Before taking two cold medicines or two painkillers together, read the ingredient list; acetaminophen (paracetamol) should come from only one of them
- Top value
- Evidence B
- Buys life
- Free
- Takes minutes
- No willpower
In plain words
Many cold medicines contain acetaminophen (paracetamol, 对乙酰氨基酚). Taking two boxes together means a double dose, and too much damages the liver. In the U.S., of the acute liver failure patients it causes, nearly 30% died before they could get a liver transplant. Chinese package inserts advise taking no more than 2 g a day, and no alcohol while taking it.
- Cost
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Free. Look at the ingredient list on each box, a minute or two.
- What you get
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Across 22 hospitals in the U.S., 662 cases of acute liver failure were registered consecutively over 6 years. Of these, 275 (42%) were caused by acetaminophen, with a median dose swallowed of 24 g. Among these 275 people, 131 (48%) had taken too much by accident rather than on purpose. Of those who took too much by accident, 38% had taken two or more medicines containing this ingredient at the same time. Of the 275, 27% died before getting a liver transplant, and 8% had a liver transplant. In 2020 the National Medical Products Administration (国家药监局) required over-the-counter drug inserts to state that overuse can cause serious liver damage and to recommend a maximum of 2 g a day. The insert must also say to avoid, as far as possible, using it together with drugs that contain acetaminophen or other fever-reducing painkillers. U.S. rules require these over-the-counter drugs to list three liver-damage situations first in the warnings: exceeding the maximum daily dose, taking it with other drugs containing acetaminophen, and drinking 3 or more alcoholic drinks a day while using it.
- Notes
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Acetaminophen is also called paracetamol (扑热息痛). In the generic names of combination cold medicines, the characters 氨酚 (ānfēn, short for acetaminophen), as in 氨酚伪麻 and 氨咖黄敏, mean the product contains it. If you are not sure, show the boxes to the pharmacist at the drugstore. Graded B because the U.S. figures are a case registry with no comparison group, so they can't show how many problems reading the ingredient list would prevent. The benefit is rated “large” because of the outcome: nearly 30% of acute liver failure cases died directly.
- Evidence grade
- B : Supported by research but without a precise number, or based on small or single studies.
- Sources
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- Larson AM, Polson J, Fontana RJ, et al.; Acute Liver Failure Study Group (2005). Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology, 42(6):1364-1372. https://doi.org/10.1002/hep.20948
- 国家药监局关于修订对乙酰氨基酚常释及缓释制剂说明书的公告（2020年第15号）及附件2《对乙酰氨基酚常释制剂非处方药说明书修订要求》（湖南省药品监督管理局转载）. http://mpa.hunan.gov.cn/mpa/xxgk/tzgg/wjtz/202003/t20200311_11809335.html
- 21 CFR 201.326(a)(1)(iii)(A) Liver warning. https://www.ecfr.gov/current/title-21/chapter-I/subchapter-C/part-201/subpart-G/section-201.326
Mentioned in
- For period pain, take a painkiller such as ibuprofen rather than toughing it out; if the pain keeps you from work or school, or three months of medicine doesn't control it, see a gynecologist
- Don't give a child under 2 combination cold medicines or cough medicines on your own for a cold
- Don't drink alcohol while taking antibacterial drugs like cephalosporins or metronidazole, or for 7 days after stopping, and don't touch alcohol-containing medicines such as Huoxiang Zhengqi liquid (藿香正气水) or cough syrup
Translated from the Chinese original. Original book, section 34, tip 1. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer