Acetaminophen—commonly known as over-the-counter Tylenol in the United States—isn't an effective choice for relieving osteoarthritis pain in the hip or knee, or for improving joint function, a new study finds.
Although the drug rated slightly better than placebo in studies, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or prescription diclofenac are
better choices for short-term pain relief, the researchers said.
"Regardless of dose, the prescription drug diclofenac is the most effective drug among painkillers in terms of improving pain and function in osteoarthritis," said lead researcher Dr. Sven Trelle. He's co-director of clinical trials at the University of Bern in Switzerland.
However, NSAIDS and diclofenac come with side effects--some deadly.
"If you are thinking of using a painkiller for osteoarthritis, you should consider diclofenac," Trelle said, but also keep in mind that like most NSAIDs the drug increases the risk for heart disease and death." The study was summarized in an article by Steven Reinberg in WebMD on March 17, 2016 and published in the journal The Lancet.
Acetaminophen (known as paracetamol outside the United States) is a popular worldwide analgesic and fever reducer with tens of millions of consumers. Because it is remarkably safe when used as directed, and is generally well tolerated in the stomach, as non-prescription Tylenol the drug is a preferred physician recommendation for temporary pain relief for many health issues, including arthritis.
Acetaminophen is an alternative to NSAIDs, which have common side effects of abdominal pain and bleeding, nausea, heartburn and dizziness.
As prescription acetaminophen-hydrocodone (combined), it is prescribed for moderate to severe pain. In either case it does not significantly relieve the arthritis symptoms of joint inflammation, swelling and stiffness.
Acetaminophen works mostly on the central nervous system and is not an anti-inflammatory. It does not reduce the inflammatory swelling or stiffness caused by osteoarthritis, an injury, or rheumatoid arthritis.
Acetaminophen is a non-narcotic analgesic (pain reliever) and antipyretics (fever reducer) that decreases the formation of prostaglandins, therefore relieving pain. It is found in over 100 over-the-counter medications for the relief of mild pain.
It’s best known by the brand name, Tylenol, the number one non-prescription choice of painkiller in the U.S. Click here for a list of acetaminophen brand names.
In addition to pain relief, acetaminophen is a common remedy for symptoms such as fever, colds and coughs.
For moderate to moderate-severe pain relief, acetaminophen is included in generic combination prescription medications, such as hydrocodone and acetaminophen (see details later in this report) but is more recognizable by the brand name Vicodin.
The combination of hydocodone/acetaminophen (HYCD/APAP) as a generic narcotic painkiller, was the #1 prescribed generic medication with 123 million prescriptions for the 12 months ending September 30, 2014, according to a report on The Rubins website.
The maximum allowable daily dose of acetaminophen is was reduced in 2011 from 4,000 mg (4 grams) daily to 3,000 mg (3 grams), which is aimed directly at reducing the risk of accidental overdose. The label says you should not take this much for more than 10 days unless under medical supervision.
The recommended daily maximum for Extra Strength Tylenol 500mg tablets went down from 8 per day to 6 per day, i.e. from 4,000mg per day to 3,000mg per day.
Acetaminophen can be found in various cold and flu medications. It can be found in over 600 OTC and prescription drugs, including Vicodin, Percocet, NyQuil, and Tylenol. Over 50 million people in the USA use acetaminophen each week.
In citing the lowered daily maximums, the Vice President of OTC Medical Affairs and Clinical Research at McNeil Consumer Healthcare, Edwin Kuffner, M.D., was quoted as saying:
"Acetaminophen is safe when used as directed. But, when too much is taken (overdose), it can cause liver damage. Some people accidentally exceed the recommended dose when taking multiple products at the same time, often without realizing they contain acetaminophen or by not reading and following the dosing instructions. McNeil is revising its labels for products containing acetaminophen in an attempt to decrease the likelihood of accidental overdosing in those instances." His remarks appear in Medical News Today in an article by Christian Nordqvist, July 28, 20ll.
