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From: ((Steven B. Harris))
Subject: Re: ester c: better or worse?
Date: 27 May 1995

In <> (Paul Iannone) writes:

>: > That's pretty much my feeling as well. Incredible that somebody can
>: > bottle oxidized vitamin C, call it something it isn't (no ester is
>: > present) and sell the stuff at double the price.  There's a sucker born
>: > every minute.
>: >
>: >                                            Steve Harris, M.D.
>Steve has apparently never seen a Tylenol ad.

Oh, I feel the same about Tylenol.  In spades.  Even generic APAP ought
to banned outright, as it kills WAY more people every year than
tryptophane ever did.  If glutathione ever is proven to have anything
to do with aging, APAP will be aging-in-a-bottle, sort of like

                                           Steve Harris, M.D.

From: ((Steven B. Harris))
Date: 10 Jul 1995

In <3to3i8$> (LJHERDEZ)

>In addition,
>how many OTC items, such as Tylenol, ibuprofen, etc. items are available
>to the public - WITHOUT prescription - and can be potentially harmful?
>Tylenol has been reported in the past to have problems related to liver
>disorders.  Ibuprofen is known to be harsh on the kidneys and other organs
>with its usage.

Quite true.  Neither should be taken long term without being under the
care of a doctor.  I don't think that Tylenol should be taken long term
by anybody, under care of a doctor or not <g>.

>  Cortisone is frequently used by people with allergies and
>eczema.  It can also harm vital organs.

No.  Not in the mild 1% creme form which is the only form available over
the counter.

>Again, if anyone wants to use herbs, he must be responsible enough to
>become educated and read BEFORE using them.  Many health food stores,
>naturopaths, homeopaths, etc. have such info. and seminars available.

Yeah?  Based on what?  Scientific studies of the herbs sometimes.  Just
as often based on folklore and hearsay.  Caveat emptor.

                                         Steve Harris, M.D.

From: (Steven B. Harris )
Date: 09 Sep 1995

In <42qr94$> (Itype) writes:

>My opinion on chiropractors. Do your homework and find one who uses a
>hands on approach to adjustments. I have a bad neck, low back, sacroiliac
>joints and right hip. Before chiropractic I was taking Darvocet N 100 on
>an as needed basis just to get through the day and so I could sleep at
>night. After just a few months with my chiropractor the strongest
>medication I take is an occasional Tylenol. To me a good chiropractor is
>worth his/her weight in gold!

   Comment: Warning, you might not have made as much "real" progress as
you think.  Darvocet N 100 is scarcely more powerful than Tylenol.  It
has a great placebo name, though.  Unfortunately, propoxyphene is a
lousy pain reliever, and the combinations of it and Tylenol, taken in
mass quantities to try to achieve some kind of mild narcotic effect,
cause a lot of renal damage in this country.   But this damage is due
to the Tylenol, not the propoxyphene (anything more than ONE Tylenol a
day on average for a few years puts you at risk).  If you want to see
what propoxyphene napsylate alone does, get your doc to let you try
Darvon N-100, which is basically the Darvocet without the Tylenol.
You'll find it pretty much of a nothing drug.  When you understand that
the Tylenol (acetaminophen or APAP) is what's stopping your pain, you
might consider switching to omega-3 oils, pycnogenol, or even aspirin.
Do NOT get "addicted" to Tylenol, unless you don't mind the chance to
get acquainted real well with your local dialysis techs (a few hours, 3
times a week...)

                                            Steve Harris, M.D.

