Tylenol, APAP, acetaminophen Common Question...."How much is too much?" Answers....

[painenduser]

Tylenol, APAP, acetaminophen Common Question...."How much is too much?" Answers....

I have been reading a number of threads and post in BDD since my time here regarding how much APAP is too much, or oh I took (n) percs last night and now my side hurts, and there have been many replies as to how much APAP is acceptable, so I decide to put this thread together to help people understand APAP and what the FDA guidelines are for it as well as the possible ramifications for taking such large doses that I have seen people post they have taken. This thread is not to scare you perse, but to give you an honest factual understanding regarding this.

There are a few things you should be aware of regarding large doses of N-Acetyl-p-Aminophenol (APAP, acetaminophen, paracetamol, Brand Name Tylenol), I think are important to understand and not to be overlooked, although commonly are. Please keep in mind that everyone's tolerance to the drug is different. Some may have a sensitivity to it, others may have pre-existing conditions making onset of heptatoxicity (liver toxicity) quicker and more severe, while others may have little problem with it, however in the higher doses everyone is at risk! Respect the drug and it may just respect you, abuse the drug, and it is bound to abuse you!

****"Acetaminophen is one of the most common pharmaceuticals associated with both intentional and unintentional poisoning and toxicity, as reported to the American Association of Poison Control Centers, and acetaminophen toxicity is the most common cause of hepatic failure requiring liver transplantation in Great Britain. In the United States, acetaminophen toxicity has not only replaced viral hepatitis as the most common cause of acute hepatic failure, but it is also the second most common cause of liver failure requiring transplantation", which results in thousands of hospitalizations every year. Source: medscape.com

In the US the maximum daily dosage of APAP used to be 4 grams (or 8 x 500mg's/24hrs APAP) per day*, however due to the overwhelming amount of overdoses the FDA has limited the maximum dose to 3 grams (or 6 x 500mg's/24hrs APAP) per day* .The dosage was dropped in an attempt to reduce the risk of overdose as there are over 600 OTC and RX medications on the market today that have APAP as an active ingredient. This includes many cold and flu OTC meds as well as Schedule II narcotics such as Percocet and Schedule III narcotics such as Vicodin**.

*This does not mean all in one dose, this is during a 24 hour period
** For the purposes of this forum we are mainly talking about narcotic pain relievers. The most popular, such as, but not limited to APAP w/Codeine, Capital w/Codeine, Darvocet, Endocet, Lorcet, Lortab, Panlor, Percocet, Pyregesic, Roxicet, Vicodin, Zerlor.

Acetaminophen is primarily metabolized by the liver. Too much can overwhelm the way the liver normally functions causing an increase in the AST an ALT enzymes which indicates an inflamation of the liver. As you can imagine this is not a good thing. This may also explain why some people who have taken extremely high doses of percocet, just to get their high from the oxycodone, have reported pain in their side the next day. This pain is likely visceral pain cause by this inflammation of the liver causing pressure on the lesser omentum or gastrohepatic sub-division of the visceral peritoneum. A lot of medical terms to say "OUWWW MY LIVER!"

A person who has taken an overdose amount may remain symptom free for 8hrs up to 24 hours. After this initial period one may have some or all of the following symptoms:

• Nausea
• Vomiting
• Not feeling well
• Not able to eat or poor appetite
• Abdominal pain

The antidote to APAP (acetaminophen) overdose is N-acetylcysteine (NAC). It is most effective when given within 8 hours of ingesting acetaminophen and must be given under doctors order by paramedics or in a hospital setting. Infact, NAC can prevent liver failure if given early enough. For this reason, it is absolutely necessary that acetaminophen poisoning be recognized, diagnosed, and treated as early as possible.

A person with a completely healthy liver (no prolonged alcohol use, no infections such as hepatitis) can overdose or cause severe liver damage with a single dose of 7-10 grams of acetaminophen which can cause death. This is considered to be the single toxic dose.

A person who drinks more the 2-3 alcoholic beverages a day should not exceed more then 2 grams in a 24 hour period. It is also important to note that doses of 3-4 grams in a single dose or 4-6 grams in a 24 hour period have caused severe liver injury in some people who have no history of prior liver conditions or illnesses.

It is also important to note that the liver is an amazing organ. It is the only organ in the human body that can regenerate and repair itself, providing the damage to the liver is not permanent. For example, when the liver is worked hard for a long period of time, say from a person who drink many drinks a night and then binges on the weekends, or for the purposes of this thread/forum a person who continually takes more perc's then they should to get a buzz but not enough to cause the liver to become toxic. The liver is given time to heal can fix itself up with little to no permanent damage. However if one is constantly hitting the toxic mark and not giving their liver a break, permanent damage like cirrhosis can occur and over time can be fatal. There is much more about this if interested, but for the purpose of this thread just know that short term non-habitual damage can be repaired by the liver however long term habitual damage, or one severe 7-10 gram use of APAP can cause permanent damage to the liver, ultimately leading to either needing a transplant or death.

