I remember reading the warning on the label and thinking "wow, there's no way someone would ignore this warning and have 6-7 of these over a few hours".

And yet, here you stand. Warning us against the obvious overdose that the label warns against as well.

Only if you use it in a manner not prescribed or on the label - 10-15mg/kg body weight every 8 hours with a maximum of four doses within 24 hours. It is available OTC everywhere except maybe the USA. Then again. USA has many things restricted OTC because the pharmacy/medical industry is more interested in milking you for money than helping you. They disguise this behavior as 'safety'.

Paracetamol is incredibly easily available in the US (acetaminophen) and is actually far cheaper at a place like Costco than in European countries in which I've lived or visited pharmacies (CH, DE, or even UK). Like, 50x cheaper per tablet than in CH in my experience if you're willing to buy an obnoxious amount of them, and still typically cheaper if you buy more standard quantities.

> Paracetamol is incredibly easily available in the US (acetaminophen) and is actually far cheaper at a place like Costco than in European countries in which I've lived or visited pharmacies (CH, DE, or even UK).

Costco: 1000 @ $0.01 each

Boots: 16 @ £0.03 each

Nice!! In most EU countries it's not allowed to buy more than 24 (sometimes 48) paracetamol at a time because people sometimes try to suicide on them (which doesn't actually work but permanently damages the liver)

It's a bit of a stupid precaution though because you can just come back and buy another box or go to the next store. It doesn't prevent anything.

It can work but it's a really, really painful and slow way to die. And this kind of prevention can work: a lot of suicide prevention is focused on just putting enough barriers in place that it's harder to do on impulse. In the case of the limitation it's probably mostly so that people don't normally have a huge jar of them at home, which is what you get with buying them from costco. How many lives have actually been saved by this is pretty hard to judge though, but I would bet it's non-zero.

On the other hand it's left me without when I really needed it :( I would love to have a huge jar of this. There's so many ways to commit suicide and we can't stop them all.

I think medications in general are too restricted in the EU. Many medications that are really innocent require a doctor's prescription (which when I lived in Ireland cost me 60 euro just for the visit - at least here in Spain it's free to visit the GP).

Assuming the numbers in [1] are correct, the answer to "How many lives have actually been saved by this" is, what, somewhere around 4-5000 (~300 a year for 15 years + some extra)?

More interesting is that it took a long time for it to drop after the legislation was introduced in 1998 - presumably people were still working off their stockpiles?

[1] https://www.statista.com/statistics/471227/death-by-paraceta...

Paracetamol is available in the US as Tylenol/acetaminophen

Paracetamol, called Acetaminophen in some countries (mainly US and Japan) and is available OTC with Tylenol being the main brand in the US.

Do you have a source for that? It is the default painkiller in the Netherlands, and it's what GPs typically prescribe people that come to them with something that doesn't really need treatment, to the point that it's a meme.

I'd be interested in hearing how they're wrong to that extent, on such scale.

It’s a half right sort of thing. Overdose is acutely toxic to the liver. Dosage guidelines are safe unless you’ have impaired liver function (been drinking?), or you’re taking another drug that also has paracetamol (e.g. combo paracetamol/ibuprofen, painkillers for period cramps, etc). I’ve seen opiates compounded with paracetamol and I wouldn’t be surprised if it’s mostly to (try to) limit abuse.

Then again this is in contrast to NSAIDs like ibuprofen that can result in gastric bleeding even at the recommended dose.

I prefer paracetamol/acetaminophen for most uses but I’m pretty careful about how much and what else I’m taking.

I think it is disingenuous to call it toxic. You can even drink toxic doses of water, or ingest toxic doses of salt. Water and salt aren't toxic or dangerous.

Comparing it to water or salt is such a low bar add to be meaningless. Acetaminophen toxicity starts at less than twice the recommended dose, which isn’t hard to achieve if someone doesn’t read the guidelines (we generally expect otc medicines to be safe) or if they’re mixing drugs. And that’s for a healthy liver that’s not further burdened with alcohol or other hepatotoxic medicines.

