Acetaminophen is one of the most commonly used drugs for pain and fever. In 2005, 28 billion doses of products containing acetaminophen were purchased in the U.S. When more than 4 grams per day of acetaminophen are taken, it can cause liver damage or even death. Despite efforts since 1990 to reduce acetaminophen-related liver injury, the number of liver failure cases related to acetaminophen use continues to be a serious health problem.

Acetaminophen is the generic name for a very effective pain and fever reducer found in many over-the-counter products such as Tyenol and prescription pain medications such as Lortab. Acetaminophen differs from other commonly used pain and fever remedies such as aspirin and ibuprofen in that it does not cause stomach irritation or bleeding. Acetaminophen is considered safe when taken at recommended doses but it can cause liver damage, liver failure or even death when taken at more than 4 grams per day.

The FDA increased the warning requirement in April, 2009, about acetaminophen use and is considering further changes to try to improve the safety of use. Some options being considered include reducing the total daily dose especially in those who also drink alcohol to less than 3.25 grams per day, limiting OTC package size, expanding product warning labels, eliminating combination products, and limiting the dosing formulations for liquid products to require a dosing device to measure the dose. These changes could affect tremendously the availability of some of the most commonly used pain medications.

Another commonly used pain medication, propoxyphene, is also coming under scrutiny by the FDA. Propoxyphene is found in the prescription products Darvon and Darvocet (which also contains acetaminophen). Propoxyphene is already banned in the UK and is rarely used in Canada. Its advantages are that it causes less nausea than other opioid pain relievers and it can often be used in persons allergic to codeine or hydrocodone. The danger with its use is that it is metabolized to a chemical that causes cardiac toxicity at doses not much higher than therapeutic doses. It can cause death at amounts as low as 6 to 15 tablets or capsules, especially if combined with alcohol or anti-depressants. Adding to the problem, overdoses are not easily reversed by naloxone which is used to reverse other opioid overdoses. That makes propoxyphene easy to overdose on with no good antidote. The maximum dose of propoxyphene products should be one tablet or capsule every 4 to 6 hours.

Lantus, insulin glargine, has been reported in some European studies to increase the risk of cancer. These studies were not specifically designed to evaluate the risk of cancer with Lantus, these were just observations during studies for other purposes. Patients should not change their insulin without talking with their doctor. There is no current evidence that Lantus increases the risk of cancer.

References: http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/DrugSafetyandRiskManagementAdvisoryCommittee/UCM164897.pdf.

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