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More news on the importance of limiting paracetamol dosage

The US Food and Drug Administration (FDA) is finally asking physicians / Doctors and other healthcare professionals to stop prescribing combination prescription pain relievers that contain more than 325 mg of paracetamol (acetaminophen) per table due to the potential risk for liver damage.

Many prescription analgesics  contain both paracetamol and another ingredient (like codeine) and may have up to 750 mg of acetaminophen per dose.

In a statement, the FDA stated, “There are no available data to show that taking more than 325 mg of acetaminophen per dosage unit provides additional benefit that outweighs the added risks for liver injury.”

“Further, limiting the amount of acetaminophen per dosage unit will reduce the risk of severe liver injury from inadvertent acetaminophen overdose, which can lead to liver failure, liver transplant, and death,” they added.

Severe liver injury in patients taking paracetamol have occurred when patients  took more than the prescribed dose of an acetaminophen-containing product in a 24-hour period or took more than 1 paracetamol-containing product at the same time; or drank alcohol as well as medicine that  contained paracetamol.

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Look after your liver, don’t take too much paracetamol

The US Food and Drug Administration (FDA) is finally asking Physicians / Doctors and other healthcare professionals to stop prescribing combination prescription pain relievers that contain more than 325 mg of paracetamol (acetaminophen) per table due to the potential risk for liver damage.

Many prescription analgesics have both paracetamol (up to 750 mg of acetaminophen per dose) as well as another ingredient (like codeine)

The FDA stated: “There are no available data to show that taking more than 325 mg of acetaminophen per dosage unit provides additional benefit that outweighs the added risks for liver injury.”

“Further, limiting the amount of acetaminophen per dosage unit will reduce the risk of severe liver injury from inadvertent acetaminophen overdose, which can lead to liver failure, liver transplant, and death,” they added.

Severe liver injury in patients taking paracetamol have occurred when patients  took more than the prescribed dose in a 24-hour period or took more than 1 paracetamol-containing product at the same time; or drank alcohol as well as had medicine that contained paracetamol.

Look after the pain – low level laser therapy and osteopathy can help with that in some cases – as well as looking after your liver!

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Overdoses of Prescription Opioid Pain Relievers in the USA

KEY POINTS from a recent paper by the US Centers for Disease Control and Prevention:

Death from opioid pain relievers  (like Tramadol and Vincodin) is an epidemic in the USA.

http://www.cdc.gov November 4, 2011 / 60(43);1487-1492)

Sales of opioid pain relievers quadrupled between 1999 and 2010.

Enough opioid pain relievers were prescribed last year to medicate every American adult with a dose of 5 mg of hydrocodone (Vicodin and others) taken every 4 hours for a month. Abuse of opioid pain relievers costs health insurers approximately $72.5 billion annually

In 2007, nearly 100 persons / day died of drug overdoses in the US. The death rate of 11.8 per 100,000 population in 2007 was roughly three times the rate in 1991. Prescription drugs have accounted for most of the increase in those death rates since 1999.

In 2009, 1.2 million emergency department (ED) visits (an increase of 98.4% since 2004) were related to misuse / abuse of pharmaceuticals. opioid pain relievers now account for more overdose deaths than heroin and cocaine combined.

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The risks of NSAIDS

Even short-term NSAID use is considered risky in cardiac patients

In patients who have previously had a heart attack (myocardial infarction / MI), most nonsteroidal anti-inflammatory drugs (NSAIDs), even when only taken for a week, have been associated with increased risk of death and recurrent heart attacks.

The study, published on May 9  2011 in Circulation, found that use of NSAIDs was associated with a 45% increased risk of death or recurrent MI in the first 7 days of use and 55% increased risk if patients continued taking NSAIDS.

“We found that short-term treatment with most NSAIDs was associated with increased and instantaneous cardiovascular risk” said one of the authors. “Results indicate that there is no apparent safe therapeutic window for NSAIDs in patients with prior MI and challenge the current recommendations of low-dose and short-term use of NSAIDs as being safe”.

Some NSAIDs were associated with more risk than others, but none were shown to be completely safe. Researchers could not identify a period that appeared to be safe, no matter how little time they were taken. Patients were taking commonly available / prescribed medication like ibuprofen and diclofenac as well as COX-2 inhibitors like Vioxx and celecoxib. Diclofenac was associated with early and higher cardiovascular risk than Vioxx (withdrawn in 2004 because of its high cardiovascular risk).

All NSAIDs, except naproxen, were associated with an increased risk for death or recurrent MI, diclofenac had the worst risk.

So, if you know anyone who has had a heart attack, make sure they are aware of the real risks of even small doses of NSAIDs like ibuprofen – which is commonly taken for headaches, back and neck pain and tendinitis.

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Hypnotic relaxation vs amitriptyline for tension-type headache – relaxation wins!

A new study of 98 patients chose to either try Hypnotic Relaxation or medication (in the form of amitryptiline, an antidepressant known for alleviating headaches when taken in smaller doses). Patients who were already using more analgesics were more likely to opt for the medication option. Eleven of the patients initially choosing medication and 2 of the patients initially choosing hypnotic relaxation decided to try the other group during the trial.

Long-term adherence to treatment with Hypnotic Relaxation exceeded that of amitryptiline. At the end of the study period, 26 of 47 patients who tried Hypnotic Relaxation compared with 10 of 27 who tried amitryptiline decided to continue receiving their initial treatment. It wasn’t a ramdomised study as patients chose which group they wanted to be in.

The study concludes that the relaxation therapy was more popular choice, patients who tried this reported greater symptom relief than those choosing the medication and they were found to have greater treatment compliance.

Despite decades of research showing the effectiveness of non-pharmacological treatment of headaches, self-management or complementary methods like this are not commonly recommended by all GP’s yet.

Interestingly a number of patients at the clinic find osteopathy very relaxing and also find it beneficial if they are headache sufferers. Maybe research will show if there is a similar mechanism of action.

Hypnotic Relaxation vs Amitriptyline for Tension-type Headache: Let the Patient Choose. Ezra, Y; Gotkine, Marc et al. Headache. 2012;52(5):785-791. © 2012 Blackwell Publishing

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As well as being principal at Amersham Osteopathic Clinic, I am also Consultant in Charge at the Osteopathic Centre for Children's London clinic (part of the Foundation for Paediatric Osteopathy) and teach theory and practical techniques on the current Diploma course. I am on the Sutherland Cranial College of Osteopathy Teaching Faculty. I teach … Read more...