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Comment by InclinedPlane | Hacker News Reader

Also, take care to notice how many other medicines have acetaminophen/paracetamol. If you take tylenol for pain and also take cough syrup then you could be doubling up on paracetamol. If you take too much of each, which is common, and maybe take the 2nd dose a little too soon after the 1st, and maybe if you have a habit of chronic drinking you could easily get yourself into severe trouble without even knowing it.

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Formulations with ibuprofen and other less toxic NSAIDs exist, though they all have their drawbacks. Look for them. There's really no reason to be ingesting Tylenol if you don't have to.

Agreed, that's why it's better to get paracetamol-free variants of medicines if available.

Also, caffeine makes paracetamol more effective for pain relief. There are pills available with paracetamol + 50mg caffeine (or just take two cups of coffee); this may be more effective than doubling up on the paracetamol.

Unfortunately, the DEA and US public like to poison people with APAP to reduce the perceived danger from opiates. Someone, literally, decided that if you add APAP to hydrocodone then it can be under a lesser restriction (Schedule III). Not to mention the doctors that go along with this wickedness and are very hesitant to prescribe opiates without APAP.

And just look at the outrage a year or two back when Zohydro was announced. All they did was remove APAP from hydrocodone tablets, but it was spun as creating super power heroin for everyone.

I was going to argue that combining paracetamol (APAP) with opiates might make them more effective for pain relief, but then I found this, which points to the opposite (i.e., adding APAP may not increase pain relief): http://www.ncbi.nlm.nih.gov/pubmed/17965980

I didn't read the paper, only the abstract.

People used to think that combining the two would make them both more effective allowing you to use less of both, thus reducing the toxicity. See for example coproxamol which has a sub-therapeutic dose of paracetamol and dextropropoxyphene. Paracetamol in overdose is very dangerous, but this drug kills you before the paracetamol does becausethe opiate (opiod?) used is so toxic.

There's a bunch of stuff about long term pain that we had very wrong ideas about and that we're only recently getting better understanding of.

Opiates are incredibly non-toxic compared to APAP. So adding the latter to reduce the former is ... misguided at best.

It's just classic puritanical morality run amok, as usual. They'd rather that some people died from paracetamol overdoses than be allowed to live as "sinners".

Not really. Opiates are terrifyingly addictive, especially compared to paracetamol, and inhibit your senses and abilities far more than paracetamol. Their side effects when mixed with other commonly (ab)used products such as alcohol, diazepam are far more dangerous than the interactions those other drugs have with paracetamol. There is definitely a reason to be concerned when companies are pushing out more variations on existing products.

I'm NOT saying that the appropriate reaction is to get up in arms about companies pushing opiates, but some care should be taken. I don't know what the correct solution is, but I'd hazard a guess that freeing the sale of opiates to anyone over the counter tomorrow will result in more problems than we have currenty. Especially as there are other less drastic alternatives available for various pain sources.

In the context of pain relief, there are also issues like building a tolerance and developing increased pain sensitivity due to long-term use of opiates.

I've definitely noticed a massively increased tolerance for opiates, but not an increase in pain sensitivity.

You wouldn't notice the sensitivity unless you are completely off the drug

Did you read the post you're replying to? I didn't see anything in there about "freeing the sale of opiates to anyone over the counter tomorrow." I did see a reasonable concern that adding paracetemol to prescription opiates can lead to liver failure and death. And you don't have to be an evil drug addict hippie scum to be bothered by this. People who take multiple medications prescribed by multiple doctors might be damaging their livers without even knowing it.

There is no logical reason, besides the "drug war", to add paracetemol to prescription opiates. Is your argument really that because opiates might have "side effects when mixed with other commonly abused products such as alcohol"... that therefore we should stuff them with paracetemol? It's safer to kill people who overdose or get addicted than let them experience a possible bad drug interaction with alcohol? I don't think you thought this through.

Two cups of coffee would be closer to 200 - 300mg of caffeine. (source: google and http://www.cspinet.org/new/cafchart.htm for more details).

Thanks, I'm sure I read 50mg == 2 cups somewhere, but it's incorrect.

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