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Should the elderly back away from Acetaminophen?
#1
In what may come to many as no surprise to many, the medical community is suddenly making public assertions about the use of the heavily promoted drug Acetaminophen.

Paracetamol, or acetaminophen, is a non-opioid analgesic and antipyretic agent used to treat fever and mild to moderate pain. It is a widely used over-the-counter medication. Common brand names include Tylenol and Panadol.

From FoxNews reporting: Common pain reliever could cause medical complications in some people over 65, study suggests
Subtitled: Acetaminophen, a painkiller and fever reducer, can be found in cold and flu medicines, gels and ointments

Researchers in the UK have produced a study of 180,000 acetaminophen users compared to 400,000 non-users over 20 years.  

The findings revealed that the use of acetaminophen – sometimes also called paracetamol – was associated with an increased risk of serious medical complications.
Acetaminophen may be found in cough, cold and flu medications, as well as in creams, gels, salves and even suppositories, one gerontologist noted. (iStock)
This includes peptic ulcer bleeding, uncomplicated peptic-ulcers, lower gastrointestinal bleeding, heart failure, hypertension and chronic kidney disease.


Apparently, this drug, while immensely profitable, has has many contradictory assurances associated with it... for example:

 Dr. Marc Siegel, clinical professor of medicine at NYU Langone Health and senior medical analyst at Fox News, shared his reaction with Fox News Digital.

"It is generally accepted doctrine that acetaminophen is not associated with GI bleeding or advancing kidney disease, but the thinking is starting to change on this front," said the doctor, who was not involved in the study.  There is evidence suggesting that acetaminophen "modulates the same cyclooxygenase-related pathways" as anti-inflammatory drugs like ibuprofen, which can "increase adverse GI side effects," according to Siegel.


It's not associated with GI problems, but there is evidence it is... interesting.

"And yes, over-the-counter medications are still medications. Acetaminophen is well-known for its liver toxicity, but there are other side effects as well, as this study suggests."

For decades, the industry has foisted this drug onto the population... ever since the beginning of the 21st century, regulators have guided the industry to reduce the amounts of dosages more than once... usually due to the increasing data showing the toxicity of the product represented a health risk...

Concerns about paracetamol's safety delayed its widespread acceptance until the 1970s, but in the 1980s paracetamol sales exceeded those of aspirin in many countries, including the United Kingdom. This was accompanied by the commercial demise of phenacetin, blamed as the cause of analgesic nephropathy and hematological toxicity. Available in the U.S. without a prescription since 1955.

In June 2009, an FDA advisory committee recommended that new restrictions be placed on paracetamol use in the United States to help protect people from the potential toxic effects. The maximum single adult dosage would be decreased from 1000 mg to 650 mg, while combinations of paracetamol and other products would be prohibited. Committee members were particularly concerned by the fact that the then-present maximum dosages of paracetamol had been shown to produce alterations in liver function.

In January 2011, the FDA asked manufacturers of prescription combination products containing paracetamol to limit its amount to no more than 325 mg per tablet or capsule and began requiring manufacturers to update the labels of all prescription combination paracetamol products to warn of the potential risk of severe liver damage. Manufacturers had three years to limit the amount of paracetamol in their prescription drug products to 325 mg per dosage unit.

In November 2011, the Medicines and Healthcare products Regulatory Agency revised UK dosing of liquid paracetamol for children.

Two reports by ProPublica alleging that the "FDA has long been aware of studies showing the risks of acetaminophen. So has the maker of Tylenol, McNeil Consumer Healthcare, a division of Johnson & Johnson" and "McNeil, the maker of Tylenol, ... has repeatedly opposed safety warnings, dosage restrictions and other measures meant to safeguard users of the drug."


I suppose this is fertile ground for speculating how the FDA is an industry-captured agency... and profit drives their loyalties...  I have always had reservations about certain petroleum-distillate drugs... this kind of thing doesn't bolster my confidence in modern western medicine.
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#2
Well Max the various studies are really telling us what the medical community knew all along.

The science of aging (Gerontology) and its subforms have really only recently become more mainstream and prominent with the average age of people rising. It’s well documented that as we age our bodies ability to metabolize medications, toxins and to some extent different foods, changes to the point where lower doses are required to prevent toxic buildup. Acetaminophen/Paracetamol are no different, although it does have a relatively safe therapeutic index, it can be extremely dangerous to the very young and the elderly.

The safest dosage is always the lowest amount that creates the desired effect. Although as we age our liver ages as well taking into consideration all that we may have put it through, it’s safe to say that we should cut it some slack.

I’ve never felt that Acetaminophen was a particularly safe drug, but I remember every second commercial would be hyping it up.

