Dialing back the dosage

You pop a few Tylenol for a headache, take allergy medicine for hay fever and a few Vicodin for your back pain, all in the same day.

You’ve just downed a cocktail of drugs containing the painkiller acetaminophen — and your liver could suffer serious damage.

The role that overuse of the drug plays in liver damage is receiving increased attention from the federal government. On Tuesday, a U.S. Food and Drug Administration panel voted to lower the recommended maximum daily dose of nonprescription acetaminophen, which is 4 grams, or eight pills of a medication like Extra Strength Tylenol.

The group was not asked to recommend an alternative maximum daily dose. The FDA is not required to follow the advice of its panels, although it usually does.

Acetaminophen, on the market for about 50 years, is one of the most widely used drugs in the country. Many patients find it easier on the stomach than ibuprofen and aspirin, which can cause ulcers. But it is the leading cause of liver failure, according to the FDA.

Problems develop when people unknowingly boost their acetaminophen dosage by combining it with other drugs they don’t know contain it, such as certain medications for allergies, colds and pain. Or they simply take too much Tylenol or Excedrin.

“People assume because it is over-the-counter, you can take as much as you want,” said Dr. Ron Kirschner, medical director of the Nebraska Regional Poison Center.

Acetaminophen, he said, is a safe drug. Even though it’s smart to limit doses, people should generally not worry about liver damage if they are taking it within the current recommended level of 4 grams per day, he said.

So how much is too much?

Taking more than 4 grams of acetaminophen for even one day can cause damage, said Dr. Dan Schafer, a liver specialist at the University of Nebraska Medical Center. Symptoms include jaundice, frequent nosebleeds and dark urine. Immediate medical care is needed.

The extent of any liver damage would depend on a number of factors, including the person’s size and overall health, Schafer said.

In general, people need to exercise more caution. Some are too quick to take acetaminophen for a minor headache or muscle soreness, said Victor Padron, an associate professor of pharmacy sciences at Creighton University.

Kirschner said it can be particularly tempting for those with chronic pain to exceed recommended doses of acetaminophen. Doing so will increase the risk of liver damage but do little to make a difference in pain control, he said.

“It’s maxed out in terms of pain relief.’’

Kirschner said people with chronic pain should talk with their doctors and seek a referral to a chronic pain specialist who can provide more effective medications.

Padron said pharmacists and doctors must do a better job of educating patients about the potential dangers of high doses of acetaminophen.

The government panelists on Tuesday rejected a proposal to pull certain over-the-counter cold and cough medicines off the market because of their role in overdosing. The drugs in question, such as Procter & Gamble’s NyQuil and Novartis’ Theraflu, combine acetaminophen with other ingredients that treat coughs and runny noses.

Panelists cited FDA data that said the medications play a minor role in acetaminophen overdoses, with only 10 percent of acetaminophen-related deaths involving a cold and cough product.

This report contains material from the Associated Press.