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  #1  
Old 24 January 2008, 06:53 PM
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Icon81 NyQuil + Tylenol PM = death

Comment: Received this recently, and while I don't take them together nor
take more than 2 tablets at a time, I do use both medications from time to
time. So, could you check this out?

So you feel you have a cold coming on?

Do not take NyQuil and then a Tylenol especially Pm.

Or Tylenol and any thing with alcohol in it and NyQuil does have enough
alcohol to eat the liver. No return.
A customer of mine just told me she lost her 34 year old perfectly healthy
daughter to this ugly combination. I have heard several of you, my
friends, say I just take a Tylenol and it goes away.
Well this little beautiful lady had back trouble so she took 4 Tylenol and
NyQuil so she could sleep better. She's dead. That little cocktail has
killed more people that we want to think.
You can be an alcoholic and it just puts little holes in your
liver--which can be fixed. But not the Tylenol horror. It kills your
liver.
My friend said the Doctor told her Tylenol with any alcohol from
anything no matter how little kills the liver.
Alcohol alone just damages the liver. And with proper diet can be
repaired.
Answer to this is throw away any Tylenol you might have in your house.
How many moms have given their child Tylenol, because the Dr. said to.
And then later gave him NyQuil for a cold or any over the counter cold
medicine. What does the cough medicine with codeine have in it as a base.
Alcohol.
Save a life. Stop taking Tylenol.
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  #2  
Old 24 January 2008, 07:01 PM
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I accidentally took them in conjuction (well, DayQuil and Tylenol) at one point and just got really nauseous. The label does say, not to take products with acetominophen together...
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  #3  
Old 24 January 2008, 07:02 PM
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I wouldn't be surprised - it only takes as few as 10 Extra Strength Tylenol to put a normal person at a risk for an overdose. If the person in the story took four extra strength Tylenol (it doesn't say what kind they were in the OP, but in theory) and NyQuil, yeah I bet it could cause serious problems and possibly death, especially in a smaller person.

Here is some information about Tylenol overdose - it's a real problem and according to that page it's one of the most common poisonings.

ETA: According to wikipedia, the recommended adult dose of liquid NyQuil has 1000 mg acetaminophen. Each Extra Strength Tylenol contains 500 mg acetaminophen, so this would be a total of 3000 mg acetaminophen. According to the the Medline link, you should not take more than 4000 mg in a day, and more than 7000 carries a significant risk for overdose. While this falls short of this, it's still an unhealthy amount of acetaminophen, especially if she was small. If she did it regularly, it could certainly cause liver failure.

Last edited by Jahungo; 24 January 2008 at 07:09 PM.
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Old 24 January 2008, 07:08 PM
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Quote:
Originally Posted by snopes View Post
A customer of mine just told me she lost her 34 year old perfectly healthy daughter to this ugly combination.
Must have been a suicide!

While acetominiphen overdose is a real possibility, I think that this is nothing more than hysterics. Don't all drug labels over the counter have warnings about not combining without doctors instruction?
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  #5  
Old 24 January 2008, 07:16 PM
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I've always heard that Tylenol is incredibly hard to impossible to actually fatally overdose with. Because it's so easy to acquire, people often try to kill themselves with it, and I've never heard of anyone actually succeeding. In fact, I've heard of people taking entire bottles of Tylenol (13,000mg at least) and getting violently sick, but not dying. Part of this is due to the fact that there's a high possibility of interference, but I don't think taking a few Tylenol and a few Nyquil will actually kill you. Even the above link says that 7000mg will cause sickness, but it never mentions (apart from "a very large dose") how many will cause death. (It also says that death will take a few days.)

Not to mention, I'm talking about attempted suicides. I would think that if a woman with no intention of dying accidentally took too many Tylenols and started getting ill, she would definitely get help. She wouldn't just pass out and die.
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  #6  
Old 24 January 2008, 08:06 PM
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Quote:
Originally Posted by Beejtronic View Post
I've always heard that Tylenol is incredibly hard to impossible to actually fatally overdose with.
Depends on your definition of incredibly hard and what you consider a "fatal overdose" as opposed to a long lingering death from liver failure.

I have seen a lot of attempted suicides and a couple of successful ones from overdoses of acetaminophen. The typical scenario is an overly dramatic young woman (sorry for the stereotype but this is typical) who wants to scare her boyfriend/husband/parents and proceeds to take a bottle (or handful) of Tylenol then calls and tells them that she has taken pills. The usual thinking (of the ones who survived to tell the tale) is that it is "just Tylenol" so they think there will be no real harm and it is a great way to get (whomever) to pay attention. However, by the time they make that call (to boyfriend/parents/whomever) and actually get to the ER, the damage is done and a significant percentage of them do end up dead. The death is not always instant as would be the case with other methods, but dead is dead even if it takes a little longer.

