Millions of people take acetaminophen, commonly known as the brand name drug Tylenol, frequently. People use acetaminophen for treating everything from fevers and muscle aches to headaches, hangovers and other pain. Because acetaminophen is available over the counter and is an ingredient found in many other preparations such as those for cold and flu, few people think twice about taking it. They should. Acetaminophen is the top cause of acute liver failure in the U.S.1 and overdoses are a leading cause of emergency department visits and hospitalizations.2 According to UT Southwestern Medical Center, more than 200 people a year die from acetaminophen poisoning in the U.S. and there are 15,000 hospital visits due to accidentally taking too much.3 Acetaminophen is also correlated with serious side effects4 such as certain skin conditions, abdominal and gastrointestinal problems and allergic reactions. As I mention later in this article, it also could be dangerous for pregnant women. And, if California state regulators are correct, the latest risk to be associated with acetaminophen may be cancer. The regulators are in the process of determining whether to classify acetaminophen as a carcinogen on the Proposition 65 list. Public Hearing on Carcinogenicity May Be in Spring 2020California's Proposition 65, enacted in 1986, requires the state to maintain a list of chemicals known to cause cancer or reproductive toxicity. Businesses are required to provide a warning if the products they sell or use expose the public to chemicals on the Proposition 65 list.5,6 California state regulators reviewed 133 acetaminophen studies in peer-reviewed journals and are considering whether to classify the drug as a carcinogen. They will hold a public hearing in spring 2020. According to The Associated Press, acetaminophen is:7
Since the drug is so popular, some fear that a warning will unnecessarily worry the public but Thomas Mack, chairman of the Carcinogen Identification Committee, the group appointed by the governor to identify chemicals linked to cancer,8 dismisses the fears. "That’s not what our mandate is," he says.9 In addition to the tremendous popularity of acetaminophen, inclusion of a chemical on the Proposition 65 list can pave the way for lawsuits, so industry is resisting the classification.10 For example, reports The Associated Press:
What Are the Possible Cancer Links to Acetaminophen?Suspicion of acetaminophen’s carcinogenic potential stems from the fact that it is a major metabolite of phenacetin, a drug connected with cancer more than three decades ago. In 2001, researchers in the International Journal of Cancer wrote:11
Still, the researchers added that they did not find what you would interpret as very strong cancer links with acetaminophen:12
Nearly 20 years later, in January 2020, the Los Angeles Times weighed in on the possible risks and downplayed them, saying the "standards for inclusion" for the Proposition 65 list are so low, even coffee was put on it.13 Acetaminophen Can Cause Liver DamageAs I wrote before, acetaminophen is the top cause of acute liver failure in the U.S. It can even be toxic to your liver at recommended doses when taken daily for just a couple of weeks.14 Part of the reason for the risk is that acetaminophen's recommended dose and the amount of the drug that causes an overdose are very close. There is not much margin of safety. In fact, studies reveal that taking just a little more acetaminophen than the recommended dose over a few days or weeks (referred to as "staggered overdosing") can be deadlier than one large overdose.15 Research in the Journal of Clinical and Translational Hepatology found:16
Acetaminophen Is Linked to Fatal Skin ReactionsFew people have heard of three serious skin reactions linked to acetaminophen, but they are concerning enough that the FDA issued a warning in 2013:17
The three skin conditions that the FDA warns of are very rare but also life-threatening:
No one knows why acetaminophen can cause these extreme skin conditions and there is no way to predict who may be at risk before they take the drug. Even more concerning, as the FDA points out in its warning, the reactions can occur in someone who has safely taken acetaminophen before. Acetaminophen Not Safe During PregnancyAcetaminophen is likely not safe to take for women who are pregnant. A study in JAMA Pediatrics found disturbing links between hyperkinetic disorders (HKD), a severe form of attention-deficit/hyperactivity disorder (ADHD), and ADHD itself.18 The study found a 29% increased risk for ADHD in the children whose mothers had used acetaminophen during pregnancy in the first seven years of their lives and a 37% increased risk of being diagnosed with HKD.19 In a 2015 communication, the FDA cited the JAMA Pediatrics ADHD study. It also cited research that found a possible connection between the use of acetaminophen and other drugs called nonsteroidal anti-inflammatories (NSAIDs) and miscarriage but found the evidence inconclusive.20 The fetal exposure of mothers taking acetaminophen during pregnancy may also increase a child's chances of developing asthma.21 Researchers analyzed data from the Norwegian Mother and Child Cohort Study, which includes many mother/child pairs, and found that prenatal acetaminophen exposure was associated with an increased risk of asthma in offspring.22 Finally, use of acetaminophen during pregnancy may cut levels of testosterone in the womb, negatively affecting males, according to research in mice.23 It's possible that this apparent testosterone reduction interferes with the development of the male reproductive system and explains genital birth defects, infertility and testicular cancer, according to other research.24 In addition to harm to male fetuses, a rat study found that the use of acetaminophen or NSAIDs in pregnancy could reduce the size of ovaries and follicles, and if applied to humans, might indicate that it could affect fertility of resulting daughters and granddaughters.25 Other Acetaminophen RisksAcetaminophen may not be safe to take when you are drinking alcohol. Research suggests it can greatly increase your risk of kidney dysfunction — even if the amount of alcohol is small.26 Combining alcohol with acetaminophen was found to raise the risk of kidney damage by 123% compared to taking either of them individually. Besides alcoholics, young adults are particularly at risk of kidney harm as they're more likely to consume both alcohol and acetaminophen.27 Acetaminophen can also affect the immune system. According to a study in Human Vaccines & Immunotherapeutics,28 infants who received acetaminophen right after getting a vaccination experienced lowered immune response and developed significantly fewer antibodies against the disease they were vaccinated against. Acetaminophen's anti-inflammatory activity might explain the apparent effects by interfering with the body's immune system antibody response, say the researchers. Other risks that have been associated with the use of acetaminophen include chronic obstructive pulmonary disease (COPD) and reduced lung function, brain damage, increased blood pressure and hearing loss. Finally, acetaminophen may have psychiatric effects, according to research conducted by University of British Columbia researchers in 2016.29 The researchers found that use of acetaminophen may both lessen the ability of people to recognize errors that they make and their concern about whether or not they have made an error.30 Past research has also revealed subtle cognitive effects associated with acetaminophen use, like a 2010 study that indicated acetaminophen may reduce the pain of social rejection.31 Research also showed that acetaminophen had the ability to blunt both positive and negative emotions.32 Regardless of whether acetaminophen is added to California's Proposition 65 as a carcinogen, there are many reasons to avoid this drug when possible and use it cautiously. Further, there are many pain-relieving herbs and practices that you can use to replace acetaminophen for natural relief. from http://articles.mercola.com/sites/articles/archive/2020/02/21/california-considers-declaring-common-painkiller-carcinogenic.aspx
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