From: (Steven B. Harris )
Subject: Re: What is Acetaminophen?
Date: 24 Sep 1995


>T>   What is Acetaminophen?
>Acetaminophen = Paracetamol (N-acetyl-para-aminophenol).
>T>What kind of drug is it?
>T>and what other drugs are under it's catigory?
>Broadly, it's a analgesic-antipyretic (also frequently named NSAIDs,
>Non-Steroid Anti-Inflammatory Drugs). Whithin this group, the
>"sub-group" is that of para-aminophenol derivatives or "coal tar
>analgesics", which count Phenacetin and one of it's metabolites,
>It has little anti-inflammatory action. Not unlike Aspirin, but better
>tolerated gastrically.
>T>Such as IBprofin, Motrin, Tylonal, etc...
>Acetaminophen: TEMPRA, TYLENOL, etc... (in the US, according to source)
>(Source: Gilman AG et al. Goodman & Gillman's The Pharmacological
>Basis of Therapeutics. New York, 1991. 8th ed. ISBN 0-02-946-568-0)

 A small semantic quibble.  I think most would NOT consider Tylenol an
NSAID, for exactly the reason you mentioned: little anti-inflammatory

                                          Steve Harris, M.D.

From: B. Harris)
Subject: Re: Tylenol toxicity
Date: 18 Sep 1996

In <> David Knapp <> writes:
>D. C. Sessions wrote:
>> Della Noche wrote:
>> > It's been my impression that the liver
>> > effects we've been hearing about in pop articles are addressing
>> > damage done with longterm use rather than higher than average
>> > levels of ingestion.
>> You'd be wrong.  Acute toxicity.  (MVS saw too many cases in PICU.)
>   Actually, you're _both_ right.  The effects of acute Tylenol
>toxicity have been well-known for a long time.  However, new concerns
>about liver damage from long-term use of relatively high doses are
>now being raised.
>   Tylenol is a popular way for people (most often women, FWIW) to make
>"suicidal gestures."  That is, a suicide attempt that is intended not
>to actually be fatal, but to appear serious.  People think "what could
>I OD on and not really kill myself?"  and they think of Tylenol,
>at least partly because of the numerous ads telling how safe it is.
>Well, it turns out that Tylenol in big doses is quite lethal, and not
>at all quick.  If you OD on it, you die of liver failure unless they
>get it out of your system fast enough or you get a liver transplant!
>   And, believe me, liver failure is not a quick, painless, or
>easy way to die.
>  -- Dave
>P.S. Ritalin and Dexedrine do not have acute liver toxicity, so they
>     are _extremely_ unlikely to cause liver damage via long-term use,
>     as Tylenol may.

To which I'd add the addendum that chronic Tylenol/APAP/acetaminophen
toxicity is quite often RENAL (kidney) toxicity, and ends up causing
permanent renal failure far more often than permanent liver failure.
Some nasty fraction (10 or 20%) of people on chronic dialysis have been
heavy users of schedule III narcotics, which are "denatured" as it
were, with Tylenol/APAP.  Stuff like Darvocet.

                                          Steve Harris, M.D.

From: B. Harris)
Subject: Re: Spray Vitamins
Date: 18 Oct 1996

In <546urg$> (Scott
E. Latham) writes:

>That wasn't a endorsement? That was a negative statement I assume about
>spray vitamins! Either you didn't understand what Dr. Harris said, or you
>conviently cut out what he said and made it look like an endorsement for
>you to reply to. I will assume that you didn't understand what he said.
>He's a simple translation. Maybe Dr. Harris could reply in great detail
>about his statement?

   Tylenol (acetaminophen or APAP) is metabolized to a vicious producer
of free radicals, which in overdose will rot your liver in the same way
that (say) carbon tetrachloride will (the effect is partly reversed by
agents such as N-acetyl cysteine which cause the production of
glutathione, which is antidotal to this attack).  Chronic users of APAP
preparations are known to run a much higher risk of renal failure as
well, presumably due to this effect.  Renal failure after years of
chronic use was (you will remember) why all phenacetin products were
taken off the market some years ago.  Well, Tylenol and phenacetin are
metabolized to the same free radical producing products.

                                            Steve Harris, M.D.

