Tylenol 83407 225359247 2008-07-13T07:42:23Z 81.56.190.45 /* Overdose */ {{For|more information about the active ingredient of Tylenol, acetaminophen|Paracetamol}} [[Image:Extra Strength Tylenol and Tylenol PM.jpg|thumb|Tylenol and Tylenol PM]] '''Tylenol''' is a popular North American [[brand]] of [[drug]]s for relieving [[analgesic|pain]], reducing [[fever]], and relieving the symptoms of [[allergy|allergies]], [[common cold|cold]], [[cough]], and [[flu]]. The active ingredient of its original, flagship product, [[paracetamol|acetaminophen]] (called "paracetamol" outside of North America), is marketed for [[headache]]s, [[fever]], [[muscle pain|muscle]] and body [[pain]], [[arthritis]], and [[joint pain]]. Like the words "acetaminophen" and "paracetamol", the brand name is derived from the chemical name for the compound, N-ace'''tyl'''-para-aminoph'''enol''' (APAP). It is available [[over-the-counter drug|over the counter]] without prescription, has few side effects, and reacts with very few medications. However, it can have fatal interactions with large amounts of alcohol. In addition to products related to allergies and cold, [[Johnson & Johnson]] also sells a stronger pain reliever containing [[codeine]]. ==History== The active substance of Tylenol, [[acetaminophen]] (APAP), was first used in medicine in 1893. Acetaminophen only gained widespread use after 1948, when scientists concluded that another popular drug, [[acetanilide]], was toxic and that the same therapeutic effect could be safely achieved with acetaminophen, which was already known to be a [[metabolite]] of acetanilide. James Roth, a U.S. [[gastroenterology|gastroenterologist]], advocated paracetamol as a safer alternative to [[aspirin]], which was shown to have some [[adverse drug reaction|negative effects]]. Roth was also principal consultant to [[McNeil Laboratories]]. In 1953 McNeil Laboratories introduced Algoson, a preparation containing paracetamol together with sodium [[butabarbital]], a sedative. In 1955 McNeil Laboratories introduced Tylenol Elixir for children, which contained paracetamol as its sole active ingredient. It was originally marketed mainly towards children, but soon came to dominate the North American pain-killer market. There are a number of different varieties of Tylenol available today including extra-strength (with 500&nbsp;milligrams of acetaminophen), children's doses, longer-lasting, and sleep aiding (in combination with a sedative [[antihistamine]]). In 2005 Tylenol Ultra was introduced in Canada, with 500&nbsp;mg of acetaminophen and 65&nbsp;mg of [[caffeine]]; caffeine has [[Vasoconstriction|vasoconstricting]] effects, for which there is some disputed evidence for additional efficacy.<ref>{{cite journal | author = Diener H, Pfaffenrath V, Pageler L, Peil H, Aicher B | title = The fixed combination of acetylsalicylic acid, paracetamol and caffeine is more effective than single substances and dual combination for the treatment of headache: a multicentre, randomized, double-blind, single-dose, placebo-controlled parallel group study. | journal = Cephalalgia | volume = 25 | issue = 10 | pages = 776–87 | year = 2005 | pmid = 16162254}} - which concludes ''"the fixed combination of ... caffeine was statistically significantly superior to the combination without caffeine"''</ref><ref>{{cite journal | author = Loder E | title = Fixed drug combinations for the acute treatment of migraine : place in therapy. | journal = CNS Drugs | volume = 19 | issue = 9 | pages = 769–84 | year = 2005 | pmid = 16142992 | doi = 10.2165/00023210-200519090-00004}} - which notes that ''"benefits assumed for ... caffeine ... are not clearly confirmed in these trials"''</ref> The patent on paracetamol has expired, and the continued successes of Tylenol brand preparations are largely due to marketing, the backing of Johnson & Johnson, and new patented delivery mechanisms such as quick-release and extended-release forms of the medication. On [[September 29]], [[1982]], a [[Tylenol Crisis of 1982|"Tylenol scare"]] began when the first of seven individuals died in [[metropolitan Chicago]], after ingesting Extra Strength Tylenol that had been deliberately contaminated with [[cyanide]]. The crime was never solved and Tylenol sales temporarily collapsed, but the brand was rebuilt and recovered in a few years. At the request of later Chairman, Joseph Chiesa, new product consultant Calle & Company rescued the brand with the invention of the first inherently tamper-proof [enrobed] [[capsule (pharmacy)|capsule]], Tylenol Gelcaps, recapturing the 92% of capsule segment sales lost after the cyanide incident. The scare led to the introduction of [[tamper-evident]] packaging and "gelcaps" across the [[over-the-counter drug]] (OTC) and [[prescription drug]] industry. Tylenol remains a top seller, controlling about 35% of the pain killer market in North America.