Choose med­i­ca­tions care­fully for al­lergy re­lief

The Guardian (Charlottetown) - - FEATURES/ENTERTAINMENT - Dr. David Wong Ask Dr. Wong Dr. David Wong is a con­sul­tant pe­di­a­tri­cian in Summerside and re­cip­i­ent of 2012 Distin­guished Com­mu­nity Pae­di­a­tri­cian Award of the Cana­dian Pae­di­atric So­ci­ety. His col­umn will ap­pear in The Guardian on the last Tues­day of ev

Q ues­tion: Our fam­ily is full of al­ler­gies. We all have si­nus prob­lems and headaches. Nat­u­rally, we take Tylenol when the headache gets worse and pills for colds and si­nus when we are mis­er­able with si­nus con­ges­tion. I re­cently heard that Health Canada is warn­ing about Tylenol over­dose. I never re­al­ized that a com­mon medicine like Tylenol can be dan­ger­ous. What can we do to pre­vent this and keep our si­nus prob­lem at bay?

An­swer: Tylenol is one of the most trusted medicine in Canada. It can re­lieve mod­er­ate pain and con­trol fever. It has been around for more than 50 years, with many over-the­counter (OTC) med­i­ca­tions con­tain­ing tylenol as one of the in­gre­di­ents. You can find tylenol in many com­bi­na­tion pain med­i­ca­tions, as well as drugs that re­lieve cold and flu symp­toms.

Tylenol, when taken as di­rected, is gen­er­ally very safe. The max­i­mum rec­om­mended dose for adults is 4 grams in 24 hours. This trans­lates to eight 500 mg ex­tra-strength tylenol or 12 325 mg reg­u­lar-strength tylenol. It should be taken no more fre­quently than ev­ery four hours.

In chil­dren, the max­i­mum dose is 75 mg per kilo­gram of body weight a day or 15 mg per kilo­gram per dose. Be­cause chil­dren's size varies greatly, it is far safer to dose ac­cord­ing to your child's weight in­stead of his age.

Af­ter ab­sorp­tion from the in­testines and do­ing its job to re­duce pain and fever, Tylenol is bro­ken down and ex­creted by the liver. If too much Tylenol is taken, it can­not be me­tab­o­lized in the usual safe man­ner. Ex­ces­sive Tylenol is me­tab­o­lized into a toxic sub­stance called NAPQI that can dam­age liver cells. Depend­ing on the sever­ity of over­dose and how quickly emer­gency treat­ment is avail­able, liver dam­age can be re­versed in some, while oth­ers go into se­vere liver fail­ure and die un­less emer­gency an liver trans­plant is avail­able.

If you are drink­ing al­co­hol and tak­ing Tylenol around the same time, you can get liver dam­age much eas­ier. This is be­cause both Tylenol and al­co­hol are me­tab­o­lized by the liver. The usual safe dose of Tylenol is not safe any more. There­fore, tak­ing Tylenol to treat s headache from a hang­over can dam­age your liver a lot eas­ier.

Another com­mon source

of Tylenol over­dose is OTC med­i­ca­tions that con­tain Tylenol as one of the in­gre­di­ents. The amouTnt of ylenol is hid­den un­der the long list of in­gre­di­ents. In North Amer­ica, it is listed as ac­etaminophen, the generic name for Tylenol. In other coun­tries, it can be called parac­eta­mol or APAP. When you buy these OTC medicines that can re­lief mul­ti­ple symp­toms, ac­etaminophen is likely there. You should take into ac­count the amount of ac­etaminophen as part of your to­tal daily dose.

I rec­om­mend that you avoid buy­ing any of these OTC medicine for colds and si­nus re­lief. In­stead, use Otrivin or a sim­i­lar de­con­ges­tant nose spray to open si­nus pas­sages, but make sure that you don't use it for more than three to five days. Long-act­ing an­ti­his­tamines like Re­ac­tine and Clar­itin can re­duce al­lergy symp­toms and nasal con­ges­tion. Your doc­tor can ar­range blood tests or skin tests to iden­tify those things that cause your al­lergy. There are strate­gies that you can use to avoid these trig­gers and re­duce al­ler­gies and si­nus con­ges­tion.

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