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Risk with chronic paracetamol (acetaminophen) use? Re hearing loss, tinnitus?

JohnBoy2000

JohnBoy2000

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Staying within the dosage guideline of 2000 mg every four hours, not more than 4000 mg per day.

So 4 tablets per four hours, not more than 8 a day.

Normally I used 2 tablets every 6 hours, total 4 per day, sometimes 6 when necessary.

But typically for months on end.

Given each dose has sufficient time for liver clearance, is there potential for long term damage with this routine?

I've read studies this can be implicated in hearing loss and tinnitus, especially in under 50's.

Painkillers can cause hearing loss - hear-it.org

Taking pain drugs such as ibuprofen or acetaminophen (paracetamol) twice or more weekly increases the risk of hearing loss, a study has found.
www.hear-it.org www.hear-it.org

........

I take it with codeine/caffeine in Solpadeine so, 8 mg codeine with each dose, total 32 mg codeine per day. Could that carry health risk? (some contend hearing damage with chronic codeine use).

Addiction isn't a concern for me at that dose (used it forever any never any problems during discontinuation).
 
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I would have it checked out. Even within the 'safe' guidelines,, long term use can cause tinnitus. It COULD be a sign of toxicity. Paracetamol toxicity is due to the body running out of a specific amino acid. If you don't have enough in your diet or your body doesn't absorb it well, you may have an issue.

After all, wouldn't you go to the doctor if you got tinnitus after taking a prescription drug at the higher doses for a protracted period of time?

Better safe than sorry, in my opinion.
 
Fertile said:
I would have it checked out. Even within the 'safe' guidelines,, long term use can cause tinnitus. It COULD be a sign of toxicity. Paracetamol toxicity is due to the body running out of a specific amino acid. If you don't have enough in your diet or your body doesn't absorb it well, you may have an issue.

After all, wouldn't you go to the doctor if you got tinnitus after taking a prescription drug at the higher doses for a protracted period of time?

Better safe than sorry, in my opinion.
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If I mentioned that to my Dr, they'd probably just stop prescribing it, which I don't want.

Besides I'm not sure if tinnitus is because of that.

It's a possible cause.

I noticed it for the first time the night after getting my third covid vaccine.
 
Mjäll said:
I meant: Why are you taking that much paracetamol?

I think you should just stop taking way too much of a barely perceptible analgesic that's a known liver toxin. If you want the codeine, extract it.
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Using it to treat exertion/stress headaches.

It's the mildest most effect remedy I've found.
 
Ah - well the Covid vaccine seems more likely. It's a rare side-effect but we don't know if it's permanent.
 
JohnBoy2000 said:
Using it to treat exertion/stress headaches.

It's the mildest most effect remedy I've found.
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Alright.

Still way too much paracetamol. I don't think any sensible person could tell you this regimen sounds like a good idea.
 
In the UK we used to prescribe paracetamol + methionine. If I ever use paracetamol, I take methionine. Seems a sensible precaution, given it's certainly NOT a great idea long term.

My father was on paracetamol + dihydrocodeine for YEARS. The specialist actually said it would knock 10 years off my father's life. But for his pain, amitriptyline + botox injections (in the mouth) work vastly better.

His own fault - he played rugby. A second-row punchbag.
 
As well as methionine, N-acetylcysteine is useful (my ex - a toxicologist - told me that an IV drip of this drug is the standard treatment for paracetamol overdose). It caused damage because it is metabolized to para aminophenol and the body needs glutathione to prevent the metabolite causing damage throughout the body. Both methionine & NAC are precursors for glutathione in the body.
Sorry if this breaches the rule about sources, but NAC is available from Holland & Barrett (but it is fucking expensive). Like Fertile, I take NAC, when using paracetamol, because my ex told me dying of a paracetamol overdose is possibly the most painful overdose death.
 
JohnBoy2000 said:
Staying within the dosage guideline of 2000 mg every four hours, not more than 4000 mg per day.

So 4 tablets per four hours, not more than 8 a day.
Click to expand...

The correct dose for paracetamol is:
<80kg 1000mg/4 hours
>80kg 1500mg/4 hours

Paracetamol is clinically indicated for acute pain, if symptoms persist you should consider other options, like investigating the root cause of the condition, including seeking medical advice. (which you are doing)..
 
Extract the codeine and you get rid of the worries! Codeine is way less toxic than paracetamol. Perform a CWE, for your own health's sake!
 
The CWE isn't great. You will still be left with quite a lot of paracetamol. Thus either use a different solvent or form an addition salt of the paracetamol and find a solvent that will remove the stuff entirely.

Soluble paracetamol is sodium paracetamolate BUT it may be the case that some salts (possibly the calcium) will be totally insoluble in water.

But of course, ibuprofen is profoundly insoluble in water and so compound analgesics with ibuprofen in place of the paracetamol allow for totally clean extraction.

