Not all painkillers are created equal
I am not really a big fan of acetaminophen (brand name Tylenol). For our European members, that is paracetamol.
In an earlier article on the subject of painkillers, we discussed the potential danger of irreversible liver damage as a consequence of Tylenol overdose. Did you know Tylenol overdose is one of the most common causes of acute liver damage requiring an emergency room visit in this country? Every one of the over-the-counter pain pills have hefty advertisement budgets, I think that is a pretty safe guess. Johnson & Johnson is reputed to spend as much as $250 million dollars in their advertisement efforts to promote Tylenol!
The abstract below comes from the “Hutch” and University of Washington. They studied a very large number of patients roughly in our age bracket for their use of pain-killers and the risk of blood cancers. High use of Tylenol was seen to almost double the risk of blood cancers other than CLL/NHL. There was no similar increase in incidence of blood cancers if the patients used other non-aspirin NSAIDS, ibuprofen etc.
OK, this study says there is no increased risk of CLL/SLL incidence. Small comfort, our guys already have CLL/SLL, that train has already left the station. How about secondary cancers? Myeloid cancers as secondary cancer have been documented in CLL patients, especially if they have been exposed to high dose alkylating agent therapy (cyclophosphamide, chlorambucil, drug combos such as FCR etc). The Reuters article does a good job of describing the implications of this study in plain English.
Why take a chance? For the odd aches and pains, I think it is safer for our guys to take something else. Personally, ibuprofen (trade name “Advil“) and naproxen sodium (“Aleve“) work just fine for me when my knee starts hurting. How about you? What do you reach for when you hurt just a little?
J Clin Oncol. 2011 May 9. [Epub ahead of print]
Long-Term Use of Acetaminophen, Aspirin, and Other Nonsteroidal Anti-Inflammatory Drugs and Risk of Hematologic Malignancies: Results From the Prospective Vitamins and Lifestyle (VITAL) Study.
Walter RB, Milano F, Brasky TM, White E.
Fred Hutchinson Cancer Research Center; University of Washington, Seattle, WA.
PURPOSE Among previous studies examining the associations of over-the-counter analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) and incident hematologic malignancies, results were inconsistent for NSAIDs but suggested an increased risk with acetaminophen (paracetamol). Herein, we used a large prospective cohort study to examine these associations. PATIENTS AND METHODS In total, 64,839 men and women age 50 to 76 years were recruited from 2000 to 2002 to the Vitamins and Lifestyle (VITAL) study. Incident hematologic malignancies (n = 577) were identified through December 2008 by linkage to the Surveillance, Epidemiology and End Results cancer registry. Hazard ratios (HRs) associated with use of analgesics for total incident hematologic malignancies and cancer subcategories were estimated by Cox proportional hazards models. Models were adjusted for age, sex, race/ethnicity, education, smoking, self-rated health, arthritis, chronic musculoskeletal pain, migraines, headaches, fatigue, and family history of leukemia/lymphoma. Results After adjustment, there was an increased risk of incident hematologic malignancies associated with high use (≥ 4 days/week for ≥ 4 years) of acetaminophen (HR, 1.84; 95% CI, 1.35 to 2.50 for high use; P trend = .004). This association was seen for myeloid neoplasms (HR, 2.26; 95% CI, 1.24 to 4.12), non-Hodgkin’s lymphomas (HR, 1.81; 95% CI, 1.12 to 2.93), and plasma cell disorders (HR, 2.42; 95% CI, 1.08 to 5.41), but not chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL; HR, 0.84; 95% CI, 0.31 to 2.28). By comparison, there was no association with risk of incident hematologic malignancies for increasing use of aspirin, nonaspirin NSAIDs, or ibuprofen. CONCLUSION High use of acetaminophen was associated with an almost two-fold increased risk of incident hematologic malignancies other than CLL/SLL. Neither aspirin nor nonaspirin NSAIDs are likely useful for prevention of hematologic malignancies.
PMID: 21555699
6 comments on "Acetaminophen (brand name “Tylenol”) in the news"
Very interesting article since according to NCI and various hem-oncs, Acetaminophen, is the preferred drug for aches, pains, fever etc. for CLL patients versus NSAIDS which can reduce effectiveness of platelets (problem for those with less robust platelets) and for those of us with GI problems NSAIDS can irritate the GI tract, not to mention that there can be renal effects also. Again, there is no free lunch. Care is required not to exceed the recommended dosage for Acetaminophen since the warnings are clearly stated.
I was on an FDA panel concerning Protein Pump Inhibitors used to control GI ulcers. One interesting point that came out was that as far as upper gastrointestinal toxicity is concerned, Naproxen (Motrin) is more risky than ibuprofen (Advil).
Because of low platelets I’ve been advised not to take NSAIDS. I take an occasional Tylenol for fever, but as for chronic pain–e.g. arthritis in the metacarpal joint– I just live with it. There is no painkiller that I’d want to take daily.
Chaya,
Interesting article. In general, I think people were led to believe that Tylenol was a safer drug than the Nsaids. Now we learn this may not be true. Always a dilemma, where ever we turn.
Chaya,
This is a first for me of hearing info on Tylenol warning of it’s danger. Thank you for bringing it to our attention. When I broke my leg I also broke my neck, so Tylenol has been a steady “friend/pain killder” since 1997. I think I will talk to my oncologist about this when I see him in two weeks.
Again, thank you.
Maria Cherie
So, here I am… one steel knee, the other in bad shape, hands twisted from arthritis, and other aches & pains associated with CLL. It seems there is no way out but to grin and bear it.
Betty
Chaya,
Interesting article. The field is narrowing as far as what is safe for the CLL population. Terry takes ibuprofen as needed, especially after messing about outdoors.
He’s not doing any playing in the dirt as of yesterday.
His 4-week checkup after completing his fourth and last Rituxan of FCR-lite, showed #Nuet at 200. Below 500 is severe. He is taking Levanq. . . antibiotic and returns in 48 hours. Meanwhile we monitor his temp and avoid people. He did not have any troubling cytopenias during treatment except platelets which delayed one cycle for one week.
Thanks Chaya, for all the articles and info on delayed onset nuetropenia. You were ahead of the curve on that subject! I chuckled that my son in Sicily was the one who directed me to your previous alerts on the subject. He posted the link on my Facebook page.
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