Comment by skissane | Hacker News Reader

Comment by skissane | Hacker News Reader

Parent Full thread

Paracetamol is a lot more dangerous than melatonin.

Take a big paracetamol overdose, get acute liver failure, significant chance of either death or urgent need for liver transplant–even if you are getting the best possible medical care.

Take a massive melatonin overdose, nothing anywhere near as serious happens. You may become unconscious for 12 hours. There are reports of other negative side effects – tachycardia, hypotension, hypothermia, etc [1][2] – medically risky, but still your odds of survival without serious long-term consequences are pretty high, especially if you get proper medical care. Animal studies have failed to determine an LD50 for melatonin, even giving massive overdoses to animals they survive–it isn't clear if it is even possible for a healthy human to die by massive melatonin overdose, I think if it were to ever happen it would require a complete lack of medical attention combined with a very big dose of bad luck. By contrast, fatal paracetamol overdoses (mostly intentional, sometimes accidental) occur with some regularity.

[1] https://journals.sagepub.com/doi/pdf/10.1177/102490790100800...

[2] https://pubmed.ncbi.nlm.nih.gov/31553200/

It's been oft repeated that acetaminophen would not be OTC if it were discovered today. The difference between a therapeutic and a toxic dose are waaaaay too small.

It's setting the bar _really_ low to compare to acetaminophen. There's a good chance if it weren't basically the only safe painkiller for pregnant and breastfeeding women it would simply not exist anymore.

> basically the only safe painkiller for pregnant and breastfeeding women

Huh, is that why they keep it around? I thought it was mostly cruft/momentum. But it looks like NSAIDs are risky in the 3rd trimester.

https://www.aafp.org/afp/2003/0615/p2517.html

And doctors will tell you to pound paracetamol all day just to stop bothering them with a problem that is ‘just in your head’.

Why would we ever assume that another person, totally unrelated and unconnected, would ever prioritize our needs ahead of their benefit? This is the assumption of so many institutions where authority over ourselves is forcefully delegated to chosen others. This goes predictably wrong just about every time. We shouldn’t even be upset about it.

I think OP made that comparison because in Australia even a kid can get a pack of paracetamol for $1 over the counter at most grocery shops.

20 x 500mg tables $0.70 at Coles.

Two packs will end the average teen, formanent liver failure takes about 5 days though, quite uncomfortable I'm told.

The antidote is n-acytel-cysteine, available from most sport supplement type places, I always keep 100g or so around cos early / immediate oral treatment can make the difference until medical intervention arrives, where they give the n-acytel-cysteine intravenously.

Hi, It may be better not to publish exactly the dosage that is dangerous. For example, I tried not to read this part, because I know I’m tempted, and sometimes ignorance is bliss. I know you seek to share excellent knowledge, I’m myself passionate about air crashes and causes which is a topic a lot of people don’t like to hear about ;) It’s just, it’s very interesting to know for a public health perspective that lethal doses are possible to get at the local supermarket, perhaps the exact quantity is one detail too much. Cheers.

Don't do it!

This is a good point and something I consider every time I bring it up.

I don't have a perfect response though sorry.

I try to put people of this particular method by noting it's painful and takes a long time.

Do you have someone(s) you can talk to? Support people?

Yes, don’t worry too much for me, I have a psychologist and we got several things rolling recently, so I’ll be fine for a couple of months already. Thank you for your concern ;)

That's such a weird perspective to take. No information, including the exact dosage that will kill you, should be hidden "just in case". It's like security by obscurity of medical world. In fact I'd advocate that every paracetamol packet should say, in big letters in the back "TAKING X OF TABLETS WILL KILL YOU WITH NO KNOWN TREATMENT, AND IT WILL HURT ALL THE TIME AS YOU'RE DYING". There's so many people who don't realize how easily taking too much paracetamol can kill it's crazy.

Yeah, exact dosage is irrelevant. If you're going to kill yourself, you just take a few packs. As you say and has been said elsewhere in here, the dosage difference between therapeutic and fatal is really small, so if you take multiple times the normal dosage, well... you don't need exact dosage for that.

France: buying paracetamol can be done freely here ,but it has to be asked for at pharmacies, and the dangerous dosage (4000mg/day) is heavily stressed.

Also, it is written on the instruction manual, in quite big letters.

Anything you consume to the point of unconsciousness is likely to kill you. Your world is full of intentional poisons (we use them to kill the things we don't like, germs and bugs) and dangerous things you aren't supposed to eat. The numbers don't matter.

