Paracetamol dependency?

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13 Oct 2009, 6:22 am

Yesterday I went to the drug counter at Albert Heijn, because my paracetamol (a.k.a. acetaminophen) medication ran out. I asked the clerk, "what do people take for headaches?"

"It depends," she said. "Is it for a hangover?"

"No," I elaborated, "I just get headaches. I'd like something with paracetamol."

"Okay." But then just as she reached behind her, she asked, "do you get headaches often?"

"About two times a week."

She looked back at me and crossed her arms. "You should see a doctor. The medication may not be helping you, in fact it may be causing headaches."

"You can't become dependent on paracetamol, though."

"You can."

I wasn't about to have an argument with her, so I left. I have a few reasons why I don't think my headaches come down to a paracetamol dependency, one of them being that for a year-long interval I treated my headaches with aspirin (and they occurred just as frequently). Another reason is that I don't think you can become physically dependent on paracetamol, which is why you can buy it over the counter even though certain physically addictive drugs (such as codeine) require a prescription in many countries. Does anyone have any evidence to the contrary?

racooneyes
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13 Oct 2009, 7:00 am

That's what's called a responsible pharmacist, you should keep going there. You can become dependant on anything doesn't need to be physically addictive, sex and cannabis both spring to mind (often lol) as things people get addicted to without actually being physically addictive. Obviously paracetamol isn't quite as enjoyable as those examples but the relief people get or think they get can still be addictive.

My mum aets paracetamol like smarties and I'm constantly telling her not to, they're not harmless. The pharmacist thinks you should either find alternative relief or find the root cause of the headaches, sounds reasonable to me.

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Asmodeus
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13 Oct 2009, 7:25 am

Don't drink coffee with it, certainly don't drink alcohol with it and never take it regularly. The stuff is actually fairly toxic. Your doctor can help you find out why you're getting headaches.

Azharia
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13 Oct 2009, 10:51 am

Actually recent research shows that paracetamol is quite toxic, and is VERY easy to overdose on. VERY VERY easy. It should be used rarely and with caution.

And I know someone who used to take it going out any time he left the house, and when he stopped, he got blinding headaches...

Hector
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13 Oct 2009, 12:09 pm

Well, I've had frequent headaches all of my life, or at least as far as I could communicate it to my parents, and no source has ever been identified. I also haven't always used paracetamol, there was a year in between where I only took aspirin. Eventually the effects of the aspirin wore off.

I've heard all about how lethal paracetamol overdoses can be so I tend to be very careful. As for long-term effects hopefully the four paracetamol a week is not slowly destroying my liver or anything like that, but I haven't seen any studies that would suggest that it is.

ben10scotland
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10 Jan 2011, 4:14 pm

http://www.patient.co.uk/health/Headach ... nduced.htm about Medication Overuse Headaches

Background from patient.co.uk

Quote:

Which medicines cause medication-overuse headache?

All of the common painkillers used to treat tension-type headaches or migraine attacks can cause this problem. These include:

Codeine and codeine-containing combinations such as co-codamol. This is probably the worst culprit.
Paracetamol - especially if it is combined with codeine (for example, co-codamol).
Anti-inflammatory painkillers such as aspirin, ibuprofen, naproxen, diclofenac, etc.
Triptans used for migraine attacks such as almotriptan, eletriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan. (Strictly speaking, triptans are not classed as painkillers. They work in a different way. However, they can cause medication-overuse headache.)
Ergotamine (although this is now rarely used).

The amount and frequency of medication use needed to cause medication-overuse headache is not clear. It varies between different people. As a general rule, the diagnosis should be considered in people who take codeine or codeine-containing combinations for an average of 10 or more days a month, or other painkillers or triptans for an average of 15 or more days a month. However, it may develop in some people who take less than this. This is why the general advice is that you should not take painkillers or triptans for headache or migraine for more than a couple of days at a time. Also, on average, you should not take them for more than two days in any week for headaches or migraine.
What about taking painkillers for other conditions?

