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The Straight Dope



I recently overheard an individual in the medical profession state that the current leading cause of liver failure is actually "the combined use of acetaminophen (i.e., Tylenol) and alcohol rather than alcohol alone." Most pain relievers provide a warning against using their product if you consume three drinks or more a day, but my impression was that the danger from nonaspirin analgesics was far more serious than most people realize and not limited to daily drinkers. Are we losing a large number of weekend party animals to this combination of libation and hangover relief? If so, why hasn't it become common knowledge? --BDR, Chicago

Beats me. No less than Sam Donaldson has reported on the danger, so it's not like the media have been hiding this under a bushel. However, coverage often meets with skepticism and complaints of scaremongering. So let me put the issue as objectively as I can. Tylenol is the most popular pain reliever in the U.S. Tens of billions of doses of it and other acetaminophen-based products are consumed each year. For the overwhelming majority of users these medicines work as advertised and are completely safe. However, you do face the slight chance of abrupt death.

Acetaminophen overdose is the leading cause of acute liver failure, even if we leave alcohol out of the picture. According to one study, it accounts for 20 percent of cases (Schiodt et al, Liver Transplantation and Surgery, January 1999). An as-yet-unpublished follow-up puts the number even higher--30 percent. Acute liver failure isn't that common. Still, 70,000 cases of acetaminophen toxicity are reported each year.

The real problem with drugs like Tylenol is that the difference between a therapeutic (that is, medically effective) dose and a toxic one is surprisingly small. In adults the maximum safe dosage is four grams (eight 500-milligram tablets) over a 24-hour period. The toxic dose is a mere seven grams taken all at once.

You can make the margin even thinner by drinking too much and eating too little. I'll spare you the biochemistry, but basically acetaminophen and alcohol in combination overwhelm the liver's ability to remove toxins from your bloodstream. At the same time, starving yourself reduces the liver's output of glutathione, a natural detoxicant produced in response to food.

The upshot is that heavy drinkers (two or more drinks per day) who don't eat can suffer worse liver damage from Tylenol than people who OD on purpose. Of 71 patients treated at a Dallas medical center for acetaminophen overdose, 50 were attempted suicides and 21 were victims of an accidental overdose (Schiodt et al, New England Journal of Medicine, October 1997). The would-be suicides on average took twice as much of the drug as the accidental victims. Yet far more of the latter went into a coma (seven versus three) and died (four versus one). Why? Because most of the accidental victims were alcoholics. Five people--three accidental victims, two attempted suicides--overdosed on less than four grams, the claimed safe dosage for 24 hours.

Let's not forget kidney damage. A December 1994 study in the New England Journal of Medicine found that a daily tablet of acetaminophen for a year or 1,000 pills over a lifetime doubled the odds of kidney failure.

It's not clear from the medical literature what happens if you take acetaminophen after a onetime bender (as opposed to chronic alcohol abuse). But don't substitute some other painkiller--aspirin and ibuprofen can have side effects too. Better to be suffering than dead.


After reading your bizzare and wildly inaccurate column [about the world's tallest building, July 21] I contacted the CN Tower's PR department and verified its height at 553.55 meters, as we say in Canada, or 1,815 feet and 5 inches in a language Cecil and his ilk would understand. My guess is that since Toronto is so far from Chicago, Cecil may not have heard of it.

--The Marquis, via the Straight Dope message board

This is so pathetic. Whenever anybody in the universe writes about the world's tallest buildings, he gets letters from ticked-off Canadians. This is because the CN Tower is never included, on the grounds of its not being a building. It is so! shriek les habitants. I've been inside it! It's got restaurants and an observation deck and stuff! Sorry, Pierre. The CN Tower isn't primarily a building. It's primarily an antenna. If we counted antennas, I could get 3,000 feet of copper wire, tie one end to a balloon and the other to a cell phone in my pup tent (I've been inside it!), and bingo--world's tallest building. One curls one's lip. So get over it, Canadians. You want to call the CN Tower a building, fine. But I think I speak for the rest of the world when I say it looks like rabbit ears to me.

Comments, questions? Take it up with Cecil on the Straight Dope message board,, or write him at the Chicago Reader, 11 E. Illinois, Chicago 60611. Cecil's latest compendium of knowledge, Triumph of the Straight Dope, is available at bookstores everywhere.

Art accompanying story in printed newspaper (not available in this archive): illustration/Slug Signorino.

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