What Older Adults Need to Know About Acetaminophen's Hidden Health Dangers

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Did you know the pain reliever that’s found in most medicine cabinets acetaminophen is not maybe as harmless as we’ve believed, particularly for people 65 and older? If you’re going for that trusted bottle to ease your pains, it’s time to examine what the new studies are showing us.

For decades, acetaminophen (a.k.a. Tylenol or paracetamol) has been the “safe” substitute for NSAIDs such as ibuprofen for pain management in older adults. But fresh evidence is rattling that supposition. In a huge study following more than 180,000 older adults, scientists discovered long-term use of acetaminophen was associated with a dramatic increase in severe complications such as peptic ulcers, GI tract bleeding, chronic kidney disease, and even hypertension. Based on the Arthritis Care & Research published study, risk for sole lower gastrointestinal bleeding increased 36% in heavy users versus non-users (acetaminophen exposure recorded more negative risks for several severe complications).

That’s just half of it. The study also demonstrated a dose-response: the more scripts, the greater the risks for disorders such as peptic ulcers and kidney disease (increasing with the number of acetaminophen prescriptions). And among people who have osteoarthritis a group taking pain medication daily the risks were elevated.

Why is this occurring? It appears acetaminophen is not as gentle on your gut and kidneys as we thought. Dr. Marc Siegel went so far as to just say it: “It is generally accepted doctrine that acetaminophen is not associated with GI bleeding or advancing kidney disease, but the thinking is starting to change on this front.” Why? It seems that acetaminophen can affect the prostaglandin pathways of the body, similar to NSAIDs, which have a tendency to create GI side effects. So although it’s not officially an NSAID, acetaminophen is not home free in your belly.

The kidney tale is no less shocking. A recently released meta-analysis combined data from more than 13,000 adults and discovered that using acetaminophen was associated with a 23% increased risk of acquiring new renal impairment that is, acute kidney injury and chronic kidney disease (using acetaminophen was discovered to have statistically significant effects on the enhanced risk of renal impairment). The suspected culprit? A. Toxic byproduct formed through acetaminophen metabolism can trigger cell injury in the kidneys, leading to necrosis of tissue and ultimately organ failure. Danger is even more so if you’re taking higher doses, diabetic, drink alcohol, or take other kidney-tensing medications.

So what does it mean for you or a loved one who must take acetaminophen for everyday relief? To begin with, it’s a wake-up call that even those old standby meds are in need of a healthy dose of respect particularly for older adults whose bodies process drugs differently. Dr. Macie P. Smith explains, “Older adults often metabolize drugs differently, which can increase risks.” That is to say, what is safe for a 30-year-old may not be quite as safe for someone in their seventies.

And although acetaminophen has long been the “less hazardous” choice over NSAIDs, perhaps the difference isn’t as great as we’d thought. NSAIDs are infamous for inducing stomach ulcers and kidney damage, but now acetaminophen is turning up with the same warning signs just in a very subtle way.

If you’re juggling multiple prescriptions (hello, polypharmacy), the risks can add up fast. That’s why experts are now urging seniors and caregivers to take a proactive approach:

• Always check with your doctor before starting or continuing acetaminophen, especially if you’re already on other meds or have chronic health conditions.
• Read the labels on all medications acetaminophen hides in everything from cold remedies to sleeping aids, and it’s easy to accidentally double up.
• Fill prescriptions at one pharmacy so your pharmacist can monitor for potential interactions and give personal advice. As Dr. Smith recommends, Using one pharmacy helps pharmacists monitor potential interactions and provide safety advice.
• Pose questions. “Always read the included information, and don’t hesitate to ask your doctor or pharmacist if you have questions,” says Dr. Smith.

Several medicines do not need to be daunting. Smart tactics like maintaining a current list of medications, employing pill boxes, and arranging periodic check-ins about your medications with your medical staff can help you catch potential problems before they begin. And if you ever wonder if acetaminophen remains the best option for your pain, it’s a discussion worth having. As Professor Weiya Zhang has it, “Given its minimal pain-relief effect, the use of paracetamol for long-term conditions such as osteoarthritis needs to be carefully considered.”

The bottom line? Although you might feel you can trust over-the-counter medications regardless, even the most innocent-looking ones carry some risk, particularly when we get older. By keeping up to date, asking questions, and consulting closely with our health care providers, we can all make wise decisions about what is best for us.