Feeling better with the right meds

Dear Dr. Peg
When I get a headache or get sick with body aches or fever, I like to take something to help me feel better. But I heard that acetaminophen can destroy your liver and ibuprofen can destroy your stomach. Is there anything else? What can I do?
-Achey

Dear Achey,
It gets confusing, I know. Pharmacy shelves are loaded with products claiming to cure whatever ails you. Many of the products have multiple ingredients, which can add to the confusion. Both of the drugs you mentioned have been in the limelight and were revealed to be not quite as benign as they seemed.

Acetaminophen goes by the brand name Tylenol, among others. You might also see it on
labels as APAP, which stands for N-acetyl-p-amino phenol, the official chemical name. This drug made the news because it caused liver damage in some people. In normal doses, acetaminophen is usually safe. The problem is that people take more than they realize.

Acetaminophen is an ingredient in lots of products, like Dayquil, Nyquil, Theraflu and Excedrin PM, just to name a few. Add this to the fact that, for acetaminophen, the distance between maximum safe dose and toxic dose is quite short. So if you take one of the multi-symptom products and also take acetaminophen, you can end up with a toxic dose of acetaminophen without realizing it.

Since alcohol can damage the liver too, there is some concern about taking acetaminophen if you drink alcohol. If you have a weakened liver, like from chronic hepatitis or heavy alcohol use, you should talk to your doctor before you take acetaminophen.

The FDA has taken a few steps to decrease the risk of people getting liver damage from acetaminophen. As of this month, product labels are required to highlight the presence and danger of this drug. There is talk of taking it further, like limiting the maximum single dose to less than the current 1,000 mg (two extra strength pills), and decreasing the maximum recommended daily dose, which is currently 4 grams in total, but those steps haven’t happened yet.

My best advice to you is to read labels carefully. You might also want to buy single ingredient medications. I know it is easier to take one product than three, but it might be safer to address one symptom at a time. It can also be cheaper. Multi-symptom products can be quite pricey compared to single ingredient generic drugs. If you doubt that, do your own recon in the nearest pharmacy.

You also asked about ibuprofen. Like all drugs, it can be a wolf in sheep’s clothing. Ibuprofen is in a different class of drug from acetaminophen, a class called nonsteroidal anti-inflammatory medicines, or NSAIDs. Aspirin and naproxen are also in this group. Naproxen is the active ingredient in Aleve. There are many more NSAIDs available by prescription only.

NSAIDs work for fever and pain, like acetaminophen. Unlike acetaminophen, however, these drugs also work on inflammation. These are the drugs you’ll take if you sprain your ankle or hurt your back.

NSAIDs can cause you to bleed more easily and they can also irritate your stomach. I have seen patients with bleeding ulcers from taking too many NSAIDs. Again, it is usually a matter of dosage, but even at normal doses some people have trouble. Take these medicines with food, don’t exceed the maximum dosages and pay attention to your body for signals that the
medicine might not agree with you.

A word about aspirin before I leave you. Aspirin, also known as ASA or acetylsalicylic acid, is an old drug, tried and true for many problems. However, it has a rare but dangerous side effect. In a few children and teens who are recovering from viral illnesses, aspirin has caused something called Reye’s Syndrome. This is a rare but potentially fatal complication causing internal chemical derangements and swelling in the liver and brain. For this reason, most doctors don’t recommend aspirin for kids or teens.
If you think you might have taken too much of anything, call Poison Control locally at (505) 272-2222 or nationally at (800) 222-1222. In addition, your local pharmacist can be a source of excellent information. Student Health and Counseling Pharmacy may be reached at (505) 277-6307. They are located on the second floor
of SHAC.

Peggy Spencer is a board-certified family physician. She has been a UNM Student Health physician for 17 years. Drop your questions into her box in the lobby of Student Health and Counseling, or e-mail her directly at pspencer@unm.edu. All questions will be considered, and all questioners will remain anonymous. This column has general health information only and cannot replace a visit to a health provider.