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I know I was taught that 2gm/day was the maximum chronic dose we could safely prescribe, but I can't find literature to support this. Anyone have any citations they'd care to share?
Max Chronic Tylenol Dose
- Thread starter ampaphb
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I was taught 4,000- apparently it is now 3,000
http://news.consumerreports.org/hea...m-dose-reduced-to-help-prevent-overdoses.html
http://news.consumerreports.org/hea...m-dose-reduced-to-help-prevent-overdoses.html
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N Engl J Med. 2001 Dec 20;345(25):1801-8.
Acetaminophen, aspirin, and chronic renal failure.
Fored CM, Ejerblad E, Lindblad P, Fryzek JP, Dickman PW, Signorello LB, Lipworth L, Elinder CG, Blot WJ, McLaughlin JK, Zack MM, Nyrén O.
Source
Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden. [email protected]
Abstract
BACKGROUND:
Several epidemiologic studies have demonstrated an association between heavy consumption of nonnarcotic analgesics and the occurrence of chronic renal failure, but it is unclear which is the cause and which is the effect
METHODS:
In a nationwide, population-based, case-control study of early-stage chronic renal failure in Sweden, face-to-face interviews were conducted with 926 patients with newly diagnosed renal failure and 998 control subjects, of whom 918 and 980, respectively, had complete data. We used logistic-regression models to estimate the relative risks of disease-specific types of chronic renal failure associated with the use of various analgesics
RESULTS:
Aspirin and acetaminophen were used regularly by 37 percent and 25 percent, respectively, of the patients with renal failure and by 19 percent and 12 percent, respectively, of the controls. Regular use of either drug in the absence of the other was associated with an increase by a factor of 2.5 in the risk of chronic renal failure from any cause. The relative risks rose with increasing cumulative lifetime doses, rose more consistently with acetaminophen use than with aspirin use, and were increased for most disease-specific types of chronic renal failure. When we disregarded the recent use of analgesics, which could have occurred in response to antecedents of renal disease, the associations were only slightly attenuated
CONCLUSIONS:
Our results are consistent with the existence of exacerbating effects of acetaminophen and aspirin on chronic renal failure. However, we cannot rule out the possibility of bias due to the triggering of analgesic consumption by predisposing conditions.
After reading the article it is a little hard to interpret. It appears that 500g cumulative dosing is the cutoff for a 2.5 risk of chronic renal failure.
This equates to 1370mg per day.
Or listen the the Am Liver Foundation:
http://www.liverfoundation.org/downloads/alf_download_39.pdf
Acetaminophen, aspirin, and chronic renal failure.
Fored CM, Ejerblad E, Lindblad P, Fryzek JP, Dickman PW, Signorello LB, Lipworth L, Elinder CG, Blot WJ, McLaughlin JK, Zack MM, Nyrén O.
Source
Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden. [email protected]
Abstract
BACKGROUND:
Several epidemiologic studies have demonstrated an association between heavy consumption of nonnarcotic analgesics and the occurrence of chronic renal failure, but it is unclear which is the cause and which is the effect
METHODS:
In a nationwide, population-based, case-control study of early-stage chronic renal failure in Sweden, face-to-face interviews were conducted with 926 patients with newly diagnosed renal failure and 998 control subjects, of whom 918 and 980, respectively, had complete data. We used logistic-regression models to estimate the relative risks of disease-specific types of chronic renal failure associated with the use of various analgesics
RESULTS:
Aspirin and acetaminophen were used regularly by 37 percent and 25 percent, respectively, of the patients with renal failure and by 19 percent and 12 percent, respectively, of the controls. Regular use of either drug in the absence of the other was associated with an increase by a factor of 2.5 in the risk of chronic renal failure from any cause. The relative risks rose with increasing cumulative lifetime doses, rose more consistently with acetaminophen use than with aspirin use, and were increased for most disease-specific types of chronic renal failure. When we disregarded the recent use of analgesics, which could have occurred in response to antecedents of renal disease, the associations were only slightly attenuated
CONCLUSIONS:
Our results are consistent with the existence of exacerbating effects of acetaminophen and aspirin on chronic renal failure. However, we cannot rule out the possibility of bias due to the triggering of analgesic consumption by predisposing conditions.
After reading the article it is a little hard to interpret. It appears that 500g cumulative dosing is the cutoff for a 2.5 risk of chronic renal failure.
This equates to 1370mg per day.
Or listen the the Am Liver Foundation:
http://www.liverfoundation.org/downloads/alf_download_39.pdf
Also my understanding. 4 then 3. And it's three only because they found people didn't know Tylenol was in lots of other medications, such as Tylenol PM, and they were taking too much from other sources. So they were taking 4 grams of tylenol, then ultracet, nyquil, etc. Patients thought there was just PM in Tylenol PM. So because the public is stupid, it has been reduced in the "recommendation"
I have always told patients 3 grams, since medical school, for this exact reason.