As usual, my two pesos…

Tecate
If it’s hot, wet and sticky and it’s not yours, don’t touch it!
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#3
Well, acetaminophen seems to be the pain killer of choice in nursing homes as my 90 year old mother can attest (with a few shots of morphine here and there).

If it's that bad, why is is the go-to drug for the elderly?
"The real trouble with reality is that there is no background music." Anonymous

Plato's Chariot Allegory
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#4
(Yesterday, 10:10 AM)quintessentone Wrote: Well, acetaminophen seems to be the pain killer of choice in nursing homes as my 90 year old mother can attest (with a few shots of morphine here and there).

If it's that bad, why is is the go-to drug for the elderly?

And perhaps the idea of minor pain relief seems to outweigh the liver damage over long term, and that is acceptable to medical technicians.  

Many of elderly who report pain are treated as if they were 'making it up' or 'exaggerating' their pain for attention, and most nursing home staffing situations are far from the nurturing caring facilities they promote themselves to be... what is the single lowest "cost" treatment for pain?  Acetaminophen.  One dose... walk away.

Does it really work? Is it a liver-damaging problem over long term?  Do the administrators and accountants care?  Or do they not likely hold that "They're just "old people" who are going to die anyway... and this is a business... not a charity... our employees and services are not based on love and caring... that's just marketing for investors and suckers customers.

I truly hope that I am completely wrong, at least in some cases, because my Mom spent a lifetime there for a few years before I got her out of there... 
It was horrific, if you care about the actual point of living... as opposed to be in a perennial 'holding pattern' until you die... among uncaring strangers.
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#5
(Yesterday, 10:30 AM)Maxmars Wrote: And perhaps the idea of minor pain relief seems to outweigh the liver damage over long term, and that is acceptable to medical technicians.  

Many of elderly who report pain are treated as if they were 'making it up' or 'exaggerating' their pain for attention, and most nursing home staffing situations are far from the nurturing caring facilities they promote themselves to be... what is the single lowest "cost" treatment for pain?  Acetaminophen.  One dose... walk away.

Does it really work? Is it a liver-damaging problem over long term?  Do the administrators and accountants care?  Or do they not likely hold that "They're just "old people" who are going to die anyway... and this is a business... not a charity... our employees and services are not based on love and caring... that's just marketing for investors and suckers customers.

I truly hope that I am completely wrong, at least in some cases, because my Mom spent a lifetime there for a few years before I got her out of there... 
It was horrific, if you care about the actual point of living... as opposed to be in a perennial 'holding pattern' until you die... among uncaring strangers.

Well my mother is properly looked after and there is nothing wrong with her liver and that's after a decade of being given the right dosage of acetaminophen and before that she was popping them at will. Believe me, she keeps asking for larger doses of it and they won't give it to her, hence the introduction of morphine (but very little, and she wants more of that too).
"The real trouble with reality is that there is no background music." Anonymous

Plato's Chariot Allegory
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#6
(Yesterday, 10:34 AM)quintessentone Wrote: Well my mother is properly looked after and there is nothing wrong with her liver and that's after a decade of being given the right dosage of acetaminophen and before that she was popping them at will. Believe me, she keeps asking for larger doses of it and they won't give it to her, hence the introduction of morphine (but very little, and she wants more of that too).

That's wonderful and comforting to hear!

The acetaminophen issue is, like any other medical concern, subject to each individual and their own physical needs. 
My mother suffered a broken neck upon a fall, and the pain was often treated with the liver-destroying drug... because "that's policy."
It wasn't until we removed her, and retained her own doctor, who verified her liver had been compromised over the years that treatments took a different form... which required 'skilled' care to dispense.   That was the kind of care that her 'home' was unwilling to offer.

I recognize my bitterness about this is my own... 
I am very happy that your mother and you have not had a similar experience...  but then some communities are simply better at caring for the elderly... in mine it was largely a 'matter of commerce.'
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#7
(Yesterday, 11:51 AM)Maxmars Wrote: That's wonderful and comforting to hear!

The acetaminophen issue is, like any other medical concern, subject to each individual and their own physical needs. 
My mother suffered a broken neck upon a fall, and the pain was often treated with the liver-destroying drug... because "that's policy."
It wasn't until we removed her, and retained her own doctor, who verified her liver had been compromised over the years that treatments took a different form... which required 'skilled' care to dispense.   That was the kind of care that her 'home' was unwilling to offer.

I recognize my bitterness about this is my own... 
I am very happy that your mother and you have not had a similar experience...  but then some communities are simply better at caring for the elderly... in mine it was largely a 'matter of commerce.'

Well proper elderly care is not perfect so of course there are circumstances where bittnerness is justified.

If my mother did not herself choose to go to a retirement then nursing home for various reasons, she would still be popping acetaminophen in large doses which may have harmed her liver.
"The real trouble with reality is that there is no background music." Anonymous

Plato's Chariot Allegory
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