Pain relievers can work wonders, allowing many people to carry on with their lives

despite disabling arthritis, for instance, or recurrent headaches. But all pain relievers,
prescription or over-the-counter (OTC), have potential risks, especially when taken in
high dosages or for a long term. Recent events have raised concerns about these
widely-used drugs, in particular the No. 1 non-prescription pain reliever, acetaminophen.

For a long time, acetaminophen, the active ingredient in Tylenol, has seemed to be the
safe bet among the commonly available pain relievers. Although acetaminophen is one
of the safest and most effective drugs on the market, this pain reliever can damage your
liver when taken in too high a dose. In fact, acetaminophen overdoses are the No. 1
cause of acute liver failure in the United States. One key reason: So many medications
contain acetaminophen that it’s easy to take too much of the drug without realizing it.
Although the problem of accidental overdoses isn’t new, the issue became headline
news last year when an advisory committee of the US Food and Drug Administration
(FDA) put new restrictions on drugs containing acetaminophen. Here’s more of what
you should know about acetaminophen and how to take it safely.

WHAT IS ACETAMINOPHEN?

Acetaminophen, which in other countries is called paracetamol, was first synthesized

and used in patients in the late 19th century. But it was dropped in favor of a related
drug, phenacetin, and fell into obscurity until it was rediscovered in the 1950s after
phenacetin proved to have too many side effects. Acetaminophen did not catch on until
the early 1980s, when it filled the void left by aspirin as the safe pain reliever and fever
reducer for children after aspirin was linked to Reye’s syndrome, a rare but potentially
fatal condition that affects the brain and the liver.

Today, although OTC acetaminophen is often associated with the brand-name drug
Tylenol, it can be found in numerous other products designed to treat headaches, cold
and flu symptoms, sinus problems, sleeplessness, arthritis pain, and even menstrual
cramps. But that’s not all. The drug also is an active ingredient in some popular pain
medications, such as Dolcet, and muscle relaxants, such as Norgesic Forte.

Acetaminophen is sometimes confused with nonsteroidal anti-inflammatory drugs

(NSAIDs) which include aspirin, naproxen, ibuprofen, and others. That’s because these
medications all belong to a class of pain-relieving drugs called analgesics and are
readily available without a prescription. Acetaminophen, however, is usually put in its
own category, separate from the NSAIDs, because it doesn’t have their anti-
inflammatory effects. Some research shows that it does interfere with prostaglandin
synthesis, like NSAIDs, but in a way that doesn’t produce widespread effect on
inflammation.

However, in recent years, acetaminophen has often been recommended instead of

aspirin as a day-to-day pain reliever because it’s much easier on the stomach and is
considered safe when taken properly. In fact, new pain management guidelines
released by the American Geriatric Society in 2009 highly recommend acetaminophen
as an initial and ongoing therapy for common forms of muscle and bone pain in older
adults.

SIDE EFFECTS

With NSAIDs, the main concern is stomach bleeding. This is especially true in adults
who are over age 60, are taking prescription blood thinners, and have a history of
stomach bleeding or ulcers. The regular use of NSAIDs also can raise blood pressure,
damage kidneys, and cause cardiovascular complications in some adults. With
acetaminophen, the main concern is liver damage which can cause everything from
abnormalities in liver function tests to acute liver failure and even death.

To add insult to injury, acetaminophen may have deleterious effects beyond the liver.
Harvard researchers have linked the drug to high blood pressure. Other researchers
have identified a possible connection to asthma. These are preliminary findings, not
proof of cause and effect. Still, they’re another reason the perception of acetaminophen
as a harmless drug is changing.

DANGER TO CHRONIC DRINKERS

If you drink a lot of alcohol in one session and take a normal dose of acetaminophen,
you probably are not going to have liver problems. It also seems that heavy drinkers
aren’t any more likely than nondrinkers to suffer liver damage from a single large dose
of acetaminophen

The trouble starts when heavy drinkers take a lot of acetaminophen over a period of
time several days, at least, and maybe longer. A drinking habit and a poor diet often go
hand in hand. Multiple high doses of acetaminophen are more dangerous for drinkers
partly because they don’t eat well.

However, early signs and symptoms of liver damage caused by acetaminophen, such
as loss of appetite, nausea, and vomiting, can sometimes be difficult to spot. That’s
because they may take time to appear or be mistaken for something else, such as the
flu.