If you’re a woman, research in August, 2005 has shown that continual routine use of as little as 500 mg of this pain reliever daily may elevate the risk of developing high blood pressure for some women. The study involved 5,123 women participating in the Nurse’s Health Study at Harvard Medical School and Brigham and Women's Hospital in Boston. Results were published in the American Heart Association journal Hypertension.
A Jan. 14, 2014 post on Medline Plus reports the FDA is recommending health care professionals discontinue prescribing and dispensing prescription combination drug products that contain more than 325 milligrams (mg) of acetaminophen per tablet, capsule or other dosage. Consumers are cautioned against taking two or more products that contain acetaminophen at the same time.
Prescription dosages of acetaminophen might be restricted for patients taking anticoagulants (blood thinners) and certain medications for seizures, pain, fever, coughs and colds. It is important to always tell your doctor what medications you are taking, whether over-the-counter, prescription, vitamins or even herbal supplements.
Acetaminophen is generally considered a safe pain reliever option, when taken as directed for ten days or less. It’s also not as likely to cause stomach damage, like aspirin and ibuprofen, but large doses may cause irreversible liver damage and death. In fact acetaminophen toxicity has replaced viral hepatitis as the most common cause of acute liver failure, according to the Acetaminophen Toxicity page on Medscape. updated January 22, 2018.
Most people experience little or no side effects with this medication. However, tell your doctor immediately if any of these highly unlikely but very serious side effects occur:
If you do not have liver problems, the adult maximum dose of acetaminophen is 3 grams per day (3000 milligrams). If you take more than the maximum daily amount, it may cause serious (possible fatal) liver disease. Tell your doctor immediately if you have any of the following symptoms of liver damage:
A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include:
If you notice other effects not listed above, contact your doctor or pharmacist. Click here for a list of acetaminophen side effects published by the website Drugs.com.
Acute liver toxicity and death are the major acetaminophen side effects.The drug is capable of irreversibly destroying the liver at about 2.5 times the daily dose, and in some cases smaller doses, for some people or when taken with alcohol or when fasting.
Accidental acetaminophen overdose was implicated in 1500 deaths in the past decade, more than any other over-the-counter pain reliever, according to ProPublica.org, Sept. 20, 2013, citing data from the U.S. Centers for Disease Control and Prevention and the American Association of Poison Control Centers.
In addition, inadvertently taking too much acetaminophen sends as many as 78,000 Americans to the emergency room and results in 33,000 hospitalizations a year, federal data shows. It is also the nation’s leading cause of acute liver failure, according to data from an ongoing study funded by the National Institutes for Health.
It concluded that there was an alarming rise in reports of serious adverse drug events (ADEs) associated with acetaminophen, in addition to fatalities.
If you could achieve the arthritis relief you need safely, without total reliance on drugs, wouldn’t it be worth a try? Arthritis-Relief-Naturally explores clinically-proven, natural alternatives for pain relief of arthritis that safely reduce harmful side effects of drugs. As documented previously in this article, acetaminophen has potential serious side effects from overuse.
Do you have pain that requires non-prescription or prescription medication as many as five days a week?
If so, you may wonder about the potential damage your drug has on your liver, or other organs. Are you discouraged looking for an arthritis program you can trust for performance and safety? The natural arthritis relief products featured on this site are based on science--concrete scientific evidence accumulated from hundreds of clinical studies--and not merely personal opinion.
It’s possible to free yourself completely (or cut back substantially) from pain relief drugs by switching to safe, natural alternatives. One clinically-proven natural pain relief product is manufactured by the number one natural nutrition company in America. It is an excellent substitute for acetaminophen or NSAIDs and is one of three arthritis products featured at the conclusion of this article.
Acetaminophen preparations are for short-term use for temporary relief and are remarkably safe when taken as directed. However, alcohol consumption of three or more drinks per day is cause for special warnings.