Medication-overuse headache is much less likely to develop if you take painkillers regularly for other painful conditions such as arthritis. It usually only occurs if you take painkillers or triptans for headaches or migraine. It is not clear why this is so. It may be because people who are already prone to frequent migraine attacks or headaches are the same people who are more prone to getting another type of headache - medication-overuse headache.

---

I just found out paracetamol [American name: acetaminophen] can cause this - I though it wouldn't -though paracetamol is the best thing to try for a headache -it is a simple relatively non-toxic painkiller. However I don't think that the pharmacist took a full history though.

Racooneyes, If someone is in pain they should usually take a painkiller such as paracetamol - of all the painkillers it has the fewest side effects, I agree the original poster really needs to see their GP if they experience frequent headaches - and any cause of chronic pain should be investigated, but it is ok to take painkillers in the meantime. I don't think paracetamol is physically addictive

Paracetamol only becomes toxic if you exceed the recommended dosage [usually 4 grams per day for adults [thats 8 x 500mg tablets]. You should avoid having a lot of alcohol with paracetamol - dont get drunk, it should be reasonably safe with minimal alcohol consumption but some people may be more affected than others such as those people with malnutrition or liver problems.

for individuals weighing less than 50kg, you would dose it at 15mg per kilogram upto four times a day [rounding down to the nearest tablet size if giving tablets] and not exceed a dose of 3 grams per day [except some newborns] - and in very young children such as those 2 months and under you'd be better getting the child to a doctor who may advise you to give your child a very small dose.

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10 Jan 2011, 5:05 pm

ben10scotland wrote:

I just found out paracetamol [American name: acetaminophen] can cause this - I though it wouldn't -though paracetamol is the best thing to try for a headache -it is a simple relatively non-toxic painkiller. However I don't think that the pharmacist took a full history though.

What meds is this in; I'm not sure I've heard of this before

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10 Jan 2011, 5:11 pm

I've had headaches for years and years, tried tons of medications. Acetaminophen doesn't help me anymore.

And the pharmacist is right...you can become physically dependent on it and it can cause rebound headaches. If you didn't have as many headaches before you started taking it, try not taking any for a week and see if your headaches improve. If they've been like that for a while now (at least a couple months), you should see a neurologist.

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astaut
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10 Jan 2011, 5:11 pm

nick007 wrote:

ben10scotland wrote:

What meds is this in; I'm not sure I've heard of this before

Acetaminophen is what's in tylenol.

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nick007
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10 Jan 2011, 5:20 pm

astaut wrote:

nick007 wrote:

ben10scotland wrote:

What meds is this in; I'm not sure I've heard of this before

Acetaminophen is what's in tylenol.

Oh OK. Is that is Aspirin or Naproxen to :?:

astaut
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10 Jan 2011, 8:29 pm

nick007 wrote:

astaut wrote:

nick007 wrote:

ben10scotland wrote:

What meds is this in; I'm not sure I've heard of this before

Acetaminophen is what's in tylenol.

Oh OK. Is that is Aspirin or Naproxen to :?:

Nope, those are their own drugs. However, Naproxen/Naprosyn is what's in Aleve.

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markko
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12 Jan 2011, 5:07 pm

American clinics and hospitals now have limits on the amount of paracetamol or acetaminophen a person may be given. No more than 2000 mg in a day or 5000 mg in any three contiguous days. At least that's what the limits were where I worked. It's up to the nurse and pharmacist to calculate doses and be aware that it may be included in other drugs (like Vicodin, Lortabs, Percocet, etc.)

I've been a nurse in a small town for 17 years now and I've seen two people ruin their livers by taking too much paracetamol/acetaminophen. These were not suicide attempts.

Hector
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13 Jan 2011, 11:11 am

There might have been a couple of days in my life in which I've taken more than 2000 mg in a day (i.e. a headache that lasts the entire day and just won't shift), but never more than 5000 mg in three days. As frequent as they are, my headaches have a way of not appearing within intervals of at least 24 hours.

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