[justinc8687]

I lived with an ICU nurse for years and one of the things he emphasized was the risk of acetaminophen overdose. He's more than once treated the liver failure (and death) from it and by his words, it's one of the worse ways to go.

The positive of it is it got me in the habit of logging whenever I take it, either in a note on my phone or just a sheet of paper I place on my dresser under the bottle. This helps make sure I stay under the 3-4g/d limit.

Last year I was diagnosed with a rare headache disease (NDPH). We thought it completely came out of nowhere, but I had logs in my phone recording headaches and acetaminophen use intermittently from a few weeks prior. This proved useful in the diagnosis.

Moral of the story: log when you take it to avoid overdosing. Combine that with some basic symptom logging (like 1 line, 10 words or less). You never know when that might be useful for your doctors later on.

[jmalicki]

In my wilderness first responder class they emphasized taking a cocktail of ibuprofen and acetaminophen - both are effective pain relievers, each with different dangerous side effects.

The benefits stack, the side effects don't.

So if you are going to be loading up on higher doses of pain relief, take half acetaminophen and half ibuprofen.

[justinc8687]

P.S. like someone mentioned in a comment below happened to them, be careful with NSAIDs over the long term. Until recently I took them daily for better part of 3 years. I was recently diagnosed with chronic kidney disease. Can't definitively say causation, but they definitely contributed. They're fine for short term use but can really f$%# you up with long term, daily use.

[vidarh]

It is absolutely valid to warn about long term use, and NSAIDs in particular (I was lucky and had a gastroscopy before they'd done any serious damage, but they found significant erosion of my stomach lining due to NSAIDs), but acetaminophen/paracetamol isn't an NSAID (ibuprofen and aspirin, for example, are)

[justinc8687]

To be clear, it was nabumetone, celecoxib or meloxicam (at various times, not overlapping) for me.

[marcogarces]

In mozambique i was committed to the hospital with my liver failing after spending two weeks taking acetaminophen daily because everyone at work got sick and someone had to keep the business up (it was a bank, our IT department was very specific and only 6 people knew that job and everyone got extremely hill). After two weeks, i finally went to the hospital and I couldn't leave; spent the next two weeks fighting for my life and at some point I was told I was not going to make it. All due a simple over the counter medicine... crazy. This was 2016. To this day I still get extremely tired if I take it, so I have to choose it carefully when to take it.

[molf]

That sounds terrible! Glad you made it out alive and hopefully recovered well! Out of curiosity: how much did you take per day?

[marcogarces]

I think I was taking 3 grams a day, 1g every 8 hours; the day I finally decided to go seek medical help, I felt extremely tired... when I traced back how much I had taken, it was 3 grams in less than 8 hours, but this was due to being extremely tired and exhausted from the fever, which made me "forget". Lesson learned, I now keep a strict journal with all medicine I take.

[e40]

Agreed!! Here’s my trick: take 1g and set an alarm for +6 hours. If I don’t need it, fine. If I do, repeat.

[isoprophlex]

I'm not disagreeing with you or trying to be disagreeable, but how do people accidentally exceed 3-4 grams daily? That's 6-8 pills!

[brainwad]

It often happens when people take the max dose of straight paracetamol, and then also take another drug that has paracetamol in it without knowing that (e.g. a codeine/paracetamol or ibuprofen/paracetamol combination).

[skrebbel]

People who are in a lot of pain and don’t know the risks.

Rationalizations like “they probably put the limit way lower than the real limit so idiots don’t OD themselves, so I can safely take a bit more” become very attractive when you’re in a lot of pain.

[jeroenhd]

To be fair, the "real" limit depends on how lucky you are with your body's makeup. The safe limit is below that limit.

I know people with permanent pain due to medical conditions who have been given a doctor's approval to exceed the limits printed on the packaging (after having previously been monitored). You can exceed the limit on the packaging by one or two pills.

A bit more is often not deadly, but it's very easy to take more than a bit. When I had a messed up mouth for several days, I took the maximum doses and set timers to help me regulate the dosage throughout the day, but I sure wished I could've taken more at that time.

[isoprophlex]

Okay that's right, if you just keep upping the dose because you're still in pain it might be easy to just slam a few every 4 hours

From personal experience if i have a headache I'll take 1000 mg all at once; it either works right away or it doesnt and I stop bothering until I've had a good nights rest...

[kakacik]

Imagine if that rest will do nothing for that headache and its there morning day and night. Or some injury-related pain which simply can't be downtuned. Plus when old, half of the body aches, all old injuries and general deterioration.

I had only very brief experiences with longer intense pain but it made my mind into pudding and desperate knot of how-to-stop-this-at-all-costs. Normal life is not possible and sanity is not granted.

[justinc8687]

Yah...I've been there for 6 months now with a constant headache. The first month or so, I was taking 3.5g/day consistently. At hour 4.5 - 5, it would wear off. If it wasn't for my tracking, I probably would have ODed.

[vidarh]

If you take 2 on average every 4 hours, you're at 12. If you're feverish or otherwise feeling ill enough and sleep deprived enough, forgetting when you took them last is easy. Personally I write down the time I took the last one.

[justinc8687]

You are running a high fever or have a massive headache, so know you are going to max out at 4g/day. At that point, it's kind of hard to keep track of the clock.

"My head is pounding. Shit...did I take this at 3PM or 5PM? I know I took it and then fell asleep, but I can't remember when. It is now 9PM, can I take more or not?"

[mordae]

Hot Coldrex (Tylenol) + Pills. People don't read.

[Salgat]

My mother in law did this. There are a lot of ignorant and uneducated people out there. They think "take this for pain" = "take more for more pain", popping one an hour not really understanding how insanely dangerous it is since acetaminophen has such a subtle effect until it's too late.

[alphager]

It's in all kinds of medicine. People take some pills and then add a cough syrup, not noticing that the syrup also contains it as an active ingredient.

[e40]

If you're taking a lot of pills, which ill people often do (e.g., cancer patients), it's easy to forget.

Also, people with memory issues...

[ufo]

It can also happen if the person has some disease that affects the liver, which in turns lowers how much of the drug they can take.