Daily use of alcohol, especially when combined with acetaminophen, may increase your risk for liver damage.
Tylenol label warnings: The package label for adult Tylenol acetaminophen products contains an alcohol warning that states, "If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take acetaminophen or other pain relievers/fever reducers. Acetaminophen may cause liver damage."
The label also instructs adults not to take Tylenol for pain for more than 10 days or for fever for more than 3 days unless directed by a doctor. As with all over-the-counter analgesics, this warning is necessary so that patients and parents will seek appropriate medical evaluation of their condition if it persists beyond these time periods.
Acetaminophen is listed by the American Association of Poison Control Centers as one of the most common drugs taken in overdose quantities either intentionally or accidentally, according to a report in U.S. Pahrmacist.com, December 16, 2016.
There are no prescription drugs that contain acetaminophen alone, but it is formulated in combination with many other drugs, hydrocodone in particular (widely prescribed for moderate to severe pain). Hydrocodone is in a group of drugs called narcotic (opioid) pain-relievers, and is a cough suppressant, similar to codeine. Hydrocodone blocks the receptors on nerve cells in the brain that give rise to the sensation of pain. Acetaminophen is a non-narcotic pain reliever and fever reducer. Acetaminophen works by elevating the threshold to pain, that is, in order for pain to be felt, greater stimulation of the nerves responsible for the sensation of pain is necessary. It reduces fever through its action on the temperature-regulating center of the brain.
Frequently, hydrocodone and acetaminophen are combined in a single prescription drug to achieve moderate to severe pain relief for arthritis and other conditions, as in Vicodin and Lortab. As a narcotic, hydrocodone relieves pain by binding to opioid receptors in the brain and spinal cord. Acetaminophen is a less potent pain reliever that increases the effects of hydrocodone.
While this combination drug is prescribed frequently as a generic, it is also recognized by brand names Vicodin, Lorcet, Lortab, Maxidone, Norco, Stagesic, Xodol, Zydone and others..
Hydrocodone may be habit-forming as a narcotic and should be used only by the person it was prescribed for.
Less serious side effects for hydrocodone and acetaminophen as a combined drug include:
Serious side effects (call your doctor at once) include:
This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect or allergic reaction.
Note: Hydrocodone is an opioid, the use of which has reached epidemic proportions in the United States over the past 20 years. It has become common prescription therapy to treat arthritis pain and can be quite useful to control pain of periodic flares.
From 1999-2016 more than 639,999 people have died from a drug overdose. In the same period, more than 350,000 people died from an overdose involving any opioid, including prescription and illicit opioids. In the year 2016 alone, 66% of the more than 63,600 drug death involved an opioid, which is five times higher than 1999. On average, 115 Americans die everyday from an opioid overdose. The above statistics are revealed by the Centers for Disease Control and Prevention (CDC) on its Opioid Overdose, Understanding the Epidemic page updated August 30, 2017.
It is safe to say that addiction to the opioid hydrocodone was not the goal for physicians or patients when initially prescribed for pain. So, despite opioid benefits, the downside is scary, especially for patients with chronic arthritis conditions requiring long term treatment.
It certainly begs the question: Can arthritis relief painkillers provoke more harm than good?
The Nurses’ Health Study cohort was assembled in 1976 when 121 700 female registered nurses, 30 to 55 years of age, completed and returned a mailed questionnaire. Follow-up questionnaires have been mailed every 2 years to update information on health-related behaviors and medical events.
In 1990, questions were included regarding frequency of use of acetaminophen, aspirin, and other NSAIDs. Those women who relied on acetaminophen nearly doubled their likelihood of developing higher blood pressure within a three-year period
In the study, continual use was defined as 22 times a month or more. The study showed that women taking non-aspirin NSAIDs were 86% more likely to have high blood pressure than those who did not take NSAIDs. Those taking acetaminophen were twice as likely to be hypertensive. Aspirin did not increase the risk.
