What the Label Really Means, or Rough Weather Ahead

[dr_pretentious]

"If condition persists, consult your doctor." Straightforward, right? No, not so much. Apparently, if you follow the dosing instructions on a bottle of Extra Strength Tylenol for any prolonged period of time--like, say, three months--you can tox out your liver. Apparently, the doctors who told me that tylenol would do just fine, now that I can't take ibuprofen or any of its NSAID cousins, never considered the possibility that I'd try the extra-strength tylenol. Considering that most people with the chronic pain diagnosis I have take opiates as daily maintenance drugs, I don't know why it didn't occur to them that I'd choose the stronger over-the-counter version over the weaker one. As far as I knew, I had consulted my doctor.

So now, until the bloodwork says my liver is happy, no more painkillers for little me. At all.

Maybe the lab will have something nice to say about my blood, and I'll be in the clear.

Just in case, though, I figured I'd give y'all a heads-up. I may be less useful than usual for a little while. As I discovered back in November, asking for help isn't the end of the world. (Who knew?) It's possible I might have to do that again.

Comments

!!!!Mostly, herbs to NOT take

[tracyandrook.livejournal.com]

Oh my goodness gracious. I'm sorry. !!!BE CAREFUL ABOUT HERBS!!!

In an emergency there is an antidote for Tylenol: N-acetylcysteine (Mucomyst) but it needs to be given soon after an OD.
The course of acetaminophen toxicity is at its maximum 4 days past OD and lessens after that. JEN PLEASE VERIFY
Here's some herbs to avoid, with their citation sources.

http://home.caregroup.org/clinical/altmed/interactions/Herb_Groups/Hepatotoxic.htm
Pyrrolizidine alkaloids (PA's) are found in over 240 species, mostly amongst the Asteraceae (Daisy) and Boraginaceae (Borage) families. The toxicity of PA's has been known since the nineteenth century; Senecio "hepatitis" in cattle was described in 1884. The mechanisms of toxicity are well documented have been reviewed recently. (See, for example, Denham A.1996). Hepatotoxicity among PA's varies with minor differences in chemical structure
Pyrrolizidine alkaloid-containing herbs:
• Alkanna tinctoria (Alkanet, Anchusa)
• Borago officinalis (Borage)
• Cynoglossum officinale (Hound'stongue)
• Eupatorium purpureum (Queen of the Meadow)
• Lithospermum officinale (Stoneseed)
• Petasites spp. (Butterburr)
• Senecio spp. (Liferoot)
• Symphytum asperum (Prickly Comfrey)
• Symphytum caucasicum (Comfrey)
• Symphytum officinale (Comfrey)
• Symphytum tuberosum (Comfrey)
• Symphytum x uplandicum (Russian Comfrey)
• Tussilago spp. (Coltsfoot)

Abstract: Hepatotoxicity associated with supplements containing Chinese green tea.
Herbert L Bonkovsky. Annals of Internal Medicine. Philadelphia: Jan 3, 2006.Vol.144, Iss. 1; pg. 68, 4 pgs
Recent reports have identified an association between hepatotoxicity and health supplements containing green tea extract (Camellia sinensis). In our patient, the temporal pattern of C. sinensis administration and liver enzyme abnormalities (with a positive rechallenge and exclusion of other possible causes) strongly suggested that the supplement was the inciting agent for both episodes of severe, symptomatic drug-induced liver injury. Extract of C. sinensis is the most probable cause of hepatotoxicity in this patient because 1 this extract is the major ingredient of the supplement by weight (383.3 mg per 3 capsules); 2 there are now several recent reports of similar symptomatic hepatoroxiciry in patients using C, sinensis extracts; and 3 other ingredients of the supplement have not been reported to be hepatotoxic at levels found in 3 capsules (calcium, 167 mg; chromium, 67 µg; magnolia extract, 100 mg; aqueous epimedium extract, 100 mg; β-sitosterol, 40 mg; banaba leaf extract, 11 mg; and vanadium, 10 µg).

Please stay away from alcohol. Yes, alcohol is a painkiller too.
Please keep in mind that many OTC drugs contain tylenol as part of the mixture (I guess they probably would have told you)

!!!did your doctor go over ALL your prescriptions to determine hepatotoxicity?!!! Be very concerned if they did not. Liver insult is cumulative e.g like being smacked, the second adds to the first even if by a different hand (etoh, herbs, other drugs). More in a second

Re: !!!!Mostly, herbs to NOT take

[dr-pretentious.livejournal.com]

Thank you! When I hear back about the lab results, I'll be going over some of this with my doc.


It's especially fortuitous that you posted the caution about borage. I've been using a flaxseed/borage oil blend in salad dressings occasionally (omega-3 and omega-6, and all that). Now I know to lay off it for a while.