<ref>[http://content.nejm.org/cgi/content/full/349/5/474 Drug-Induced Hepatotoxicity,] William M. Lee, New England Journal of Medicine, July 31, 2003, 349:474-485.</ref>, yet acetaminophen overdose is responsible for more ER visits than any other medicine on the market.<ref name="pmid17984051">{{cite journal | author = Bushel PR, Heinloth AN, Li J, ''et al'' | title = Blood gene expression signatures predict exposure levels | journal = Proc. Natl. Acad. Sci. U.S.A. | volume = 104 | issue = 46 | pages = 18211–6 | year = 2007 | month = November | pmid = 17984051 | doi = 10.1073/pnas.0706987104 | url = }}</ref> == Tylenol products == [[Image:TYLENOL3.JPG|right|thumb|200px|Tylenol 3 - a compound of Tylenol and [[Codeine]]]] Tylenol sells products to relieve [[pain relief|pain]], [[allergy|allergies]], and [[common cold|cold]]- and [[flu]]- related symptoms. Allergy and cold products also contain [[dextromethorphan]], [[antihistamine]]s, and [[expectorant]]s. A class of stronger pain relievers contains [[codeine]] ([[Tylenol 2]] and [[Tylenol 3]]). Acetaminophen is also found in other narcotic based [[analgesic]]s such as [[Percocet]] which contains [[oxycodone]]. Unlike [[NSAID]]s, acetaminophen is not particularly effective against pain from inflammatory disorders, since it doesn't reduce the underlying inflammation. The normal maximum dose for acetaminophen per day is 65&nbsp;mg/kg or 4&nbsp;grams per day, whichever is less. However; there are cases where acute hypotoxicity has been linked to amounts lower than 2.5 grams per day.<ref>[http://content.nejm.org/cgi/content/full/349/5/474 Drug-Induced Hepatotoxicity,] William M. Lee, New England Journal of Medicine, July 31, 2003, 349:474-485.</ref> Certain patients, such as those on medications processed by the liver or diseases of the liver (''e.g.'', Hepatitis A, B, or C), may for safety need to take far lower dosages. Acetaminophen should not be used for over two weeks without seeking medical advice. It is essential to avoid excessive amounts of acetaminophen as this may cause damage to the liver or kidneys; in particular, users should be aware of the risk of taking different preparations which each contain an acceptable dose of acetaminophen, but which together produce an overdose. == Overdose == {{seealso|Paracetamol#Toxicity}} Overdose of acetaminophen is serious and can be fatal from liver toxicity, killing about 12% of those who seek treatment due to the delayed effects.{{Fact|date=July 2008}} Often the patient may not even experience symptoms for up to 24-48 hours. Typical symptoms after this period range from nausea, malaise to extreme upper abdominal pain in the region of the liver. In [[alcoholism|heavy drinkers]], regular use of acetaminophen increases liver damage from alcohol. Acetaminophen toxicity is the most common cause of acute liver failure in the United States,<ref name="pmid17984051">{{cite journal | author = Bushel PR, Heinloth AN, Li J, ''et al'' | title = Blood gene expression signatures predict exposure levels | journal = Proc. Natl. Acad. Sci. U.S.A. | volume = 104 | issue = 46 | pages = 18211–6 | year = 2007 | month = November | pmid = 17984051 | doi = 10.1073/pnas.0706987104 | url = }}</ref> accounting for 39% of cases. It occurs both after attempted suicide by c overdose and after unintentional overdoses.<ref>[http://content.nejm.org/cgi/content/full/349/5/474 Drug-Induced Hepatotoxicity,] William M. Lee, New England Journal of Medicine, July 31, 2003, 349:474-485.</ref> In some susceptible people, even small doses, combined with small amounts of alcohol, have caused irreversible liver failure.{{Fact|date=February 2008}} Acetaminophen can cause kidney failure in vulnerable persons. These include alcoholics, elderly men, and persons with pre-existing liver or kidney damage.<ref>{{cite journal | author = Lee M | title = Acute Renal Failure in an Alcoholic Taking Acetaminophen | journal = Journal of the American Board of Family Practice | volume = 11 | issue = 5 | pages = 410–13 | year = 1998 | id = unknown | url=http://www.medscape.com/viewarticle/417814_3}}</ref> ==References== <references/> ==See also== * [[1982 Chicago Tylenol murders]] * [[List of paracetamol brand names]] ==External links== * [http://www.tylenol.com Tylenol Website] * [http://www.rsc.org/Education/EiC/issues/2005July/painrelief.asp Pain relief: from coal tar to paracetamol] {{J&J}} [[Category:Johnson & Johnson brands]] [[Category:Genericized trademarks]] [[ar:تايلينول]] [[yi:טיילענאל]] [[zh:泰诺]]