Alcohol + painkillers, any thoughts? My understanding is that the standard guidelines are that a low/moderate dose of alcohol and either ibuprofen or Tylenol is “ok,” at least if not an everyday thing. But at some point I thought to myself maybe it’s wise to be more cautious… like no painkillers within 6 hours of a single drink, or 24 hours of heavier drinking.
Nothing much aside from the last three entries of the table. With acetaminophen, the danger, as always, is that your glutathione could be depleted. Alcohol itself seems to deplete this. With ibuprofen and alcohol you have the issue that they both irritate the stomach and that alcohol leads to dehydration, and you don't want to go ANYWHERE NEAR ibuprofen when dehydrated.
My lay impression is that people vary in how much glutathione they tend to produce/have.
If you're someone who genetically makes less glutathione than average, or if your glutathione is acutely or chronically depleted because you're using it to metabolize other toxins you're exposed to at a higher rate than average, that suggests to me that supplementing with NAC or glutathione when taking acetaminophen could be more important.
And probably there are people whose first-pass P450 pathway works on acetaminophen at a nonstandard rate, and they might want to do things differently than average too.
I wonder if liver doctors worry about acetaminophen not just because they deal with a population of people with already-damaged livers, but because they're aware that some people might be naturally closer to that damaging threshold than average.
Weird that that doesn't show up significantly in the overall numbers, though. Maybe there are also large populations of people for whom NSAIDs are worse than average, balancing out the conclusion.
My personal medical non-advice as a layperson would be to figure out if you are in one or both of those categories for whom one or the other is riskier than average. And/or take NAC or glutathione with acetaminophen if you can't rule out being in a higher risk category for acetaminophen.
Not sure about the premise that liver doctors worry about acetaminophen. I mean, they surely worry, but in general liver disease is understood to increase the risk of ibuprofen more then acetaminophen.
(I think you're surely right that people vary in how much glutathione they produce, but the general thresholds are set conservatively enough that few people would get into trouble by following them.)
That was helpful. I have been cautious about acetaminophen due to the liver issue. But the main reason I rarely take acetaminophen is that it rarely addresses my pain. It can help with very mild, slightly annoying aches, but not always. For anything I would term pain, no.
I think this discussion amplifies the diminution of medicine by corporate machine medicine. You can’t do this in 10-minute visits. People wind up with 10-minute increments of choreographed futility, and a co-pay.
If it were an FDA regulation that acetaminophen were only to be offered in a dose compounded with sufficient glutathione or N-acetylcysteine, overdose deaths from acetaminophen could likely be eliminated. Eliminated.
In the hospital, overdoses are treated, after the ingestion, with NAC or glutathione. Why not preload with the “antidote?” And NAC and glutathione are fairly benign, supplements sold at the vitamin stores.
I’ve had that idea for 30 years. It is unprofitable, as it adds a few cents to each pill. 💊
I am a doctor, and I’ve been saying this for years. No traction on this. I see the suggestion shared in the reference section here.
I have found that well-chosen homeopathic medicines have largely eliminated my need for NSAIDS or acetaminophen, thus eliminating my risks from both.
It is important to remember that most of us use acetaminophen when we are sick. So our livers are under the stress from our illness before we ever add the stress of the acetaminophen. Ditto for kidneys and ibuprofen, or heart and ibuprofen.
We should remember that homeopathic medicines also present their own risks. Arnica is, after all, poisonous by default. Hypericum induces p450 so has lots of complex drug interactions (SSRIs, MAOIs). I don't necessarily claim that these are riskier than conventional OTC pain meds, but I suspect they're much less studied and so harder to be sure all the risks have been mapped out...
Your answer demonstrates that you are not aware of the nature of homeopathic medicines. As most people are not.
Yes, Arnica in gross, herbal form can cause bleeding. In homeopathic form, it has been highly diluted and potentized in a homeopathic pharmacy. The dilutions are on the order of 10*6th... such that without nanotechnology, there is no detectable substance left. It is no longer toxic.
Homeopathy is based on the principle of similars, or "like treats like." Meaning that the symptoms a substance causes in gross form are the exact symptoms that the medicine can address or treat when in homeopathic form.