The main purpose for me explaining this is because I see a lot of posts and responses where people make it seem like it's no big deal to take so many perc's to get that high ("because nothing happened to me, I was fine"), because while you may have had no reaction (that you know of, the damage could have been done with out you knowing), it could easily kill the next person who read that thinking it's OK for them to do it.

So please, in the interest of harm reduction, I urge you all to take this seriously and don't assume that taking that huge dose that one time did cause any problem as it very well may have, not to mention your giving the next person the courage to try it themselves because hey the other guy was fine...

To help you put this into perspective, I have End Stage Liver Disease (not from APAP, but liver disease none the less), if I were to take 2 grams of APAP in a single dose, I would probably become hepatoxic (liver toxicity) immediately and it would more then likely kill me. If I took just 2-3 grams within a 24 hour period, I would more then likely cause even more permanent damage to my liver but it may not kill me right away, and I do not intend to test either option. In fact my GI doctor has advised me I am not even to take as much as 1 Tylenol tablet of any dosage, and I plan on listening to his advise. So please be safe and please remember this before taking such large doses of your perc's.

Take the 5-10 minutes and learn how to use CWE, the link can be found here: Cold Water Extraction (CWE) if your that desperate to get your rocks off from the perc's or mostly any of the common narcotic analgesic.

**Everything written herein is for INFORMATIONAL PURPOSES ONLY!!

**Please note that this thread/post is not for debate as the information here is fact and is taken from the FDA guidelines for SAFE acetaminophen usage, whether used alone or in combination with other active ingredients or compound medications such as Narcotic Analgesics, as well as other prominent medical documentation and literature. However comments are welcome.

**The information herein is not to override your doctors recommendations but may be used in conjunction with. If you have any question regarding something your doctor has told you, you may use this as a reference to ask your doctor questions. Questions can save lives.

My goal here was to educate every one in the safe use, and the inherent dangers associated with the misuse, and abuse of drugs with APAP.

If you notice anything of importance missing that you feel should be added or any thing that may be grossly inaccurate please PM me so that I can make the appropriate corrections.


Sources: (FDA.gov, medscape.com, webmd.com, drugs.com, wiki.com)

Respectfully,

Pain

 

[Cane2theLeft]

Good information and well written - cheers!

 

[Doug2113]

Do y'all wanna see something neat? :D

Okay...here's the smart people word for it:
N-Acetyl-p-Aminophenol









Now pay attention...

N-Acetyl-p-Aminophenol









And once more...

N-Acetyl-p-Aminophenol

 

[painenduser]

Cane, thank you and I hate to ask this, but as this topic does come up quite often can we sticky this for a bit? I know to many stickys gets cluttered but we just had another thread / post and this very topic was brought up yet again. I think it's important that people familiarize themselves with this as prevalent of an issue this has become and how people are always dismissing taking large amounts as "eh no big deal"

Thanks.

And Doug, only you would have picked up on the hidden semantics in there lol nice one!

 

[nAON]

While we're playing with semantics.. para-acetylaminophenol :D

 

[The Shadow Self]

Just some very important info for anyone that consumes anything with APAP as an ingredient. There is a supplement that you can buy, called NAC (N-Acetyl Cysteine). It is a very potent anti-oxidant. Just so you know, NAC is given to patients that are believed or known to have over-dosed on APAP upon arrival at an ER, for example. It is given in large quantities to protect the liver. Jarrow products makes a sustained-release formula called "NAC Sustain", and I can tell you that taking it, or other hi quality NAC products can help protect your liver from the effects of too much APAP. If I were anyone out there taking substances such as Vicodin, Percocet, or any of the other myriad opiate combinations that contain APAP, I wouldn't do so without also taking NAC. It is not the answer or a panacea to APAP over-consumption, and it is not in any way condoning taking anything with too much APAP, but I tell you this just so you know that it can absolutely help protect your liver, to a degree, mind you, from the deleterious effects of APAP, which is a foul compound, and can destroy your liver if abused. Just some friendly advice from someone who knows. Why this information is not more widely available is a mystery to me, and it is not some urban myth. There is plenty of science to back up NAC's usefulness in liver protection as it relates to APAP consumption. Plenty. Using NAC can protect your liver. That should be reason enough to at least look into it yourself if you don't believe me.

