264 Liver Transplants Related to Acetaminophen Use

James Geiger M.D.--

What’s wrong with Tylenol? Take too much and you could end up with a liver transplant, if your “plan” will pay for it.

The FDA has issued Tylenol, also known as acetaminophen a black penalty box warning. That means take this warning seriously.

How can such a commonly taken, over the counter medication be just now labeled as unsafe? It has been know for years now that taking 4 grams daily without alcohol can cause a rise in liver transaminases. That danger is increased causing more damage to the liver when used in daily dosages higher than 7 grams and especially if taken with several alcohol drinks, think certain cold remedies. The evidence of 264 liver transplants required due to acetaminophen related liver failure is one significant study prompting the FDA to enact the black box warning. Acetaminophen is the most common drug causing acute liver failure in children in the U.S. and the U.K. The only acute treatment for acute acetaminophen toxicity is acetylcystine.

So what is the take home message….if you do not want to risk liver failure and liver transplant for your survival then be careful of the amount of acetaminophen you take. Take the black box warning on acetaminophen very seriously. Make CAM alternative choices. For instance, ginger is described as the universal medicine in ayurvedic therapies. Highly recommended for headache and migraine therapy.

There are numerous other rare but potentially serious adverse drug reactions which have earned black box warnings attributed to many different classes (antibiotic, antidepressants, antipsychotics) of drugs including antinausea medications. These adverse drug reactions range from mild confusion, dysphoria, headache, phlebitis, tics, torticolis, serotonin syndrome, neuroleptic malignant syndrome, and alpha blockade alterations in blood pressure to potential life-threatening cardiac rhythm disturbances.

Succinylcholine is a neuromuscular blocker used to faciliate endotracheal intubation. There is an FDA black box warning on succinylcholine because co-existing conditions such as certain muscles disorders in children place them at increased risk of malignant hyperthermia.

Droperidol is the subject of a black box warning by the FDA (Habib and Gan, 2003). This controversial warning describes the rational for patients to have a normal Q-T interval documented by ECG prior to intravenous administration of droperidol. The risk of the malignant ventricular dysrhythmias, called torsades de pointes, associated with droperidol is also known to occur with several of the new selective blocking agents of the serotonin 5-HT3 receptor antagonists. This drug is commonly used by anesthesiologists.

Perhaps ginger oil Z. officinale could be considered an alternative for droperidol, even though one investigation failed to show antinausea benefit when droperidol even though one investigation failed to show antinausea benefit when droperidol was compared with powdered ginger root (Visalyuputra et al., 1998). The essential oil of ginger used topically at the time of surgery works great to prevent nausea. I apply to my anesthesia patients every day.

The King of Pop loved Propofol. It is a very good drug and very safe drug in the hands of an anesthesiologist. So is acetaminophen.

Dr. James L. Geiger is a board certified anesthesiologist practicing acute care anesthesia and clinical aromatherapy in Arizona. He completed residency at USC and Internship at St. Mary’s Center in San Francisco where he remained to perform cardiac anesthesia with his father, a Cardiothoracic surgeon, for 16 years. At St. Mary’s he developed and lectured on Fast Track Cardiac Anesthesia programs for early recovery from anesthesia and was chairman of the critical care committee. Currently Dr. Geiger is on staff at several medical centers, orthopedic hospitals and surgicenters where he has introduced therapy with essential oils into the operating and recovery rooms. Dr Geiger’s special interest is consulting in the development of patient services for Integrative Therapies and Medical Spa services which care for the needs of those seeking integrative treatments. Dr. Geiger’s speaking presentations are suitable for conventions, resorts, spas and business meetings worldwide. He is the author of The Sweet Smell of Success: Health and Wealth Secrets (LifeSuccess Publishing/ Feb 2009).

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