The Risks of Over-the-Counter Painkillers

Recently, I read an insightful article entitled ‘The Dark Side of Your Painkiller’ by Jennifer Yang and Robert Cribb that shed new light on the potential adverse effects of a very common over-the-counter drug. I’ve included below a short synopsis with my comments about what this means in the grand scheme of things.

Acetaminophen is the principle ingredient in Tylenol and other over-the-counter medications that are used to stop pain and reduce fevers. Most people take it for sore muscles and joints, chronic headaches, or pre-menstrual cramps because it’s considered the safest form of painkillers. It can be found in over 500 different products and you can buy it at your local convenience store, gas station, or pharmacy.

Most people don’t think twice about taking acetaminophen, as it’s typically considered a safer alternative to stronger painkillers like ibuprofen and naproxen. However, there is always some risk when taking a medication.

This article highlights consider how acetaminophen first became available in the 1950s, before more stringent regulations around over-the-counter medications came into effect.  Experts say that if acetaminophen entered the drug market today, it would NOT be approved as an over-the-counter medication. Dr. Paul Marotta, head of liver transplants at London Health Sciences Centre in London, Ontario states that ‘toxicity can result in death or liver transplant – it’s not just fevers or a day off work’.

The reality is that although relatively safe, acetaminophen has a very narrow therapeutic window, meaning the dose that causes you serious harm is not far off the recommended dose on the bottle. In North America, you can easily buy packages of 100 to 200 tablets, whereas in the United Kingdom packages are restricted to 16 tablets (extra-strength) and in France and Germany it can ONLY be purchased at a pharmacy. Dr. Mark Yarema, the Alberta poison center’s medical director says ‘acetaminophen is far and away the most common medication or drug-related call we receive… from pediatrics all the way up to seniors’. In the United States it sends about 78,000 people to the emergency rooms every year. This is serious stuff.

How likely are YOU really to have a problem with acetaminophen? The most common scenario involves combining these painkillers with alcohol consumption. Imagine for a moment you have back pain and decide to take acetaminophen. Thinking it’s safe, you have a few beers after golf with your friends or a few glasses of wine over dinner with clients. However, if you combine only three alcoholic drinks a day with acetaminophen use, you can cause serious liver damage. In clinical practice, I commonly see ‘weekend warrior’ clients who regularly taking acetaminophen to treat joint and muscle pain… and they are unknowingly combining it with regular alcohol consumption.

So, what does this mean for you? At the end of the day, this all comes back to moderation. While acetaminophen has benefits for pain and fever, take only the minimal amount required – start with one tablet and wait several hours before taking a second. Do not exceed four tablets per day without consulting a medical professional. Also, as a general rule if you are taking any medication or supplement for extended periods of time, always consult a medical professional.

 Like most things in life, the answer is not black and white. I prefer clients to use acetaminophen rather than anti-inflammatory drugs, as a safer alternative with fewer side effects. However, if you are taking drugs regularly to control pain, you should look into more natural alternatives to control inflammation and address the root cause of your pain. Remember, there is no ‘biochemical free lunch’; all drugs have side effects, so use them cautiously and sparingly for a long, healthy, and happy life.

Until next week…

Dr. Marc Bubbs ND