From: (Jonathan R. Fox)
Subject: Re: Tylenol poisoning
Date: Mon, 12 Oct 1998 04:35:02 GMT

On Sun, 11 Oct 1998 21:14:00 -0600, Jim Hardy
<> wrote:

>I've read a lot on these news groups about the danger of liver damage
>leading to death from overdosing on Tylenol, but what exactly would an
>unsafe dose be? Or maybe better said, what's the difference between the
>normal therapeutic dose and the lethal dose? If someone takes two 500 mg
>Tylenol tablets and then later forgets and takes another two is he in any
>danger? What is generally considered to be the upper limit for a safe,
>therapeutic dose? Also, just as an aside, is Tylenol poisoning very
>common compared to other poisonings? I hadn't heard anything about it
>until I read about it on the Net a year or two ago.

A typical poisonous dose of acetaminophen is either 15 g (that is, 30
extra-strength tablets) at once or more than 5000 mg/day over several
weeks.  The maximum daily dose for normal usage is 4000 mg/day.  But
just like with anything, there is variability.  Some people are more
susceptible to toxicity than others.  You are not guaranteed to have
no liver damage if you take, for example, 4000 mg/day.

Tylenol poisoning seems to be most common in adults in the setting of
intenional overdose as in suicide attempts or gestures, whereas in
children it is usually accidental.

Adults who take Tylenol as a suicide gesture often believe it is a
safe drug that won't really kill them, unaware that they can be on
death's doorstep awaiting a liver transplant within hours of their

Children are sometimes overdosed unintentionally.  The infant
formulations ("drops") are more concentrated than the children's
elixir, which makes it easy to give too much if using the drops
instead of the elixir.  There's a chance that mild overdosages occur
and are missed quite frequently since the symptoms are nonspecific and
can easily be mistaken for additional symptoms of the viral infection
for which the child was getting Tylenol in the first place.

Jonathan R. Fox, M.D.

From: B. Harris)
Subject: Re: Tylenol poisoning
Date: 12 Oct 1998 06:36:32 GMT

In <> DEHughes <>

>Tylenol (acetaminophen) reaches the upper limits in dosing at 4 grams/day
>for acute use (less than 2 weeks) and 2.6 grams/day for long term chronic
>use. This translates to 8 tabs/day acutely and 5 tabs/day chronically.

   Correct, though this can be modified somewhat by taking an equal
amount of N-acetyl cysteine (available from any healthfood store) along
with the Tylenol (APAP), whenever a dose is taken.  Those taking
chronic APAP or APAP-containing preparations at near the 2 or 3 gram a
day chronic limit, should have regular liver tests done to see if
they're doing any damage.  People who know they have liver or renal
damage or insufficiency, and even chronic big time drinkers, should
probably stay away from APAP altogether.  Just because it's over the
counter doesn't mean it's not nasty stuff.

                                      Steve Harris, M.D.

From: B. Harris)
Subject: Re: Tylenol poisoning
Date: 12 Oct 1998 06:46:14 GMT

<5E894D870E65B309.3D7E5ACDA9102A81.43C52C3450EAE4A6@library-proxy.airne> (Jonathan R. Fox) writes:

>Adults who take Tylenol as a suicide gesture often believe it is a
>safe drug that won't really kill them, unaware that they can be on
>death's doorstep awaiting a liver transplant within hours of their

   Well, not within hours.  It takes a day (more likely two or three)
for you to turn yellow.  The insidious thing about Tylenol is that
suicide gesture people feel fine, but for some nausea, for quite a
while after taking the dose.  Quite often, then, they don't seek
medical attention until it's too late for even the antidotes to work.
The same kind of thing used to happen with white phosphorus containing
rat poisons used in suicide gestures, back in the old days when there
was such a thing (which was also before there were liver transplants).
People would show up to the hospital saying they didn't mean it, only
to be told by the doctor that that was really too bad.  It was sort of
like jumping off a skyscraper and then changing your mind.  Sorry, no
can do.

                                         Steve Harris, M.D.