If you forgot if you drank the glass of water, no harm. Same with salt.

If you forgot if you took your Paracetamol pill, accidentally taking another one would leave you with permanent liver damage.

It's like looking into the sun: normally, you flinch/blink away and are safe. But if you stare, and suppress or your reflex isn't working, you'll catch a life-long blind spot burned into your retina.

The therapeutic margin is just insanely small for anything OTC.

Interesting. Anecdotally we (myself, friends and family) never get prescribed Paracetamol here in Germany. It's always Ibuprofen. I always felt it was obvious, given the supposedly side effects of it.

Maybe not that obvious:

https://news.ycombinator.com/item?id=34273099

It is true that the medically useful/effectful dose is not that much lower than the truly damaging one, so this is one drugs where you absolutely should never surpass the determined safe doze (or course don’t do that with any other one either, but for example frontin/xanax is deliberately made in a way that even taking a whole box of it will just send you to a really deep sleep), but I don’t think that using it from time to time would be any worse than drinking a bit of wine during your date at a restaurant.

Same in the UK - Cocodamol was my default hangover cure for years and works a treat.

I’ve heard it said (by pharmacists) that paracetamol likely wouldn’t pass a clinical trial if it went through one with modern standards, though.

If you read paracetamol label, it's funny how it says something along the line "the mechanism of action is unknown" - they literally didn't know how it works for years - I think only recently that mechanism was discovered, but I am not sure. I

That’s kind of a frequent thing though. Why should the exact mechanism be known if they can determine its safety and effectiveness without it? It is kind of a white/black box testing question though.

It doesn't sound safe nor scientific. More like "magic" pills. Just take them and don't question.

Except that you can and are encouraged to question!

But if you were to tumble upon a magic pill that cures cancer, and you tested it extensively and indeed does so without any ill effect, would you wait to really understand the molecular mechanism of it before administering it?

A pain medication that didn’t cause organ damage wouldn’t be legal due to the legacy of the War on Drugs. Drug policy isn’t the most logical. Cannabis still isn’t legal in most of the world.

Even if GPs wanted to prescribe a safer painkiller, they are hamstrung by drug policy. So, they choose something that is a short term solution but has long term consequences because there are NO alternatives that aren’t a headache (i.e opioids).

Tylenol doesn't get you high, my dude.

Unfortunately, it causes acute liver failure so getting “high” from it isn’t something you even want to think about doing. I wish the danger of it was better known though.

like what? Could you list 3?

As far as I know there's zero alternative available that is pharmacologically equivalent.

You also need to abuse paracetamol long term to get liver damage.

It's - along with ibuprofen - the first line of medication given for fever and pain management in Europe.

Actually suicide by paracetamol is pretty easy, just gobble two boxes of it (150mg/kg may kill you: that's just 9 g for a 60kg person, less than two boxes of 8g each). You may need emergency liver transplantation. Plus it will often be difficult to identify by emergency responders.

People wrongly believe that paracetamol needs to be abused long-term to cause damage, but that's not true. In general, 10 grams over the course of a day is enough to cause paracetamol toxicity in adults (or less). And the thing is, death from this isn't quick - it can take over two weeks, with symptoms not starting for a couple of days.

This is why in the US they've reduced the amount in OTC pills - I think the max is now 375mg, and less in some cases. Paracetamol probably can never be made prescription only, but as others have said, it's likely it wouldn't be approved for use today.

Can you qualify (and quantify) that risk? No medication is totally safe. For example, Aspirin can cause gastrointestinal bleeding but in reality it's safe when taken in most use cases (i.e. not chronically).

Nearly every substance can cause damage if you chronically abuse it maybe except water (unless you ingest a lot rapidly, but that's an other story.)

Please remove this comment. Giving unfounded medical and pharmaceutical advice on HN, especially when it is clearly devoid of an explanation or context like that, is dangerous and irresponsible.