In compliance with Proposition 65, the Safe Drinking Water and Toxic Enforcement Act of 1986, California may have to enforce retailers to label acetaminophen-containing products as having potential “cancer risk.”
Proposition 65 requires the state to maintain a list of chemicals that can cause cancer, birth defects or reproductive harm. Businesses must also provide warnings if their products sold contain compounds included on the list. If they don’t, they can be subject to a $2500 fine per violation per day.
There are over 900 chemicals currently on the list of toxic substances, and state regulators reviewed 133 studies to see if acetaminophen needs to be included.
Although acetaminophen use has been linked to liver disease (see below), and pediatric asthma, autism and ADHD if exposed perinatally, cancer studies have been far and few between.
However, in 2011, a study published in the Journal of Clinical Oncology, found “high use of acetaminophen was associated with an almost two-fold increased risk of incident hematological malignancies” such as myeloid neoplasms, non-Hodgkin lymphoma and plasma cell disorders. By “high use” they described taking acetaminophen more than 4 times a week for over 4 years. The cancer risk was still deemed as rare, but statistically significant.
A designation of being included in the Proposition 65 “list” is controversial as its hopes of educating the public could cause fear in the use of a medication has has been deemed relatively safe as opposed to other products used for similar illnesses (i.e. using acetaminophen for pain relief instead of an opioid), while at the same time open companies up to lawsuits if one alleges their medical condition came from an acetaminophen-containing product.
Acetaminophen (paracetamol in Europe) has long been known to cause liver failure. But now researchers reveal why its the number one cause of acute liver failure. And even more troubling, many people don’t realize they are overdosing on this common medication.
What does the liver do?
The liver filters and detoxifies blood. Additionally it breaks down and stores cholesterol and lipids and produces proteins. The liver also produces bile that gets stored in the gall bladder to help digest food after eating. It is one of the few organs in the body that can regenerate itself when tissue is damaged. So its troubled scientists how drug toxicity could irreversibly damage the liver to the same degree hepatitis, cirrhosis and cancer do. Researchers from the University of Edinburgh studied human and mouse liver cells and now know why.
What is liver failure?
In order for the liver cell to work, it needs to work in concert with the cells surrounding it but work in separate groupings, each with a different function. Excessive acetaminophen (the main ingredient in Tylenol) disrupts these cell connections, called “tight junctions”, hence the cells don’t function properly. “Failure” of an organ, such as “liver failure”, “heart failure”, and “renal failure” occur when the cells of the organ aren’t healthy enough to allow the organ to function.
Signs and symptoms of liver failure include: jaundice (yellow color to skin and eyes), fatigue, weakness, easy bleeding, nausea, diarrhea, confusion to name a few.
Knowing the mechanism of injury to the hepatocytes, liver cells, may allow scientists to create a means to repair liver cells that can’t be repaired themselves. Or design a pain reliever that doesn’t damage the liver.
How much acetaminophen is toxic?
Taking more than 4 grams a day could be considered and “overdose” and toxic. Frighteningly, this level is commonly consumed on a daily basis. Over the counter an “extra strength” dose contains 500 mg of acetaminophen. So if a person takes 1-2 pills every 4-6 hours, they can easily take 4 grams a day. Add a pain medication such as Vicodin or Percocet which contain acetaminophen, or a cough and cold remedy, or even an over the counter sleeping aid which may contain it as well, and its no surprise so many end up in the emergency room.
The following is a list of over the counter medications that may contain acetaminophen (provided by knowyourdose.org)
Saint Joseph® Aspirin-Free
TYLENOL® Brand Products
*And store brands
TYLENOL® with Codeine
*And generic drugs
We recommend discussing all your medication, especially over the counter, with your medical provider, and to not assume just because its available without a prescription, its safe in any dose.
Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and is Board Certified Family Physician