President Trump went much further than his own Food and Drug Administration did when he warned pregnant women not to take medicine containing acetaminophen because of the possibility their child would develop autism.
U.S. health officials did say, in a change of guidance, that acetaminophen-based products, including the pain reliever Tylenol and 600 other medications, should be avoided during the early months of pregnancy except when there is a high fever. Many major medical associations disagree with this, and maintain these medicines are safe for pregnant women.
The FDA said evidence that acetaminophen can cause autism has not been found, but in the spirit of patient safety it said pregnant women and their doctors should minimize the use of the drug for low-grade fevers during pregnancy.
A Sept. 30 column in The Washington Post said all this overshadows the very real risks of acetaminophen — the possibility of severe liver damage if someone takes too much of it.
Acetaminophen “is the leading cause of acute liver failure in the United States and is responsible for 1 in 5 liver transplants. Public health efforts should be targeting these dangers rather than stoking unfounded fears of neurological harm,” wrote Dr. Leana S. Wen, an emergency physician and clinical associate professor at George Washington University.
Acetaminophen is the most common drug ingredient in the country. Too much of it overloads the liver, producing a toxic by-product. If recognized quickly, there is an antidote that neutralizes the problem. Otherwise, Wen wrote, the mortality rate is 30%, and one-third of patients will not survive without a liver transplant.
Her column said acetaminophen overdose is one of the leading causes of accidental and intentional poisoning, with more than 80,000 cases reported each year.
Most adults can safely take up to 4 grams (equal to 4,000 mg) per day of acetaminophen. Two Regular Strength Tylenol pills contain 0.650 grams (650 mg) of the drug. Eight of these pills in one day contain 2.6 grams of acetaminophen, well below the 4-gram limit. But taking more than 7.5 grams at one time, or 12 grams in 24 hours, can cause serious liver injury.
Another problem is the wide use of acetaminophen. It’s in so many products that someone using more than one medication may unwittingly put themselves at risk of liver damage.
Finally, acetaminophen is a frequent cause of accidental child poisonings, typically when parents give a sick child too much medicine. The Centers for Disease Control also reported that in 2022, there were more than 19,000 “self-harm attempts” in which kids aged 10 to 19 intentionally took too much acetaminophen.
Instead of flatly saying “Don’t take Tylenol,” the president would have served the public far more wisely if he had focused on the dangers of excessive use of acetaminophen.
Wen offered common-sense protections like checking medication ingredients and using only one product at a time that contains acetaminophen. Know the correct dose. Don’t exceed the recommended amount. Double-check dosages for children, which often are based on weight by kilograms, not pounds.
“None of these precautions should take away from the fact that acetaminophen is an important and useful medication that is safe and appropriate in many situations,” Wen wrote. “The key is to use the drug as instructed.
“In other words, over-the-counter does not mean risk-free. This is the kind of clear, practical guidance that federal officials should be amplifying. They should be empowering families to prevent harm rather than sowing confusion about valuable treatments.”
Jack Ryan, Enterprise-Journal