Nobody has really researched the CWE but pH affects paracetamol solubility as much as temperature. Nobody will provide data in spite of the fact that we know it's an increasing pattern of use and that many people die of paracetamol poisoning.
 
No, aspirin is even more tricky to remove.

THE solvent to separate paracetamol and codeine is DMSO. But that is kind of costly.

I don't have a magic answer. I would strongly recommend people dependent on codeine to contact a HR agency. My only advice is to say NO when they ask if they can talk to your doctor. I went in with a codeine problem of that size and the HR agency said it was HEROIN.

I took 4mg of buprenorphine (whatever they prescribe, 4mg is plenty enough to cover 400mg of codeine) for 7 days and stopped. But I was highly motivated to stop. It did cause massive anxiety and so when I asked the pharmacist... he suggested I take a couple of Neurofen+ at bedtime! It just seems to reset the beta-arrestin recruitment. Maybe the anxiety was the equivalent of what codeine does but buprenorphine does not - act as an anxiolytic.

But stick with it - I would have been capable of working (so not that sick) and being able to take nothing changed my life.
 
Fertile said:
No, aspirin is even more tricky to remove.

THE solvent to separate paracetamol and codeine is DMSO. But that is kind of costly.

I don't have a magic answer. I would strongly recommend people dependent on codeine to contact a HR agency. My only advice is to say NO when they ask if they can talk to your doctor. I went in with a codeine problem of that size and the HR agency said it was HEROIN.

I took 4mg of buprenorphine (whatever they prescribe, 4mg is plenty enough to cover 400mg of codeine) for 7 days and stopped. But I was highly motivated to stop. It did cause massive anxiety and so when I asked the pharmacist... he suggested I take a couple of Neurofen+ at bedtime! It just seems to reset the beta-arrestin recruitment. Maybe the anxiety was the equivalent of what codeine does but buprenorphine does not - act as an anxiolytic.

But stick with it - I would have been capable of working (so not that sick) and being able to take nothing changed my life.
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So you were taking Neurofen as an anxiolytic?

Which is what i'm doing.

Paracetamol does have a mild effect on this also, but the combination with codeine is much better.

........

Pharmacists seem to think provided sufficient time for paracetamol clearance is given (6 hours between 1000 mg doses), liver damage should be minimal, even with long term use?
 
Really, I wouldn’t advise going over 1000mg paracetamol at a time. The guidance is 2 x 500mg tablets every 4-6 hours, obviously 6 is preferred. No more than 8 x 500mg tablets in 24 hours which is 4000mg.

The liver clears paracetamol well enough but I wouldn’t be dosing more than what is the guidance as it does put your liver under pressure.

I’ve seen ODs with people coming in who’ve taken 8 tablets all together, that’s 4000mg at once. Yes they had other issues but the fact is that it’s just not good for your liver.

As to the long term implications. If used along with the guidance you should be ok. It’s obviously not optimal but I know many patients who take cocodamol, for example, everyday and have done for years. Regular LFT testing is done as standard for those patients.
 
MsDiz said:
Really, I wouldn’t advise going over 1000mg paracetamol at a time. The guidance is 2 x 500mg tablets every 4-6 hours, obviously 6 is preferred. No more than 8 x 500mg tablets in 24 hours which is 4000mg.

The liver clears paracetamol well enough but I wouldn’t be dosing more than what is the guidance as it does put your liver under pressure.

I’ve seen ODs with people coming in who’ve taken 8 tablets all together, that’s 4000mg at once. Yes they had other issues but the fact is that it’s just not good for your liver.

As to the long term implications. If used along with the guidance you should be ok. It’s obviously not optimal but I know many patients who take cocodamol, for example, everyday and have done for years. Regular LFT testing is done as standard for those patients.
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Are you a nurse or such?

Your last sentence is the position I'm in. I'm taking that formulation consistently and my last liver function test was clear.

It's not that common according to local pharmacists for patients to use such a formulation consistent/chronically.

The reason I switched to codeine combo with paracetamol was to reduce the amount of paracetamol I was having to take.
 
JohnBoy2000 said:
Are you a nurse or such?

Your last sentence is the position I'm in. I'm taking that formulation consistently and my last liver function test was clear.

It's not that common according to local pharmacists for patients to use such a formulation consistent/chronically.

The reason I switched to codeine combo with paracetamol was to reduce the amount of paracetamol I was having to take.
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Well if your LFT was fine and you’re dosing in the correct manner then I wouldn’t worry too much. Just make sure you’re not exceeding recommended dosing guidelines and get your LFT checked every quarter.

I’m not sure why you’re in pain but obviously your Dr should be getting to the root of it. I’d also suggest using non pharmaceutical methods for pain relief, if possible.

And I’m a qualified Dr but I don’t practice now, I’m in research.
 
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