Most of the time, if you catch it early or if your body behaves itself it can be vomited up with little residual damage. At this point when vomiting is still an option, there is still the possibility of it causing renal failure. It would be very rare indeed for it to cause immediate death (unless combined with copious amounts of alcohol or additional hepatic problems). Without getting into a detailed lecture on the hows and whys of liver function... When too much of it makes it to the liver to be metabolized it can destroy the liver. At that point the only real option is a liver transplant (with lifelong complications even when successful) or death from hepatic failure which can take days, weeks or months and (again not to get too detailed) is most unpleasant.

Tylenol is metabolized by the liver, and causes damage through this process; and alcohol is metabolized through the liver and causes damage. Combining the two, while not necessarily fatal, causes the liver to work that much harder and causes that much more damage so it is never a good idea regardless of dosages.

All OTC meds (most?) carry a warning about overdose and combining with alcohol usage, but with Tylenol it should be taken very seriously. It is toxic at such a (relatively) small amount over the the recommended dosage that even one or two extra pills might make a difference.

And in the interest of cites, I have http://www.medicinenet.com/script/ma...articlekey=629
to start with.
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  #7  
Old 24 January 2008, 09:32 PM
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If you're talking about four Tylenol PM and a dose of Nyquil, there might be a possibility of oversedation leading to respiratory arrest. That would be a more likely cause of death from a one time combo dose than APAP toxicity. Some people are very susceptible to the sedative effects of alcohol and medications, so it's possible.

Nurse Bettie
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Old 24 January 2008, 09:37 PM
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There are also plenty of vicodin addicts out there taking upwards of 20, 30, more pills per day, each of which contains probably 500 to 750 mg of acetominophen - sometimes taken daily for years without lasting damage, and sometimes taken one large dose once with fatal damage. I would call this an unusual case, but not unheard of. It's a wonder we're not all dead.
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Old 24 January 2008, 09:59 PM
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I would call this one within the realm of possibility, certainly. Perhaps not a certain death cocktail, but 3000 mg of acetominiphen should not be glossed over.

Acetominophen does damage the liver in high doses. It's not something to be taken lightly. I have heard that it is now suggested that if you are suffering from a hangover, to take aspirin instead of acetominophen as it's easier on your recovering liver. Everyone is terrified of aspirin anymore, and just assumes acetominophin is as harmless as water (OH NOES H2O lol) but all drugs have some side effects, and if you aren't a young person with a virus (risk of Reyes syndrom) and if you don't have problems with gastrointestinal bleeding, aspirin is not necessarily more risky than tylenol. Despite what tylenol commercials would have us believe.

~regardless of the possible validity of the information I do object strenously to the damage that the wording of the OP inflicted on my brain. ARG. Save a brain, avoid the horror of the hysterically worded glurgey medical warnings.

snap*the liver is evil and it must be punished* dragonfly
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  #10  
Old 24 January 2008, 10:10 PM
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How would you know that something was wrong with your liver? Isn't it a "noncomplaining" organ? I know there are blood tests, but what other symptoms would there be?
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  #11  
Old 24 January 2008, 10:34 PM
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The warning is needlessly hysterical; don't throw out all your Tylenol because a few people can't read a label. But dosage labels on OTC medications should be taken very seriously, especially since more medicine does not usually equal more positive effect. That is, if your pain is so bad that 1000mg of Tylenol won't relieve it, then 2000mg won't either. You need to see a doctor for an Rx pain med, and to investigate to cause of the pain.

And aside from the fact that Tylenol PM + NyQuil = acetominophen overdose, the combination of, IIRC, diphenhydramine citrate in the Tylenol PM, and doxylamine succinate in NyQuil is a double dose of nervous system depressants. Like taking Valium along with Seconol.
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  #12  
Old 25 January 2008, 12:32 AM
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Quote:
Originally Posted by Buckle Up View Post
How would you know that something was wrong with your liver? Isn't it a "noncomplaining" organ? I know there are blood tests, but what other symptoms would there be?
AFAIK other than liver functions tests which might be done routinely if you are on certain prescriptions or have other risk factors, you really don't know until something goes horribly, horribly wrong.

Symptoms of liver problems are often similar to other maladies: general malaise, low grade fever, diarrhea, upset stomach and/or tender to the touch or pressure on the area. When it is more progressed you might have noticeable jaundice.