Homeopathic Arnica is quite able to stop bleeding. I've used it many times for myself and our kiddo, with remarkable results. Most recently our kiddo cut themselves with a kitchen knife. A dose of Arnica and Hypericum, and the pain was gone and the bleeding minimized within 15 minutes. Not at all the speed with which Tylenol or ibuprofen could have produced.
I'm not claiming that arnica and hypericum cannot be used safely or are ineffective, merely pointing out that they have their own risks, just like conventional OTC painkillers. I'd want to subject them to the same analysis paracetamol and ibuprofen saw here before concluding one was safer than another.
And I am saying that the homeopathic forms do not have any of the risks that you are concerned about. That is the precise beauty of homeopathy. It works *with* the body rather than against it.
With respect, this comments section is not the place for making this kind of comment with this level of evidence. It's also not the place for debating if making that kind of comment with that level of evidence is good. There are many places for that on the internet, but this is not one of them.
I spent the whole time reading this waiting for the strident conclusion - the demand for change or the moral outrage. But no. What I got instead was careful, non-emotive analysis that made the case for the competence and good faith of the regulators and thus that nothing major needs to change. How refreshing. Thank you.
Great read! The providers in my practice also recommend avoiding NSAIDS to most of our patients so it's fascinating to see another perspective on why that may be.
I am unfortunately both allergic to acetaminophen, and I have kidney issues, so I'm left avoiding both methods of pain relief altogether. Definitely interesting to read through people's experiences or preferences for one medication over the other.
You may be interested in exploring homeopathic meds.
Homeopathic Arnica and Ledum are very useful for traumatic injuries, bruising. Hypericum for injuries of nerve-rich areas like finger tips. Staphysagria for surgical incisions.
And there are many for musculoskeletal pain and injuries. Rhus toxicodendron and Ruta graveolens are but two.
No adverse effects and when chosen well based on homeopathic principles, very effective.
I'm a 30+ year Internist, who also trained & previously board certified in Pediatrics (Med/Peds), but mostly see adolescents-adults these days. I also have a terrible C-spine (but trying to avoid fusion surgery) & bad knees. I take 650-975 mg of acetaminophen early EVERY morning (usually at my 5 AM pee alarm, thank you prostate), & keep large bottle in office for 2nd dose if I'm busy that day (right at 2 Gm/day most days). I take 400-600 mg of ibuprofen rarely (1-2 times week at most), usually if I work in yard or miss that last step rushing out of house.
I had an extremely painful disease which reached a peak in the early 70s. My family doctor was understanding about keeping me supplied with as much darvon as i needed, which was the most effective thing I could find. Sometimes it was prescribed as darvocet, and i would consume it in orders of magnitude above what I later learned was the safe dose. I eventually recovered from the disease. It's amazing i lived through all the tylenol. But I did. Sometimes I guess you get lucky.
Fun fact. I took ibuprofen after my C section last year, which caused an ulcer in my small intestine, which then burst and began leaking stomach juice into my abdomen, and the only reason I didn't go septic and become very, very sick and/or dead is because my gall bladder was pinning the hole shut.
This is apparently a well-documented possibility.
So, yeah. Acetaminophen is definitely not immediately superior to NSAIDs. 🙃🙃🙃
I have always taken acetaminophen, but now in my old age am very paranoid about it. When i get sick for two weeks as i do just about every christmas, i groggily keep charts of my acetaminophen intake.
But what amazes me is when I was a teenager, i'd every other weekend get raging drunk and ameliorate the next day symptoms with 1500mg of tylenol.
Very common, recommended by doctors all the time. As long as you're not at risk from the individual drugs (and, to be clear, occasionally using ibuprofen seems to be very low risk as long as you're careful), not generally considered risky to combine them.
What's really recommended against is combining different NSAIDs, e.g. ibuprofen + aspirin.
Alcohol + painkillers, any thoughts? My understanding is that the standard guidelines are that a low/moderate dose of alcohol and either ibuprofen or Tylenol is “ok,” at least if not an everyday thing. But at some point I thought to myself maybe it’s wise to be more cautious… like no painkillers within 6 hours of a single drink, or 24 hours of heavier drinking.