From: (Jonathan R. Fox)
Subject: Re: Tylenol poisoning
Date: Mon, 12 Oct 1998 18:56:44 GMT

On 12 Oct 1998 06:46:14 GMT, B. Harris)

>> (Jonathan R. Fox) writes:
>>Adults who take Tylenol as a suicide gesture often believe it is a
>>safe drug that won't really kill them, unaware that they can be on
>>death's doorstep awaiting a liver transplant within hours of their
>   Well, not within hours.  It takes a day (more likely two or three)
>for you to turn yellow.

That's what I meant by "hours" -- around 24 to 72.  I originally had
typed "days" but figured that would be interpreted as meaning you
could go a week without symptoms then drop dead.  It acts faster than

Jonathan R. Fox, M.D.

From: B. Harris)
Subject: Re: Tylenol poisoning
Date: 12 Oct 1998 23:36:39 GMT

In <01bdf62e$759e9ea0$5dcee380@eric99> "Beachhouse"
<> writes:

>Steven B. Harris <> wrote in article
>>    Correct, though this can be modified somewhat by taking an equal
>> amount of N-acetyl cysteine (available from any healthfood store) along
>> with the Tylenol (APAP), whenever a dose is taken.
>can you cite a reference for this? while i'm well aware of NAC's utility
>in treating acetaminophen overdose.. i'm not aware of data supporting its
>use prophylactically.

   It's all animal poisoning studies, of course.  How in the world
would you prove a human prophylactic action?  Human research use
committees look down on experiments which set out to deliberately
poison healthy people.  However, since the mechanism of toxicity is the
same in animals and people, there's no reason to imagine that the stuff
won't work in people.  We know it works prophylactically in animals,
and also post-poisoning in humans, if given soon enough.  It would be
completely astounding, given all this evidence, if it didn't work
prophylactically in humans as well.

>if this is in fact true, has anyone suggested
>re-compounding acetaminophen to include NAC ?

   Yes, I've been suggesting it for years, and so have a few
organizations (The Life Extension Foundation).  But don't hold your
breath-- the necessary human epidemiologic studies would be very
difficult and expensive to do (you'd have to make it available to a
very large population and WAIT for a few to poison themselves
accidentally).  And after you got done, you product would be

                                      Steve Harris, M.D.

From: B. Harris)
Subject: Re: Tylenol poisoning
Date: 13 Oct 1998 03:33:33 GMT

In <> Anonymous <> writes:

>It's so hard reading these news groups and seeing what should be done,
>but what isn't because of legal restrictions, lack of proper economic
>incentives, or perhaps not enough concern on behalf of the average
>citizen to pressure politicians to do what's right.  The above suggestion
>by Dr. Harris would seem like such a simple thing to do.  Why couldn't
>someone just market the combination pill without having to do tons of
>human epidemiological studies, just like they put buffering compounds in
>aspirin?  If NAC is available at any health food store, and Tylenol
>over-the-counter, what in heaven's name is preventing them from combining
>the two in one pill?  Is it the bureaucracy of the FDA?  It's just so
>hard to understand.

    Comment: actually, since NAC is a food substance, I suspect you
could market a combo without FDA approval (like buffered aspirin), so
long as you didn't say anything on the label about why you were doing
it, or making any claims that your product was better (much like
buffered aspirin, which in fact is NOT easier on the stomach).  Nobody
wants to do this for Tylenol+NAC, because it would be considerably more
expensive than plain Tylenol, and if you couldn't tell people why they
should be spending the extra money, they probably wouldn't.

   As if this weren't the only problem, there's the liability issue.
Suppose somehow you managed to get it into the public consciousness
that Tylenol/NAC is less toxic than Tylenol.  Will the public
understand that "less toxic" doesn't mean "non-toxic"?  Probably not.
Some idiot is always going to manage to poison themselves with the
stuff anyway, and then they'll sue you.