The investigators conducted two prospective cohort studies, one involving 1,903 women and the other 3,220 women. Ages ranged from 34 to 77. The authors commented, "Our findings suggest that use of aspirin, acetaminophen, and NSAIDs is associated with the risk of development of physician-diagnosed hypertension. This carries important public health implications, given the frequency of use of these medications in the general population and the relation between elevated blood pressure and cardiovascular death."
Findings were published as Nonnarcotic Analgesic Use and the Risk of Hypertension in US Women in the American Heart Association (AHA) journal Hypertension; 2005 Sep;46(3):500-7. Epub 2005 Aug 15 November 1, 2002 and PubMed
Regular use of ibuprofen and naproxen also raised the risk of hypertension.
Men who take acetaminophen, aspirin or other types of non-steroidal anti-inflammatory drugs, known as NSAIDs, six to seven days a week have an increased risk of developing hypertension, according to a four-year study in the Feb. 26, 2007 Archives of Internal Medicine. The study was conducted by a group led by John Forman, MD, of the Brigham and Women’s Hospital in Boston, Massachusetts and reported on Medical News Today as High Blood Pressure Linked To Painkillers by Catharine Paddock, PhD, February 27, 2007.
The study determined the high risk percent of developing high blood pressure than nonusers as follows:
Similar results were observed when the number of pills taken per week was analyzed rather than frequency of use in days per week.
"Acetaminophen, ibuprofen and aspirin are the three most frequently used drugs in the United States," say the authors in the report. "Given their common consumption and the high prevalence of hypertension (in the United States), our results may have substantial public health implications, and suggest that these agents be used with greater caution."
The 16,031 men in the study had an average age of 64.7 years and did not have a history of high blood pressure at baseline. The results were, for the most part, consistent with the results of 2 previous large cohort studies, the Nurses' Health Study and the Physicians' Health Study, both of which demonstrated an increased risk of hypertension with these analgesic drug classes.
Nearly three out of four (74%) of U.S. adults take dietary supplements that include vitamins and minerals, according to an online survey in August, 2017 as reported by Statista--The Statistics Portal. The nutritional supplement industry has seen a large growth in the market, especially in protein supplements and vitamins. Four out of ten (40%) of U.S. adults aged 18 years and over use some form of complementary and alternative medicine (CAM) in pursuit of health and well being, according to a National Health and Statistics Report by the Centers for Disease Control (CDC), December 10, 2008. CAM consists of a variety of non-pharmaceutical treatments that include dietary, herbal and botanical non-vitamin supplements.
The use of natural products is the most common type of CAM (mind body medicine, and manipulative and body based practices comprise the remainder). Natural products include over-the-counter dietary supplements, some minerals, herbal medicines and others. (Some uses of dietary supplements—e.g., taking a multivitamin to meet minimum daily nutritional requirements or taking calcium to promote bone health—are not thought of as CAM.)
From other pages on this website, you may be aware that my husband and I both have had severe osteoarthritis for many years. Click here and scroll to be bottom for our personal testimonies. We have both taken non-prescription acetaminophen and different NSAIDs, with disappointing results in reducing pain and relieving symptoms of joint swelling and stiffness.
In 2003 the natural products company we were using for nutritional dietary supplements introduced a pain relief program, consisting of three complementary natural products containing no artificial flavors, sweeteners, colors, aspirin or preservatives. We no longer use pain relief drugs of any kind and my husband plays tennis up to four times a week.
If you are considering the use of natural products as a substitute for acetaminophen or other drugs, we strongly recommend these three featured supplements based on our personal use. They are safe. They work. We continue to use them daily.
Each of the three products has a specific purpose:
The goal of these unique clinically-proven alternatives to acetaminophen or similar painkilling drugs, is to provide rapid pain relief, support sustained relief and promote joint renewal. However, each product can be ordered and effectively taken separately.
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Disclaimer: Health statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.
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