Opiates and Acetaminophen Toxicity

[jspun]

At what dose range does the acetaminophen (or paracetamol if you are from the Commonwealth) in vicodin or other opiate pain formulations put the average adult at risk for acetaminophen toxicity?

 

[theotherside]

At 4 grams you are past the danger zone. Try to never go above 2g in any 24 hour period.

 

[dokomo]

At 4 grams you are past the danger zone. Try to never go above 2g in any 24 hour period.

Correct!

I'd also like to point out that these limits are for a 24hr period, not for a single dose, 4g over 24 hours is alot different than 4g at once.

 

[jspun]

Thanks guys! But at what dose range would someone require emergency Tx? I'm sure people on the board have taken 6+ vicodin without any negative sequale.

 

[PharmTech09]

I've taken 6 grams at a time before. I'm not saying that what I took was the best thing to do, but I'm still in good health today. It also depends on what the person's liver can handle, what other medications they are taking, whether they have an enzyme deficiency, and other risk factors. If you need large amounts of hydrocodone to get high, try to get Norco or switch to a different opiate. If that's not an option, try a CWE.

Around 5g+ of APAP at a time could easily be enough to send someone to the ER, but I've usually just seen vomiting until about 7 grams. After that, you're definitely in trouble, no matter who you are. Just switch to a different pill or do a CWE.

By the way, San Diego kicks ass. That's where I'm originally from. Here in Texas it fucking sucks! Today: High 100, 82% humidity.

 

[Too many doses]

They are lowering the level soon, read the thread about the FDA and APAP.

 

[PharmTech09]

^Yes, I know. It will soon be 3250mg/day and 650mg per single dose. They also said that 1000mg of APAP was not any more effective than 650mg. They're also asking pharmacists to write out acetaminophen on Rx's instead of just putting "APAP," to avoid confusion. My advice is to take as little APAP as possible. If you can get something without it, then do it.

 

[Virtuoso]

At 4 grams you are past the danger zone. Try to never go above 2g in any 24 hour period.

Actually, (setting aside the most recent FDA panel decision) 4g a day was considered safe to take chronically, so basically every day. A better rule of thumb is 80mg/kg of body weight. I have never heard of someone getting acute acetaminophen toxicity when taking less than 10g. But yeah, you really should keep it lower than 4g in a 24 hour period.

 

[jspun]

Thanks everyone for the info.

By the way, San Diego kicks ass. That's where I'm originally from. Here in Texas it fucking sucks! Today: High 100, 82% humidity.

Not to rub it in but its currently 82 degrees and just humid enough to be balmy.
Time to move back dude.

 

[oh-pana321]

if your worried about acetominophen toxicity, you shoul;d try plugging. it may sound kinda gay, but trust me you get the most out of your opiates that way, besides from injecting

apap basicaly isnt a factor with plugging cuz its poorly absorbed rectally.

i was in the hospital for an "accidental overdose" from taking 250 mg's temazepam and 17 perc 10's. the doctors were surprised to see that my opiate levels were high but my tylenol levels were perfectly fine. lmao idk if they knew what was up, but i got a good laugh out of it

 

[vicodelicious]

This is not at all safe or good advice, nor am I dick-sizing or bragging. But when I had a horrible Vicodin addiction, I would take up to 30 5/500 tabs a day for months and months on end. That is 15,000mg of acetaminophen a day for a long period of time...

Today I have a normal liver with a normal enzyme count. How or why...? I have no idea. I highly suggest you don't come close to this but... the 4000mg a day is probably conservitive...

 

[dokomo]

This is not at all safe or good advice, nor am I dick-sizing or bragging. But when I had a horrible Vicodin addiction, I would take up to 30 5/500 tabs a day for months and months on end. That is 15,000mg of acetaminophen a day for a long period of time...

Today I have a normal liver with a normal enzyme count. How or why...? I have no idea. I highly suggest you don't come close to this but... the 4000mg a day is probably conservitive...

With long-term use, your liver stops responding with increased enzyme levels when acetaminophen is doing damage. You still probably sustained alot of damage to the liver with that kind of dosing, it is a wonder that you're alive today!