 

[painenduser]

Just some very important info for anyone that consumes anything with APAP as an ingredient. There is a supplement that you can buy, called NAC (N-Acetyl Cysteine). It is a very potent anti-oxidant. Just so you know, NAC is given to patients that are believed or known to have over-dosed on APAP upon arrival at an ER, for example. It is given in large quantities to protect the liver. Jarrow products makes a sustained-release formula called "NAC Sustain", and I can tell you that taking it, or other hi quality NAC products can help protect your liver from the effects of too much APAP. If I were anyone out there taking substances such as Vicodin, Percocet, or any of the other myriad opiate combinations that contain APAP, I wouldn't do so without also taking NAC. It is not the answer or a panacea to APAP over-consumption, and it is not in any way condoning taking anything with too much APAP, but I tell you this just so you know that it can absolutely help protect your liver, to a degree, mind you, from the deleterious effects of APAP, which is a foul compound, and can destroy your liver if abused. Just some friendly advice from someone who knows. Why this information is not more widely available is a mystery to me, and it is not some urban myth. There is plenty of science to back up NAC's usefulness in liver protection as it relates to APAP consumption. Plenty. Using NAC can protect your liver. That should be reason enough to at least look into it yourself if you don't believe me.

Shadow, you are absolutely correct in what you shared, and while I have never had to use it, I wanted to validate your post. For those who may question this please see the following.. NAC usage for APAP overdose be for warned that there is a time limit to when one overdoses to when NAC is given before it becomes ineffective. I was aware of this when writing the original post, however, due to the amount of OD's from APAP, I did not want to give anyone any reason to chance it and take their life in their hands thinking, "oh well, there is an antidote to OD'ing on APAP". It's just a silly thing to chance! By no means am I saying that you should not have posted this, in fact I thank you for posting it. I just wanted to set the record as to why I did not mention it in my initial post. Thank you Shadow for your contribution to this thread. It is very much welcome!

Pain

 

[The Shadow Self]

I understand your points, and thought about it quite a lot before I posted it. I just thought I'd err on the side of harm reduction in sharing the info, and because I've seen some people's lives changed for the better in terms of helping them. So, again, points taken. And I agree, I think it's vitally important to never put yourself in a spot where you are relying on something like NAC to save your liver, and hence, your life, and that everyone who takes lots of APAP should understand the danger inherent in doing so. And while most anyone who begins taking lots of anything often thinks that they will somehow be immune to the effects of large doses over time, APAP is particularly unforgiving and I've seen it turn on people and wreck them to the point where they literally could not ingest any amount of APAP without getting sick and essentially, drug induced hepatitis, which is not fun and can be fatal with continued use. And when you get it, you know. You get very, very sick, and in what seems like a moment, you go from someone seeking a buzz to someone who is scared for their life. I don't want to see anyone in that spot, and you only get one liver.

 

[painenduser]

Hey Shadow, again, I do thank you and appreciate your post, in fact I know first hand how delicate the liver is. I am one who has end stage liver disease (not from APAP). The liver while you only get one, is the most resilient organ in the body and does regenerate to a degree, but no one should EVER use that or any other excuse to do harm to them selves. You did the right thing in posting what you did about NAC. It is important to be made aware of, even for those (no offense to anyone) who are stupid enough to challenge their own fate. I wanted to be clear that I was not knocking you for your post, it was the right thing to post and I should have put it in my APAP document, however, at the time, I was looking at it slightly different. In the interest of harm reduction there is a fine line between what is helpful and what it hurtful and honestly I challenge anyone to say they can definitively state they know that that line is. Your post was much welcomed by me as an addition to the reasons I created this post in the first place. I hope to see you post some more a you seem to have an understanding of the purpose of Blue, which is to educate in the ways of harm reduction.

You can't take the man out of the fool, but you can help take the fool out of the man.


Best Regards,

Pain

 

[The Shadow Self]

Of course I understand. And while I just registered, I have lurked on and off here for a long time. I have a lot of experience in a lot of very interesting areas, and hopefully I'll have something of value to share on a variety of topics. I am very much interested in Psychedelics and have been reading a lot of the posts on the boards, some old, some new, some a combination of both. I am glad there are places like this. While I tend to stray from glorifying drug use, I am a recreational user but keep that among myself and a set of like-minded friends I have had for many years. We are kind of like that group of guys who are all older than you'd expect, still enjoy the benefits of altering our consciousness, and live pretty normal lives. But, we are always looking for experiences that we can learn from, and try to find ways to explore boundaries of consciousness, even having done so for years. We are all adults, and we try and act like adults. We all have jobs, families, responsibilities, so on, but are weekend psychonauts, when we can get away with it, that is. Life gets in the way sometimes...