Nothing much aside from the last three entries of the table. With acetaminophen, the danger, as always, is that your glutathione could be depleted. Alcohol itself seems to deplete this. With ibuprofen and alcohol you have the issue that they both irritate the stomach and that alcohol leads to dehydration, and you don't want to go ANYWHERE NEAR ibuprofen when dehydrated.
My lay impression is that people vary in how much glutathione they tend to produce/have.
If you're someone who genetically makes less glutathione than average, or if your glutathione is acutely or chronically depleted because you're using it to metabolize other toxins you're exposed to at a higher rate than average, that suggests to me that supplementing with NAC or glutathione when taking acetaminophen could be more important.
And probably there are people whose first-pass P450 pathway works on acetaminophen at a nonstandard rate, and they might want to do things differently than average too.
I wonder if liver doctors worry about acetaminophen not just because they deal with a population of people with already-damaged livers, but because they're aware that some people might be naturally closer to that damaging threshold than average.
Weird that that doesn't show up significantly in the overall numbers, though. Maybe there are also large populations of people for whom NSAIDs are worse than average, balancing out the conclusion.
My personal medical non-advice as a layperson would be to figure out if you are in one or both of those categories for whom one or the other is riskier than average. And/or take NAC or glutathione with acetaminophen if you can't rule out being in a higher risk category for acetaminophen.
Not sure about the premise that liver doctors worry about acetaminophen. I mean, they surely worry, but in general liver disease is understood to increase the risk of ibuprofen more then acetaminophen.
(I think you're surely right that people vary in how much glutathione they produce, but the general thresholds are set conservatively enough that few people would get into trouble by following them.)
That was helpful. I have been cautious about acetaminophen due to the liver issue. But the main reason I rarely take acetaminophen is that it rarely addresses my pain. It can help with very mild, slightly annoying aches, but not always. For anything I would term pain, no.
I think this discussion amplifies the diminution of medicine by corporate machine medicine. You can’t do this in 10-minute visits. People wind up with 10-minute increments of choreographed futility, and a co-pay.
If it were an FDA regulation that acetaminophen were only to be offered in a dose compounded with sufficient glutathione or N-acetylcysteine, overdose deaths from acetaminophen could likely be eliminated. Eliminated.
In the hospital, overdoses are treated, after the ingestion, with NAC or glutathione. Why not preload with the “antidote?” And NAC and glutathione are fairly benign, supplements sold at the vitamin stores.
I’ve had that idea for 30 years. It is unprofitable, as it adds a few cents to each pill. 💊
I am a doctor, and I’ve been saying this for years. No traction on this. I see the suggestion shared in the reference section here.
I have found that well-chosen homeopathic medicines have largely eliminated my need for NSAIDS or acetaminophen, thus eliminating my risks from both.
It is important to remember that most of us use acetaminophen when we are sick. So our livers are under the stress from our illness before we ever add the stress of the acetaminophen. Ditto for kidneys and ibuprofen, or heart and ibuprofen.
We should remember that homeopathic medicines also present their own risks. Arnica is, after all, poisonous by default. Hypericum induces p450 so has lots of complex drug interactions (SSRIs, MAOIs). I don't necessarily claim that these are riskier than conventional OTC pain meds, but I suspect they're much less studied and so harder to be sure all the risks have been mapped out...
Your answer demonstrates that you are not aware of the nature of homeopathic medicines. As most people are not.
Yes, Arnica in gross, herbal form can cause bleeding. In homeopathic form, it has been highly diluted and potentized in a homeopathic pharmacy. The dilutions are on the order of 10*6th... such that without nanotechnology, there is no detectable substance left. It is no longer toxic.
Homeopathy is based on the principle of similars, or "like treats like." Meaning that the symptoms a substance causes in gross form are the exact symptoms that the medicine can address or treat when in homeopathic form.
Homeopathic Arnica is quite able to stop bleeding. I've used it many times for myself and our kiddo, with remarkable results. Most recently our kiddo cut themselves with a kitchen knife. A dose of Arnica and Hypericum, and the pain was gone and the bleeding minimized within 15 minutes. Not at all the speed with which Tylenol or ibuprofen could have produced.
