- How acetaminophen works isn't entirely understood. It inhibits the COX-1 and COX-2 enzymes in the body like aspirin does, but because it doesn't do this as strongly, it isn't an anti-inflammatory like aspirin and ibuprofen (Advil). Instead, it appears to work directly on the central nervous system to reduce the threshold of pain. Since inflammation plays only a small role in osteoarthritis, an anti-inflammatory drug isn't needed. This fact, coupled with the knowledge that acetaminophen doesn't cause the stomach upset aspirin and ibuoprofen can, is why the drug is so often prescribed by physicians for their arthritis patients.
- Although acetaminophen is generally safe, a dosage that is too high over a period of time can cause serious side effects and even death. Because acetaminophen overdose caused approximately 56,000 emergency room visits and 458 deaths over an 8-year period, the FDA has recommended that all patients, including arthritis sufferers, limit the maximum dose of nonprescription acetaminophen to 650 milligrams (mg), unless otherwise indicated by their doctor. Although the 2009 FDA study noted that the maximum daily dose limit is 4,000 mg, they have recommended that amount be reduced.
- Check with your doctor first about whether it's safe for you to use products with acetaminophen and also ask what your daily maximum dosage should be. Always take the minimum amount necessary to relieve your symptoms. Beware of taking multiple over-the-counter drugs at the same time you are taking acetaminophen and always read labels; there are hundreds of other products that also contain acetaminophen, such as cold and allergy medications, which can add to your daily maximum. Don't mix acetaminophen with alcohol, as patients with pre-existing liver disease or people who consume more than three alcoholic drinks per day have a much higher risk of liver toxicity when taking acetaminophen.
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