who are both doctorsl.
May the sun smiling on your face lessen your pain and bring peace to your heart.
Last edited by HBMod07; 11-10-2007 at 09:45 AM.
Reason: Please only quote the portion of the message you are responding to
My advice is to stay away from acetimenaphon all together. Don't even debate the max/min dose. There are so many other things out there and acetimeniphin put me in the hospital for 3 days to under go mucamist treatments for incidental overdose they called it. I was on high dose acetimeniphan as monitored by my doc several years ago, my liver tests were all fine and out of nowhere my eyes went yellow and I got really sick and ended up in the hospital. I was on 4grams a day. At one time I was on 8 grams, and my doc at that time said they had all kinds of elederly patients on high dose treatment for severe ahthrits and rhumitism. Since then, they have stopped that It was explained to me that acetomenipan is like alchol. It damages your liver over time and not over night. And your liver does heal. Now, but I never take it because it is just poison and it scared me how quickly that happened. Docs love to give pain meds with this as a buffer to prevent people form taking too much at at time. But people still do, and they end up damaging their liver.
Wow this just goes to show how much different information is out there. I was told that 4000 mg was the safe limit for very short term. My PM says he is somewhat comfortable with 2000 mg for long term. He also has me on the norco 10/325 4x a day. With this dosage i am getting 1300 mg of tylenol daily. He said this gives me the option to OCCASIONALLY take an extra tylenol or ibuprophen if needed. The strange thing is that my husband tends to take more tylenol daily than i do. When i found this out i made sure to share the info with him and he has cut himself back to 2 8-hour tylenol for his back. The public is very ignorant and very unaware of the dangers of this seemingly innocent medication. To be honest i was too until i had CP. God bless, morgy porgy
God Bless everyone and pray for a pain manageable day. morgy porgy
Hey CB,i think i should have worded that one paragraph a bit differently.what any lab check does is actually assess overall organ 'function' which is usually highly dependant upon the level of damage occuring,and just where it is occuring in the organ itself.the fact that you do have out of range labs is just telling your docs that you ability for your liver or kidneys to do their basic jobs is being affected in some way.THAT is what the labs show.function loss.i myself do have alot of confirmed damage but this is not affecting my actual organ function yet.it will eventually because my disease is a progressive one but for now(knock on wood here) my functions are okay.i wasn't coming down on you just wanted to be sure that you knew what your out of range labs ment for you and the tylenol intake,thats all.sorry if i confused you more,sometimes i am like that.
when in rome?just wanted to mention that when it comes to tylenol,it is NOT the same as alcohol.you CAN have an OD that can be toxic with tylenol and it will not take a whole lot of time for this to occur.in some cases,depending on how much your actual liver can actually metabolize and how much was taken in,it can cause almost immediate(within about 12 hours) liver failure.its just way too much and becomes hepatotoxic.you were given the antidote with the mucomyst(acetylcystine)i actully have to take this smelly rotten egg crap everytime i have a contrasted film done,mostly with my angiograms for my aneuerysm.this helps protect my kidneys from further damage,as well as my liver.contrast is extremely hard on your kidneys and when you have an out of range creatinine it becomes even worse and can actually cause renal failure in some patients.i had absolutely no clue til my aneurysm popped in and i needed that first angio and was told by the rad place that was doing my angio that i actually needed to take that muco before every contrasted pic was done,even CTs or other contrasted type pics.tho my labs are within the norms,i do have alot of damge within my kidneys and liver so it is just a proactive/protective measure for me.but i never had a freaking clue about this at all.muco just kind of encapsulates the contrast(or tylenol)and kind of flushes it out of your system without affecting the organs.
you can also OD on one alcohol binge,it unfortunetly appears to happen alot in college age kids daring each other to just drink whatever as fast as you can.they simply take in way more than the body(liver and the brain) can handle.alcohol is actually a form of anesthetic,it slowly puts your brain(the cerebellum) to sleep.when too much is taken in,the brain and the ability to even breathe anymore becomes affected and you just stop breathing.the liver cannot handle being slammed with that much alcohol,it can only actually metabolize about one ounce of alcohol per hour.the rest of that alcohol goes to the brain and effects the resp drive.very scarey actually when you think of how much this goes on at colleges around the US.this also happened to my nephew when he went away to college.he was not a normal alcohol drinker but was dared into chugging some very highly potent liquor.ended up in the ER and almost died.while this is not a direct thing with the liver it can be deadly for other reasons.but what your doc said about the alcohol is true in most cases,it does take awhile for it to really show the effects,just not with tylenol,it is two totally different things.it all comes down to any possible unDxed disease process possibly going on that you have no clue you even have(mine was Dxed when i was 40 but i had had it all my life,just showed up upon ultrasound after my son became sick and we needed to know which side of the family this came from)and how sensitive your liver and kidneys are to possible damage and of course,the amount that gets taken in.like CB mentioned in his post about that boy who suffered liver failure just by taking probably way too much for the daily intake recommended of tylenol for a pretty short period of time.there are sooo many people who are waiting on the transplant list for new livers and kidneys JUST because of tylenol poisoning.any other meds we take that are also metabolized within the liver will also actually impact that overall 'safe" amount for daily usage.my PM will not rx any tylenol based meds to anyone anymore.i came into it on percocet and oxycontin and was immediately taken off the percs and placed on the oxy IR.