Homeopathy is very safe.
I'm not claiming that arnica and hypericum cannot be used safely or are ineffective, merely pointing out that they have their own risks, just like conventional OTC painkillers. I'd want to subject them to the same analysis paracetamol and ibuprofen saw here before concluding one was safer than another.
And I am saying that the homeopathic forms do not have any of the risks that you are concerned about. That is the precise beauty of homeopathy. It works *with* the body rather than against it.
With respect, this comments section is not the place for making this kind of comment with this level of evidence. It's also not the place for debating if making that kind of comment with that level of evidence is good. There are many places for that on the internet, but this is not one of them.
I spent the whole time reading this waiting for the strident conclusion - the demand for change or the moral outrage. But no. What I got instead was careful, non-emotive analysis that made the case for the competence and good faith of the regulators and thus that nothing major needs to change. How refreshing. Thank you.
Great read! The providers in my practice also recommend avoiding NSAIDS to most of our patients so it's fascinating to see another perspective on why that may be.
I am unfortunately both allergic to acetaminophen, and I have kidney issues, so I'm left avoiding both methods of pain relief altogether. Definitely interesting to read through people's experiences or preferences for one medication over the other.
You may be interested in exploring homeopathic meds.
Homeopathic Arnica and Ledum are very useful for traumatic injuries, bruising. Hypericum for injuries of nerve-rich areas like finger tips. Staphysagria for surgical incisions.
And there are many for musculoskeletal pain and injuries. Rhus toxicodendron and Ruta graveolens are but two.
No adverse effects and when chosen well based on homeopathic principles, very effective.
I'm a 30+ year Internist, who also trained & previously board certified in Pediatrics (Med/Peds), but mostly see adolescents-adults these days. I also have a terrible C-spine (but trying to avoid fusion surgery) & bad knees. I take 650-975 mg of acetaminophen early EVERY morning (usually at my 5 AM pee alarm, thank you prostate), & keep large bottle in office for 2nd dose if I'm busy that day (right at 2 Gm/day most days). I take 400-600 mg of ibuprofen rarely (1-2 times week at most), usually if I work in yard or miss that last step rushing out of house.
I 💯 agree with you!
I had an extremely painful disease which reached a peak in the early 70s. My family doctor was understanding about keeping me supplied with as much darvon as i needed, which was the most effective thing I could find. Sometimes it was prescribed as darvocet, and i would consume it in orders of magnitude above what I later learned was the safe dose. I eventually recovered from the disease. It's amazing i lived through all the tylenol. But I did. Sometimes I guess you get lucky.
Does any of the literature you reviewed for this discuss proactively dosing NAC with Acetaminophen?
That seems like an easy win, no?
It's widely available dirt cheap OTC and relatively safe as far as I understand, though oral uptake may be limited?
I thought it was an easy win too; see footnote 6!
Fun fact. I took ibuprofen after my C section last year, which caused an ulcer in my small intestine, which then burst and began leaking stomach juice into my abdomen, and the only reason I didn't go septic and become very, very sick and/or dead is because my gall bladder was pinning the hole shut.
This is apparently a well-documented possibility.
So, yeah. Acetaminophen is definitely not immediately superior to NSAIDs. 🙃🙃🙃
I have always taken acetaminophen, but now in my old age am very paranoid about it. When i get sick for two weeks as i do just about every christmas, i groggily keep charts of my acetaminophen intake.
But what amazes me is when I was a teenager, i'd every other weekend get raging drunk and ameliorate the next day symptoms with 1500mg of tylenol.
I should have had liver failure as a 17-year old!
Wow...scary ...but what about combinations of paracetamol and ibuprofen....like Lekadol? What is you take both things together?
Very common, recommended by doctors all the time. As long as you're not at risk from the individual drugs (and, to be clear, occasionally using ibuprofen seems to be very low risk as long as you're careful), not generally considered risky to combine them.
What's really recommended against is combining different NSAIDs, e.g. ibuprofen + aspirin.
We are a society that likes a quick fix...hence, painkillers. If inflammation is the issue, it can be managed with a healthy diet.
As a hard drinker with a likely not good liver, thanks. I think I will just not take anything...