Liver toxicity from acetaminophen in high doses (usually 4000mg or more daily) has been an ongoing issue for patients. Sometimes it is due to abuse. But at other times it is just from patients trying to manage their pain. The combination of hydrocodone + acetaminophen in a generic tablet, or the brand name Vicodin, was especially problematic because two tablets, a usual dose, contained 1000mg of acetaminophen. Three to four doses per day put the patient in danger of liver toxicity.
The FDA and pharmaceutical manufacturers have come up with a combination tablet containing only 300mg of acetaminophen per dose. The FDA is hoping this reduced dose will decrease the incidence of toxicity. However, each tablet now contains 40% less acetaminophen and may not be as effective as the higher dosing. In addition, patients may be incentivized to add extra acetaminophen on the side because their pain is not handled as well.
Two things to remember:
1. While most cases of liver toxicity from acetaminophen occur with doses of 4000mg or more, that is not to say that lesser doses are safe. It is best to keep dosing below 3000mg or better yet less than 2000mg. When calculating how much acetaminophen you might be taking remember it can be found in cough and cold products and some sleep aids. Know what you are taking.
2. Compounding pharmacies can make capsules containing any amount of hydrocodone + acetaminophen, just the dose of each that will be right for you. As usual with big pharma products, one size is meant to fit all.
If you have any questions about acetaminophen, what you are taking, or what a compounding pharmacy can do for you, contact one of our pharmacists. They are there just for you.