Regular vs Extra Strength

I have a bit of a pet peeve. My wife and I need pain relief regularly for arthritis. For the past while, I have only been able to find extra strength, not regular in the stores. I asked the pharmacist if they had any regular strength and he said no; we don’t carry it anymore. He said that no one was buying it as most people preferred extra strength. I find this strange as Consumer Reports found in a recent study that the same amount of medication reduced pain in half of the people who reported, whether they took the regular or extra strength. This means the same relief with less medicine.

Here’s why it’s important: we found Acetaminophen in over 600 prescriptions and over-the-counter medication. So, if you take it for a headache but it’s already in another medicine you take, you might be over-medicating—and too much might damage your liver. Many over-the-counter drugs have potentially dangerous levels of acetaminophen too.

There are dozens of products in any pharmacy that contain over 325 milligrams of acetaminophen per pill — such as extra-strength Tylenol (500 mg per pill), Tylenol cold and sore throat liquid (500 mg per dose), and even some drugs with as much as 625 mg per dose. Over-the-counter products make up about 80 percent of the $2.6 billion acetaminophen market.

Chances are, you take more in a day than you should. The threshold dose is 3,250 mg. That’s 6-and a half of these 500-milligram pills.

The FDA is warning people against taking prescription drugs that include over 325 milligrams of acetaminophen per pill — and it’s a good idea to stop taking the over-the-counter drugs that contain this much, too.

We have widely used acetaminophen for decades, and it surpassed aspirin in popularity during the 1980s. Even though the FDA realized the risks posed by the drug as early as 1977, it delayed taking action until recently. In the meantime, 150 Americans have died annually and tens of thousands have gone to the emergency room each year because of overdoses.

This occurs because when the body breaks down acetaminophen, it produces tiny amounts of a toxic byproduct called NAPQI. Normally, a natural antioxidant produced in the liver neutralizes this NAPQI, but excessive amounts of the toxin — produced by extra-large doses of acetaminophen — can overwhelm the liver, causing permanent damage, and in rare cases, death.

The FDA safety alert applies specifically to prescription drugs: it tells doctors and pharmacists to avoid prescribing opioid-based painkillers (such as Vicodin and Percocet) that include over 325 milligrams of acetaminophen per pill because they’re no more effective than low-dose formulations and can be dangerous.

The manufacturers have voluntarily recalled many of these prescription products, and in the future, the FDA plans to ban them, but for now, it’s relying on health professionals to stop recommending and providing

Given the research and the FDA warning for prescription pills, it’s smart to stop taking them anyway and stick to lower-dose products (like regular Tylenol, which has 325 mg per pill) or acetaminophen alternatives, such as ibuprofen, the active ingredient in Advil. The problem is that these lower doses products are hard to find as I think COVID has frightened people to take higher doses than they need/

To minimize liver damage and the chance of an overdose, the FDA also recommends against taking multiple acetaminophen-containing products (such as headache relief pills and cough syrup) taking more doses than the package recommends in a 24-hour period, or mixing any acetaminophen-based medicine with alcohol.

For people with reduced kidney function, ibuprofen can also cause problems. If you have kidney problems, consult a doctor before taking it.