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What Are The Possible Side Effects Of Acetaminophen And Pseudoephedrine?

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Posted on Wed, 2 Nov 2016
Question: Hello, again, Dr. Wachsman. How would you evaluate the claims about the risks involved in prescribed uses of acetominophen and pseudephedrine? As in the case of Ibuprofen we are subject to media warnings about how these drugs raise blood pressure and destroy the liver even without overuse at prescribed doses. Similarly for omeprazole supposedly causing calcium depletion. Thanks.
doctor
Answered by Dr. Dr. Matt Wachsman (6 hours later)
Brief Answer:
very good question.

Detailed Answer:
First psuedophed.
It can do very bad things to people when taken in ridiculous amounts. I personally have seen basically, a brain dead young teenager who had many strokes from taking an intentional overdose of a large amount of pseudophed and this is not rare in the medical reports literature. When taken anything like normally, it might raise blood pressure a little. This is more of a concern if one is on the opposing drug (beta blockers like atenolol, metoprolol, etc.).

You mentioned ibuprofen. It was in the news again and I think it was a bad article.
First, we all know that ibuprofen can cause ulcers in up to 10% of those taking it. We know that it affects kidney blood flow and in people with fluid overload from heart, or kidney failure, it is a plain dangerous drug (or any other aspirin like drugs). The estimate of 16% of those taking it is silly. It's either 100% of those with heart and/or kidney failure or close to zero if you don't have underlying health issues.
EXCEPT that all anti-inflammatories INCLUDING ASPIRIN, block the beneficial effect of aspirin on prevention of heart and stroke. Aspirin permanently blocks platelets from making clot. And this lasts 3 days after taking a baby aspirin. BUT the bad effects on vessel lubrication is gone in a few hours with aspirin. WIth all the other aspirin like drugs the effect on the platelets and the vessles overlap much much more. So you can use aspirin to act as an anti-platelet drug, but not any of the others. They all have a tiny but significant increase in teh risk of stroke and heart attack.

Finally, acetaminophen. The hype would say that tens of thousands of people die or lose their liver in the US per year from tylenol overdose. I would have seen one if that were the case. Tylenol overdose is rare. It is generally INTENTIONAL. It has a higher safety margin than water. If I take 5 x more water than normal in a day I may have a seizure, 5 x 325 tylenol at once is slightly risky but unlikely to be bad.
I certainly have drunk thousands of times that amount of water in 10 years. Not bad for me. The point is, that the amount taken over a long time is not the same as taking it all at once. Tylenol at 4 grams all at once can be harmful to the liver, maybe fatally. This is relevant and comes up sometimes... a drug abuser takes 6 percocet with 500 mg of tylenol each... she then takes a tylenol, then takes a cold medicine with tylenol and then a few fiuricet with tylenol in it... well over 5000 mg total all at once and very likely toxic to the liver.
Of course a normal person might take all the same amount... but over 2 weeks NOT toxic.
Thank you for the question.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Matt Wachsman (2 hours later)

So what we see is a totally ignorant approach in the media, with no desire to get the entire picture in regard to normal and possibly occasional recommended doses (even of extra strength)? It also involves a measure of demonization of the pharmaceutical companies. It's scandalous.
doctor
Answered by Dr. Dr. Matt Wachsman (1 hour later)
Brief Answer:
simply put. YES.

Detailed Answer:
I think there are a number of issues that make intelligent reporting not occur. First, the papers in the science journals have to have somewhat of a breathless quality to them even when we're just going thru the motions and pushing papers around we need to make it seeeeeeeeeeem like the papers have more importance. The ones on aspirin and heart had about zero new information in them. There is another real problem with pseudophed in that it can easily be manufactured into methamphetamine which really is that dangerous. So, it has to be watched. Tylenol, there was a public serve aspect to it in that it is one of the few things on the shelf where a mere 4 times more than the recommended dose is dangerous and people can get tylenol more than 4 different ways and not realize it.

yeah, but it was hyped.
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dr. Matt Wachsman

Addiction Medicine Specialist

Practicing since :1985

Answered : 4214 Questions

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What Are The Possible Side Effects Of Acetaminophen And Pseudoephedrine?

Brief Answer: very good question. Detailed Answer: First psuedophed. It can do very bad things to people when taken in ridiculous amounts. I personally have seen basically, a brain dead young teenager who had many strokes from taking an intentional overdose of a large amount of pseudophed and this is not rare in the medical reports literature. When taken anything like normally, it might raise blood pressure a little. This is more of a concern if one is on the opposing drug (beta blockers like atenolol, metoprolol, etc.). You mentioned ibuprofen. It was in the news again and I think it was a bad article. First, we all know that ibuprofen can cause ulcers in up to 10% of those taking it. We know that it affects kidney blood flow and in people with fluid overload from heart, or kidney failure, it is a plain dangerous drug (or any other aspirin like drugs). The estimate of 16% of those taking it is silly. It's either 100% of those with heart and/or kidney failure or close to zero if you don't have underlying health issues. EXCEPT that all anti-inflammatories INCLUDING ASPIRIN, block the beneficial effect of aspirin on prevention of heart and stroke. Aspirin permanently blocks platelets from making clot. And this lasts 3 days after taking a baby aspirin. BUT the bad effects on vessel lubrication is gone in a few hours with aspirin. WIth all the other aspirin like drugs the effect on the platelets and the vessles overlap much much more. So you can use aspirin to act as an anti-platelet drug, but not any of the others. They all have a tiny but significant increase in teh risk of stroke and heart attack. Finally, acetaminophen. The hype would say that tens of thousands of people die or lose their liver in the US per year from tylenol overdose. I would have seen one if that were the case. Tylenol overdose is rare. It is generally INTENTIONAL. It has a higher safety margin than water. If I take 5 x more water than normal in a day I may have a seizure, 5 x 325 tylenol at once is slightly risky but unlikely to be bad. I certainly have drunk thousands of times that amount of water in 10 years. Not bad for me. The point is, that the amount taken over a long time is not the same as taking it all at once. Tylenol at 4 grams all at once can be harmful to the liver, maybe fatally. This is relevant and comes up sometimes... a drug abuser takes 6 percocet with 500 mg of tylenol each... she then takes a tylenol, then takes a cold medicine with tylenol and then a few fiuricet with tylenol in it... well over 5000 mg total all at once and very likely toxic to the liver. Of course a normal person might take all the same amount... but over 2 weeks NOT toxic. Thank you for the question.