Excessive use of the pain reliever acetaminophen may lead to liver failure and death, especially in alcoholics. Rates of coma and death were highest in those admitted to a Dallas emergency room with accidental -- rather than suicidal -- overdoses of the analgesic. A higher frequency of chronic alcohol abuse among the patients with accidental overdoses may be one explanation.
When acetaminophen is ingested at excessive amounts, toxins form which can lead to life-threatening liver damage. However, the liver normally secretes a toxin fighting compound called glutathione, which counteracts the poison. Chronic alcohol abuse over time causes "depletion of glutathione" -- breaking down the body's defense against even slight overdoses of acetaminophen. The researchers note that other victims of accidental overdose had been fasting while taking the drug. They speculate that starvation may lead to reduced liver glutathione levels, raising toxicity risks.
A spokesperson for McNeil Consumer Products Co., the makers of Tylenol, says Lee's study "underscores the need for more consumer awareness, which we totally support. You've got to read and follow the dosing instructions." Those label instructions include an "alcohol warning" which reads: "if you generally consume 3 or more alcohol-containing drinks per day, you should consult your physician for advice" on taking the pain reliever.
The New England Journal of Medicine (1997;337(16):1112-1117)
COMMENT: As mentioned in a previous newsletter this toxic liver reaction can be completely avoided if one were to take the supplement N-acetyl Cysteine or L-Glutlamine (usually about 500 mg one to three times per day). These amino acids are two of the rate-limiting components for the formation of glutathione. If one needs to take acetaminophen for any reason on a regular basis it would be wise to take these two supplements to limit liver damage. This study emphasized the importance of this recommendation if one also consumes alcohol on a regular basis. This is not an insignificant observation considering 10% of our popluation are addicted to alcohol.