The problem with this drug appears to be that the useful dose is very near to the level of the toxic dose -- much closer than for other drugs. What that means is that if you take double the recommended amount -- as many people routinely do with other drugs like Ibuprofen or aspirin -- it can kill you. Or even if you take just a little more than the recommended maximum dose. Or if you take the recommended dose with more than three alcoholic drinks in you. In Europe acetaminophen is the number one drug used for suicide.
The question of what level of deaths is acceptable is only one question among many, because the drug company is very reluctant to put strong warnings out in public for fear it would cut into sales. Then there are also questions about the latest warnings required by the FDA -- warnings that were recommended by their committee studying it 32 years ago. The FDA basically replies "These things take time."
Find it here: http://www.propublica.org/article/tylenol-mcneil-fda-use-only-as-directed
USE ONLY AS DIRECTED
By Jeff Gerth and T.Christian Miller, ProPublica, Sept. 20, 2013, 10:00 a.m. Design & Development: By Krista Kjellman Schmidt, Lena Groeger, Al Shaw
During the last decade, more than 1,500 Americans died after accidentally taking too much of a drug renowned for its safety: acetaminophen, one of the nation's most popular pain relievers.
Acetaminophen the active ingredient in Tylenol is considered safe when taken at recommended doses. Tens of millions of people use it weekly with no ill effect. But in larger amounts, especially in combination with alcohol, the drug can damage or even destroy the liver.
Major Takeaways1 About 150 Americans die a year by accidentally taking too much acetaminophen, the active ingredient in Tylenol, federal data from the CDC shows.
2 Acetaminophen has a narrow safety margin: the dose that helps is close to the dose that can cause serious harm, according to the FDA.
3 The FDA has long been aware of studies showing the risks of acetaminophen. So has the maker of Tylenol, McNeil Consumer Healthcare, a division of Johnson & Johnson.
4 Over more than 30 years, the FDA has delayed or failed to adopt measures designed to reduce deaths and injuries from acetaminophen. The agency began a comprehensive review to set safety rules for acetaminophen in the 1970s, but still has not finished.
5 McNeil, the maker of Tylenol, has taken steps to protect consumers. But over more than three decades, the company has repeatedly opposed safety warnings, dosage restrictions and other measures meant to safeguard users of the drug.
Davy Baumle, a slender 12-year-old who loved to ride his dirt bike through the woods of southern Illinois, died from acetaminophen poisoning. So did tiny five-month-old Brianna Hutto. So did Marcus Trunk, a strapping 23-year-old construction worker from Philadelphia.
The toll does not have to be so high.
The U.S. Food and Drug Administration has long been aware of studies showing the risks of acetaminophen in particular, that the margin between the amount that helps and the amount that can cause serious harm is smaller than for other pain relievers. So, too, has McNeil Consumer Healthcare, the unit of Johnson & Johnson that has built Tylenol into a billion-dollar brand and the leader in acetaminophen sales.
Yet federal regulators have delayed or failed to adopt measures designed to reduce deaths and injuries from acetaminophen overdose, which the agency calls a "persistent, important public health problem."
The FDA has repeatedly deferred decisions on consumer protections even when they were endorsed by the agency's own advisory committees, records show.
In 1977, an expert panel convened by the FDA issued urgently worded advice, saying it was "obligatory" to put a warning on the drug's label that it could cause "severe liver damage." After much debate, the FDA added the warning 32 years later. The panel's recommendation was part of a broader review to set safety rules for acetaminophen, which is still not finished.
Four years ago, another FDA panel backed a sweeping new set of proposals to bolster the safety of over-the-counter acetaminophen. The agency hasn't implemented them. Just last month, the FDA blew through another deadline.
Regulators in other developed countries, from Great Britain to Switzerland to New Zealand, have limited how much acetaminophen consumers can buy at one time or required it to be sold only by pharmacies. The FDA has placed no such limits on the drug in the U.S. Instead, it has continued to debate basic safety questions, such as what the maximum recommended daily dose should be.
Safety Delay36 6 20 22 5 54
years months days hours minutes seconds
In the 1970s, the Food and Drug Administration appointed an expert panel to review the safety and efficacy of over-the-counter pain relievers, including acetaminophen, the active ingredient in Tylenol. The panel delivered their recommendations on April 5, 1977. At the time, the FDA estimated it would issue final regulations before the end of 1978. The agency has still not completed its work. This is how much time has passed since then. Find out more »
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For its part, McNeil has taken steps to protect consumers, most notably by helping to fund the development of an antidote to acetaminophen poisoning that has saved many lives.
But over more than three decades, the company repeatedly fought against safety warnings, dosage restrictions and other measures meant to safeguard users of the drug, according to company memos, court records, documents obtained under the Freedom of Information Act, and interviews with hundreds of regulatory, corporate and medical officials.
In the 1990s, McNeil tried to create a safer version of acetaminophen, an effort dubbed Project Protect. But after the initiative failed, the company kept its experiments confidential, even when the FDA inquired about the feasibility of developing such a drug.
Later, McNeil opposed even a modest government campaign to educate the public about acetaminophen's risks, in part because it would harm Tylenol sales.
All the while, it has marketed Tylenol's safety. Tylenol was the pain reliever "hospitals use most," one iconic ad said. The one "recommended by pediatricians," said another. "Safe, fast pain relief," its packages promised.
In written responses to questions for this story, as well as a pre-recorded statement by its vice president for medical affairs, McNeil said it has always acted to ensure its products were used safely.
"McNeil takes acetaminophen overdose very seriously, which is why we have taken significant steps over the years to mitigate the risk," the company wrote. McNeil has engineered safety packaging and spent millions on research, education and poison control centers that advise people who have overdosed.
The company said that science on acetaminophen had evolved over time and that it had implemented safety measures accordingly. Most recently, it announced it will soon add red lettering to the caps of medicine bottles saying they contain acetaminophen and that users should read the label.
In several cases, after FDA advisors recommended the agency enact safety measures over McNeil's objections, the company adopted them before the agency forced it to do so. The company then said it was taking such steps voluntarily. McNeil also stressed that it has always followed FDA regulations.
McNeil objected to the thrust of questions from ProPublica and This American Life, saying they indicated "a clear bias" in favor of plaintiff's lawyers who are suing the company.
The company declined to answer questions about individual cases of death or injury. "Our hearts go out to those who have suffered harm from acetaminophen overdose, and to the families of those who lost their lives as a result," McNeil wrote in its statement.
FDA officials said the agency saw the benefits of keeping acetaminophen widely available as outweighing the "relatively rare" risk of liver damage or death. Some patients cannot tolerate drugs such as ibuprofen, and for them acetaminophen may be the best option, said one agency official.
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