Please don't end your life. Almost everyone who tries regrets it. Get help with your dark thoughts and keep on being a part to your communities.

I personally think paracetamol should be prescription only. The risk and consequences of overdose (whether suicidal or accidental) are too severe. A lot of far safer drugs are prescription only (or even completely illegal) yet deadly paracetamol is sold in the supermarket.

> I personally think paracetamol should be prescription only. The risk and consequences of overdose (whether suicidal or accidental) are too severe. A lot of far safer drugs are prescription only (or even completely illegal) yet deadly paracetamol is sold in the supermarket.

I can't tell if you're joking or not.

I'm being completely serious, why would I be joking?

I'm going on a stretch here but it was probably implied all NSAIDs have side effects which are all severe. Stomach bleeds, reduction of blood clotting or other problems related to thrombosis or kidney failure depending on the type. Highly unlikely when used by the book but deadly in overdosis or prolonged uses. Just like paracetamol.

Taking away people's pain medication is not a winning move I'm certain of.

At my local Coles supermarket, AUD 1.40 (USD 0.99) buys 2 packets of 20 tablet 500mg paracetamol. Swallow 40 tablets, take a 20 gram overdose. For a person who weighs 80kg, that's 250 mg/kg. That kind of overdose is likely to lead to acute liver injury; prompt treatment with NAC will avoid it, but without prompt treatment, acute liver failure is a likely outcome.

At the same supermarket, AUD 3.10 (USD 2.19) buys 2 packets of 24 tablet 200mg ibuprofen. Swallow 48 tablets, take a 9.6 gram overdose. For a person who weighs 80kg, that's 120 mg/kg. [1] reports that level of ibuprofen overdose is likely to produce mild CNS and GI symptoms. Fatalities have occurred with >300 mg/kg, so an 80 kg person would need to take over 24 grams, which is 120 tablets, 5 packets worth (cost AUD 7.75, USD 5.48). So you can immediately see how ibuprofen is safer than paracetamol, in that you have to swallow a lot more tablets to take a potentially fatal overdose. Given that, I think a case could be made for withdrawing over-the-counter paracetamol while continuing to allow over-the-counter ibuprofen.

Cannabinoids such as THC and CBD also provide pain relief, and certainly if we are just looking at overdose acute toxicity are far safer than either ibuprofen and paracetamol – indeed, there is no record of any fatal overdose ever happening from either. And yet, where I live they are only legally available on prescription, and prescribers face regulatory hurdles which do not apply to other drugs. If we are only thinking about safety in overdose, we'd make both ibuprofen and paracetamol prescription only, and allow THC and CBD over-the-counter instead.

[1] https://litfl.com/nsaids-toxicity/

Bleach will also kill you if you drink a bottle, but it's legal OTC.

Prescriptions are for things that are dangerous under casual misuse, not intentional suicide or ignorant children.

>withdrawing over-the-counter paracetamol while continuing to allow over-the-counter ibuprofen

Paracetamol is not an NSAID (unlike ibuprofen) and has a lot less negative effect on my gastritis. There are not many painkillers available OTC which are not also NSAIDs and so don't destroy your stomach lining. I'd rather not develop stomach ulcers to prevent some random lunatic from gorging himself on paracetamol into the grave.

As you've mentioned, you're only looking at overdose by healthy individuals, and in the case of both paracetamol and ibuprofen you'd be hard pressed to overdose accidentally. If you're making a concerted effort to overdose $10 vs $1 is likely irrelevant, particularly since they're both over the counter and trivial to steal.

What makes ibuprofen dangerous is that people tend to believe it can be taken safely to address arbitrary aches and pains. However, the kind of people experiencing aches and pains (beyond a common headache) tend to already be on some other form of medication. More often than not, these medications are either NSAIDs or steroids. Both of which interact poorly with ibuprofen, given that it is itself an NSAID. Paracetamol does not suffer from this issue.

I know little of how THC and CBD interact with other drugs people are likely to be consuming. However, drug interaction would need to be taken into consideration. As would subtle effects on mental state; focus, lethargy etc.

I mean, er, so is deadly drain cleaner?

Paracetamol is very safe if used correctly, and doesn't have many serious interactions or contraindications. If you have to have one OTC painkiller it's probably about the safest. There's maybe an argument that it should be prescription, but "poisonous things are available in supermarkets" probably isn't one.

Reply on news.ycombinator.com