LFTs (the blood test) are pretty common as part of annual routine physicals especially in older people or people with a history of high cholesterol or diabetes. And would likely be part of the lab work done if you went to the doctor or ER complaining of any of the above symptoms.
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  #13  
Old 25 January 2008, 03:24 AM
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Quote:
Originally Posted by Buckle Up View Post
How would you know that something was wrong with your liver? Isn't it a "noncomplaining" organ? I know there are blood tests, but what other symptoms would there be?

You probably wouldn't know until there was a signficant amount of damage: all the more reason to treat it with a little bit of TLC and heed dosage warnings IMO.

But if it gets in bad enough shape you sure do know it. Ask anyone who's had hepatitis.
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  #14  
Old 27 January 2010, 06:14 AM
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Comment: I lady that works for me just submitted an e-mail with a warning
of mixing Tylenol PM with Nyquil. Here is the test of her e-mail.

A distance relative of mine passed away two nights ago in Houston, TX due
to a liver failure caused by complications of taking Nyquil and Tylenol PM
around the same time. She was only 19 and had a bright future. Both
contain a chemical called acetaminophen which can be dangerous if the
normal dosage is exceeded. Nyquil bottle clearly states the dangers on the
bottle. I always tend to disregard the instructions when taking over the
counter drugs. I won’t anymore. Please always read the warnings and follow
instructions.

Can this happen?
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  #15  
Old 27 January 2010, 08:51 AM
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Quote:
Originally Posted by snapdragonfly View Post
Acetominophen does damage the liver in high doses. It's not something to be taken lightly. I have heard that it is now suggested that if you are suffering from a hangover, to take aspirin instead of acetominophen as it's easier on your recovering liver. Everyone is terrified of aspirin anymore, and just assumes acetominophin is as harmless as water (OH NOES H2O lol) but all drugs have some side effects, and if you aren't a young person with a virus (risk of Reyes syndrom) and if you don't have problems with gastrointestinal bleeding, aspirin is not necessarily more risky than tylenol. Despite what tylenol commercials would have us believe.

snap*the liver is evil and it must be punished* dragonfly
I read something recently about not combining acetaminophen and caffeine, which also suggested aspirin for a hangover, if you're drinking coffee.

Seems to me a lot of people take stuff because they have a headache etc; personally I don't unless said ache is interfering; like in an exam, or at night when it's bad enough to keep you awake.
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  #16  
Old 27 January 2010, 09:02 AM
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The study is a little dubious as it was conducted on E. Coli bacteria rather than anything with an actual liver, but FWIW

Paracetamol (acetominaphen) and caffeine Mor lonks at the bottom of the page.

Quote:
The researchers are reported to have said “it would take about 20 cups of coffee on top of a normal dose of the painkiller to cause such an effect”.
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Old 27 January 2010, 11:35 AM
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Quote:
Originally Posted by Eddylizard View Post
The study is a little dubious as it was conducted on E. Coli bacteria rather than anything with an actual liver, but FWIW

Paracetamol (acetominaphen) and caffeine Mor lonks at the bottom of the page.
Excedrin Migraine is still on the market here. It is Aspirin, Acetaminophen and caffeine all in one pill. And it does help me fend off a migraine until a more convenient time if I catch the migraine early enough.
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Old 27 January 2010, 11:59 AM
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When I was in hospital in late 2007 they gave me a mixture of asparin, paracetamol and ibuprophen all at once while they were evaluating me. I did sort of say "I thought this wasn't safe" but well it was prescribed.

And yes we have quite a few paracetamol (acinometaphin) products OTC that contain caffiene which supposedly booosts its effectiveness. I believe Anadin have a combined OTC pill with a similar formula to the one you describe.

When I was in Vegas I was running a bit short on my painkillers and was rationing them, but I saw an advert on the hotel telly that said Excedrin was "the most powerful painkiller you can buy". So I did - the standard excedrin.

250mg of acinometaphen per tablet? Are you sure? I wouldnt attempt to relieve the pain of a slightly wounded hamster with that low a dose. They sort of tided me over until I got home, but they were a bit on a comedown from co-codamol 30/500's

Last edited by Eddylizard; 27 January 2010 at 12:09 PM.
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Old 27 January 2010, 12:07 PM
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When I was in university, one of my psych profs worked with rats, studying genes related to alcoholism. She told us in no uncertain terms not to take Tylenol for hangovers or when there was any alcohol in our blood. In fact, she explained why and it had something to do with the receptors on the liver, but it's been ten years and I don't remember now. But I do remember not to take them together. I understood the explanation back then. And it was only a few years later that the discussion about alcoholics and Tylenol and the question of whether there should be a black box warning came up.
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  #20  
Old 27 January 2010, 01:02 PM
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I didn't think Nyquil had alcohol in it anymore.
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