the sad thing here is we have been led to believe for soo many years that tylenol was just a really safe innocuous type of med,so much so that it is in way too many meds ,mostly OTC.the newer research along with docs seeing their patints suddenly having major liver and kidney problems that were tracked back to their tylenol intake also has helped to change that.also,when taken with alcohol,it can be a highly damaging and sometimes even deadly combination since both have to go thru the livers metabolization process.kind of that double whammy effect.
while some people do not actually have any real options like CB for various reasons and have to include tylenol in their med plan,anytime you just don;t have to take it when you are having a chronic pain type situation,i would just try and avoid it all together.JMO.
CB,if you don;t mind sharing this info,can i ask just what actual individual labs you currently have that are out of range?i know my son has to have his labs done every month just to make sure the liver is still being unrecognized by his body,and the first labs i look at with his hepatics and kidneys are with the liver,the ALT,AST and alk phos.with the kidneys its the creatinine,and the GFR.also,having protien show up in your urine is not a good sign.i have both protien and blood(from the popping of hemmorhagic cysts) in mine at this point.i wasn't trying to slam your treatment plan CB,just concerned about it and wanted to make certain you knew the ins and outs of the out of range labs.i only post out of concern for my fellow pain sufferers.sorry if it came across wrong or confused you.just wondering if your doc has ever mentioned you possibly taking milk thistle?this is a really good thing to be taking when you are also having to take tylenol.i do hope things remain stable in your world,take care,marcia
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.
Actually, after re-reading your reply last night, I understood what you meant in that paragraph. I don't have any numbers at hand, but I can tell you that they are slightly elevated, and have been at that level for many years. I have never been told that it effects my liver function. Ironically, all of my brothers and sisters have the same elevated liver levels, and they have no health problems to speak of. It is generally agreed that genetics plays a part in my situation.
Each of our situations is unique to us, the specifics that is (other illnesses, meds we taken, meds we can't take, etc), but we all share a common bond, we suffer from chronic pain, and are at times met by uncaring or incompetent doctors. Some of us, if not all to some degree, deal with family and friends who are insensitive or just don't understand. I have read this forum for a long while, occasionally commenting, and have drawn inspiration from many of you, have been educated by others, and have been overcome with sadness at the tragedies and sufferings that some of you had to bear. It is a grace that we have this forum to encourage each other and share our experiences....for this I am thankful.
Oh, by the way, never been told about milk thistle. My internist highly recommends B vitamins, niacin, and getting vitamin D (mainly through sunshine... I live in the deep south so it is summer 9 months out of the year).
One of my most beneficial treatments for chronic pain, which cost me nothing, has been to look for the small joys in each moment, as it tends to keep my perspective on track most of the time, or until the pain becomes unbearable. I try and keep my eyes fixed on others and their sufferings, whether physical, mental, emotional or spiritual, so as to reach out to them in some way. This keeps me from falling into to much self-pity.
Thanks for all the great info. and thought provoking "conversation".
By the time most of us ended up in pain management we had already taken a LOT of Acetaminophen. My doc's opinion is I should not take any on a regular basis. For those who still have to use it, N-Acetyl-Cisteine from the health food store will help to protect the liver. This is what is given in the E.R. for Acetaminophen overdose. It is the precursor of the enzyme that safely metabolizes Acetaminophen.
I too was taking Percocet 10/325 4-6 times daily for about 6 months straight... not knowing any better.
Now that I am in PM I am not taking any tylenol what-so-ever.
I never actually knew about this until my dentist prescribed it (this is what got me in a lot of trouble earlier this year, lol), but there is a Vicoprofen its basically 7.5 of vicodin and 200mg of Ibuprofen. Seems like a much better choice than Vicoden ES.
Vicodin never really helped me anyways... now I'm on the Oxycontin and I feel better that theres no tylenol.
My GP did tell me that my liver functions were "very" high on my cbc. I have an appointment with a specialist tomorrow, they were supposed to fax the cbc over there but I'm sure they will have some tests of their own to run.
Wish me luck!!!! I'm only 26 and scared to have liver problems on top of chronic pain... grr!!