   Let me tell you a story:

   It turns out that some derivatives of Valium have amnestic
properties, so that you cannot remember what you were doing while under
their influence.  Halcion is one of these, and the famous Schedule I
"date rape drug" Rohypnol is another.  This effect is exacerbated by

    Now here's the interesting part: this effect is not only induced by
certain benzodiazepines, but it can also be blocked by others.  One
drug, which is nothing but a Roche number at the moment, completely
blocks alcohol's ability to make people forget what they did while
drunk.  If you take the stuff you're just about as drunk, but when you
wake up the next morning after passing out, you remember it ALL.  No
more memory blackouts.

   Now this stuff sounds like it might be socially useful.  For one
thing, you could put it in alcoholic drinks to lessen their social
impact.  Take this stuff, and you can drink at cocktail parties and
remember who you met, too.  But consider the problems: how do you keep
people from getting the impression that the stuff is a sober-up pill,
or something you can take to make it safe to drive drunk?  Roche
thought about it, and figured there wasn't anything, given the present
legal climate.  So this interesting and useful drug sits on a shelf
somewhere, and you should live so long that you'll ever have access to
it.  That's our lovely tort-happy society for you.

                                       Steve Harris, M.D.

From: "Steve Harris" <>
Newsgroups: talk.politics.drugs,talk.politics.medicine,,
Subject: Dumbest New OTC Drug of the Year Award (Re: House OKs bill to ease 
	buying of foreign drugs
Date: Mon, 28 Jul 2003 15:03:52 -0700
Message-ID: <bg46k7$qs3$>

"Kurt Ullman" <> wrote in message
>       Most as in 50% not hardly. You also aren't using the "figures" from the
> annual report are you? These include marketing, administration and
> something else. ALso, most Pharm companies have OTC divisions that
> obviously spend a bunch on marketing.

Which reminds me to give the Doc Harris award for the
Dumbest New OTC Drug of the Year:

8 Hour Extended Release Tylenol.

The reason more people don't fry their livers with regular
Tylenol, is that the organ at least gets a few hour rest
when they're asleep. Now, that's no longer true. Happy day.
Don't hold your breath waiting for 8 hour extended release
N-acetyl cysteine.


From: (Steve Harris
Subject: Re: Acetaminophen and Vicodin. Overdose causes how much damage?
Date: 2 Sep 2004 15:36:08 -0700
Message-ID: <> wrote in message

> In article <>,
> Andy <> wrote:
> >I injured myself very badly on a trip last year. My friend who was
> >with me gave me 2 vicodin pills. I believe they were the 5mg
> >hydrocodone x 500 mg tylenol. I then took 2 more in the evening. The
> >next day the pain from the wound was very intense, so I took 3, then
> >an hour later I took two more for a total of five in a very short
> >period. What happened to me next was terrible. I have probably never
> >been sicker in my life. I did not throw up, no matter how badly I
> >wanted to. I had trouble standing, urinating, thinking, moving,
> >breathing, everything imaginable. I am 6' 4'' and 170 lbs. I am
> >wondering if I possibly did any long term damage to my liver or body
> >from such an incident. Anyone have any info?
> You didn't take enough acetominophen to harm yourself.  The toxicity
> takes days to fully manifest itself -- you wouldn't have had such a
> rapid effect.
> The symptoms you describe are characteristic of a large dose of opiates
> in a person who isn't used to them.  I.e. what you experienced is
> entirely normal and expected.  Overall, opiates aren't very toxic in
> the long term, even in prolonged use.  They are mostly dangerous when
> doses so large that they suppress the breathing reflex are taken, or
> the person becomes unconscious and chokes on his vomit.  If you didn't
> die within an hour or so, you're okay.
> Caveat: I don't have any medical qualifications.


But you're entirely correct. Even somebody with severe liver problems
already, is probably going to tolerate 2.5 grams of APAP fine. 5 to 10
grams (10 to 20 extra strength pills) is where it gets toxic. And even
then, people typically get very little clinically from that but a
little nausea-- until they turn yellow 2 or 3 days later.

What is described is acute opiate toxicity, and the moron survived it.
And since he did, he'll be fine and won't contribute to the Darwin


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