Acetaminophen—Not Worth the Risk
Acetaminophen has been around for over a century and is the most widely used drug compound in the world. In the U.S., acetaminophen (also called paracetamol or APAP) is present as an active ingredient in over 600 prescription and over-the-counter medications marketed to relieve pain or
reduce fever, including Tylenol. Every week, nearly one in four Americans takes an acetaminophen-containing medication, and pediatricians routinely recommend acetaminophen as the treatment of choice for fever in children.
Despite its ubiquity, acetaminophen also
has many critics. These argue that the drug’s path to prominence has
been littered with errors, false assumptions and undue complacency about risks. Documented problems include life-threatening liver damage in individuals who consume acetaminophen in “excess amounts”—something that is all too easy to do,
given the drug’s different aliases and the sheer number of products in
which it is present—as well as cardiovascular disease and renal injury
risks associated with long-term use. In the critics’ view, these and other problems make acetaminophen “one of the most dangerous compounds in medical use.”
In the U.S., roughly 500 deaths are attributable to acetaminophen each
year, as well as 100,000 poison control calls, 50,000 emergency room
visits and 10,000 hospitalizations. Most acetaminophen-related emergency department visits are
in young children (under age 5), adolescents or young adults. The
problem of accidental (or intentional) overdoses is worrisome enough,
but there are other reasons to be concerned about acetaminophen use in
young people—notably, the drug’s association with asthma and developmental disorders such as autism. The
research linking acetaminophen to these epidemic-level chronic
conditions suggests that the drug’s automatic inclusion in the childhood
medicine cabinet ought to be reconsidered.
… two different studies found that acetaminophen use in the first year of life predicted asthma at age three and at six to seven years of age, respectively.
Acetaminophen and atopic conditions
Numerous studies link acetaminophen use during pregnancy with
increased asthma risks in offspring. Research also points to an
association between use in infancy and asthma later on. For example, two
different studies found that acetaminophen use in the first year of
life predicted asthma at age three and at six to seven years of age, respectively.
The associations hold true not just for asthma but also for allergies and eczema. Polish researchers reported “a significant dose-dependent increase”
in the risk of asthma, allergy and eczema symptoms in three age groups
who used acetaminophen in the previous 12 months: children (ages 6-7),
adolescents (ages 13-14) and adults (ages 20-44). A multi-center
European study found that the drug was “strongly positively associated
with asthma” in 20- to 45-year-old adults taking acetaminophen on a weekly basis, compared with less frequent users.
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Taking stock of the size and consistency
of the evidence, Spanish researchers—while stopping short of
recommending an outright acetaminophen ban—have advocated for a
significant rollback on its use:
“It is absolutely clear that the
scientific literature is sending a large and consistent signal that
challenges the traditional excellent safety profile of acetaminophen in
children. […] A widespread, professional-based recommendation of
limiting acetaminophen use to those cases in which ibuprofen cannot be
administered would reduce the childhood population exposure to a minimum
and would provide a good opportunity to minimize the detrimental effect
of acetaminophen.”
… the authors note that the long-term effects of acetaminophen exposure on neural development have never been evaluated in humans and point out that even at very low doses, acetaminophen triggers immune system activation and oxidative stress responses—both of which are hallmarks of autism.
Autism and developmental disorders
In addition to asthma, research has linked prenatal acetaminophen use to
“lower performance intelligence quotient (IQ), …autism spectrum
disorder, neurodevelopmental problems (gross motor development,
communication), attention-deficit/hyperactivity disorder, poorer
attention and executive function, and behavioral problems in childhood.”For
example, a longitudinal study that looked at language development in
two-and-a-half year-olds whose mothers had taken acetaminophen during
the first trimester of pregnancy found a significant association between
prenatal acetaminophen use and language delays,
particularly in boys. The researchers concluded, “Given…the importance
of language development, these findings…would suggest that pregnant
women should limit their use of this analgesic during pregnancy.”
There is especially compelling research tying acetaminophen use to autism spectrum disorder (ASD). In a 2017 study (written
by a “who’s who” of autism researchers at Duke, Harvard and the
University of Colorado), the authors note that “the long-term effects of
acetaminophen exposure on neural development have never been evaluated
in humans” and point out that even at very low doses, acetaminophen
“triggers immune system activation and oxidative stress responses”—both
of which are hallmarks of autism. They also assemble evidence for both
prenatal and postnatal associations between acetaminophen use and
neurological problems in children, including mentioning a reported link
between circumcision-related acetaminophen use and increased autism prevalence.
Many parents report witnessing the onset of regressive autism following their child’s concurrent receipt of acetaminophen and vaccines.
Impaired detoxification
Studies published in 2018 propose that acetaminophen may function as an ASD risk factor in combination with other pharmaceutical and environmental toxins.
For example, researchers speculate that acetaminophen magnifies the
damage done by antibiotics and glyphosate because it impairs sulfate
metabolism and depletes the master antioxidant—glutathione—that the body needs in order to engage in effective detoxification.
Many parents report witnessing
the onset of regressive autism following their child’s concurrent
receipt of acetaminophen and vaccines. However, researchers desirous of keeping the focus on acetaminophen tend to avoid discussing possible vaccine-related synergistic effects. This is somewhat puzzling, given vaccines’ aluminum content and aluminum’s capacity to impair detoxification in much the same way as acetaminophen. In fact, there are multiple mechanisms “whereby
significant quantities of aluminium introduced via immunisation could
produce chronic neuropathology in genetically susceptible children,”
including oxidative stress, glutathione depletion and increased
inflammation. The “synchronicity…between
the onset of the autism epidemic and the surge in acetaminophen use” is
undeniable, but so is the synchronicity between autism and the
ever-expanding childhood vaccine schedule.
No more candy
For years, health providers and parents
have handed out acetaminophen-containing products like candy, heedless
of the compound’s documented toxicity. Johnson & Johnson, the
manufacturer of Tylenol and one of the world’s largest pharmaceutical
companies, has been only too happy to continue encouraging perceptions
of a “favorable safety profile”; however, recurrent lawsuits and recalls and the abundant literature describing toxic outcomes suggest that it may be time for acetaminophen’s glory days to come to a close.
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