LAURAN NEERGAARD, "Too much Tylenol can kill", Chicago-Sun Times,
December 27, 2005,
Link: http://www.suntimes.com/output/health/cst-nws-pain27.html

WASHINGTON -- Think popping extra pain pills can't hurt? Think again:
Accidental poisonings from the nation's most popular pain reliever seem
to be rising, making acetaminophen the leading cause of acute liver
failure.

Use it correctly and acetaminophen, best known by the Tylenol brand,
lives up to its reputation as one of the safest painkillers. It's taken
by some 100 million people a year, and liver damage occurs in only a
small fraction of users.

But it's damage that can kill or require a liver transplant, damage
that frustrated liver specialists insist should be avoidable.

The problem comes when people don't follow dosing instructions -- or
unwittingly take too much, not realizing acetaminophen is in hundreds
of products, from the over-the-counter remedies Theraflu and Excedrin
to the prescription narcotics Vicodin and Percocet.

''The argument that it's the safest sort of has overruled the idea that
people cannot take any amount they feel like,'' says Dr. William Lee of
the University of Texas Southwestern Medical Center, who laments that
acetaminophen is popped like M&Ms.

Acetaminophen bottles currently recommend that adults take no more than
4,000 milligrams a day, or eight extra-strength pills.

Just a doubling of the maximum daily dose can be enough to kill, warns
Dr. Anne Larson of the University of Washington Medical Center.

Yet, ''if two is good, 10 is better in some patients' minds,'' she says
with a sigh.

Increase since 1998

The Food and Drug Administration has long wrestled with the liver risk,
warning two years ago that more than 56,000 emergency-room visits a
year are due to acetaminophen overdoses and that 100 people die
annually from unintentionally taking too much.

A study published this month by Larson and Lee has agency officials
weighing whether to revisit the issue. Over six years, researchers
tracked 662 consecutive patients in acute liver failure who were
treated at 22 transplant centers.

Almost half were acetaminophen-related. More remarkable was the steady
increase: Acetaminophen was to blame for 28 percent of the liver
poisonings in 1998, but caused 51 percent of cases in 2003. That makes
acetaminophen the most common cause of acute liver failure, the
researchers report. AP