Online Pharmacy Medicine Blog

With the FDA raising concerns last week about Extra Strength Tylenol and other acetaminophen products potentially causing liver damage, should you consider switching from Tylenol to aspirin or ibuprofen?

The short answer is “no.” If you are not taking other prescription pain medications (such as Vicodin or Percocet) in addition to Tylenol, and you take Tylenol as directed, you shouldn’t be at risk of hurting your liver.

Remember, virtually all drugs have risks in large doses. Aspirin, for example, carries the risk of stomach ulcer and gastrointestinal bleeding when taken at high doses and/or for extended periods (such as when treating chronic pain).

Here’s a brief overview of the most commonly used over-the-counter pain relievers — acetaminophen, aspirin and ibuprofen — and what you should know about each:

Aspirin. (Popular brands: Bayer, Bufferin) The most common OTC pain reliever, also known as acetylsalicylic acid, reacts with our blood chemistry to inhibit the enzyme cyclooxygenase, which helps to control headaches, minor aches and pain, and inflammation. Aspirin therapy is also being used today in the treatment of heart disease. But as ubiquitious as aspirin appears to be, it’s not without risk — and it’s not for everyone. For those with sensitive digestive systems, it can cause stomach upset, heartburn and even dyspepsia. It’s also an anticoagulant, which makes it bad for hemophiliacs and a bad choice for pain relief after you’ve had surgery. It’s also been linked to Reye’s syndrome, a disease in children, when aspirin is used to relieve discomfort associated with fever.

Acetaminophen. (Popular brands: Tylenol) This pain reliever soothes headaches and lowers fevers, but it is not an anti-inflammatory, so it won’t do much to help with arthritis and other body aches and pains. The biggest benefit of acetaminophen, relative to other headache pills, is that is won’t irritate the lining of your stomach. If you have acid reflux, ulcers or other digestive tract issues, acetaminophen is generally a clear choice over aspirin. Acetaminophen is also considered safer for hemophiliacs and children. However, doctors warn that it’s easier to overdose on acetaminophen than aspirin — a concern underscored by the FDA panel’s ruling. So be sure to take this drug only as directed.

Ibuprofen. (Popular brands: Advil, Motrin) Ibuprofen is chemically similar to aspirin and functions similarly as well, but in lower doses, it tends to be less irritating to the upper digestive system. So if you find aspirin difficult to stomach, but have body aches and pains that acetaminophen can’t treat, ibuprofen is often the best answer for ailments like arthritis, sunburns, sprains and the like.

The FDA is poised to ban prescription painkillers Vicodin and Percocet, which combine acetaminophen with an opiate narcotic. An FDA report says the potential dangers of this combination exceed the benefit to patients.

The report found that severe liver damage, or even death, can result from taking Vicodin or Percocet. They are also highly addictive. According to the FDA, these drugs cause about 400 deaths per year, attributed to either overdoses or liver damage.

Vicodin combines hydrocodone with acetaminophen; Percocet combines oxycodone with acetaminophen. Some of the notable celebrities who have admitted addiction to one or both of these drugs include John McCain’s wife, Cindy; rapper Eminem; and comedian Artie Lange.

The recommended ban will also apply to seven other acetaminophen/narcotic combination drugs.

While alternative painkillers like Percodan, which combine opiate narcotics with aspirin (rather than liver-damaging acetaminophen), are available on the market, they had been largely replaced by Percocet and Vicodin for post-operative pain, because aspirin can interfere with platelet function and lead to excessive bleeding after surgery.

Concerned that Americans are popping too much Extra Strength Tylenol and other over-the-counter acetaminophen products, an FDA panel voted on Tuesday to reduce the maximum dosage on these pain relievers.

The panel recommendation would lower the maximum daily dosage of nonprescription acetaminophen, and limit the maximum single dose of acetaminophen to 650 milligrams. The current maximum single dose of Extra Strength Tylenol is 1,000 milligrams; this would now be available only by prescription.

An FDA report concluded that many people are taking more pills than the box or bottle instructions recommend, and that acetaminophen has crept into many other medicines (such as cold remedies, etc.) that may lead consumers to accidentally take more than they should. Taking too much acetaminophen can lead to serious health problems, including liver damage.

Although the advisory panel’s recommendation has not yet been implemented by the FDA, the agency typically follows its panels’ advice.