Lisa Sanders, More Than the Flu. At first the doctors thought the pregnant woman just had a virus. But soon they began to worry about her -- and her fetus. New York Times Magazine, Nov 19, 2017 (in her, Sanders's, column Diagnosis). https://www.nytimes.com/2017/11/ ... -and-her-fetus.html
three consecutive paragraphs:
"Because she was pregnant, it [acetaminophen] was the only thing [flu medication] she was allowed to take. How much did she take, he asked. She took two extra-strength tablets (500 milligrams each) as often as every four hours, ingesting, perhaps, up to 6,000 milligrams each day. That was twice the maximum recommended dose.
"[Eric] Sweet[, an intern at ICU,] was alarmed. Acetaminophen is the most common cause of acute liver failure in the United States. Half of all patients with liver failure, and one-fifth of all patients who need a liver transplant, sustained their injury using this common over-the-counter medication.
"When acetaminophen passes through the liver, some of the drug is broken down into toxic chemicals. A healthy liver can dispose of these dangerous components. But the liver needs nutrients to do this, and because she was so sick, this woman wasn’t taking in much in the way of nutrients. In addition, because she was pregnant, she was sharing her nutrients with her fetus. All this put her at significant risk of being poisoned by the acetaminophen. What started off as simple influenza was now even more dangerous because of this possible slow overdose.
My comment:
(a)
(i) There is no need to read the rest of the article -- because if you are not a healthcare provider. You need not know the symptoms and signs of acetaminophen overdose.
(ii) In a nutshell, a woman had a common cold (influenza), and was prescribed oral acetaminophen. Then she got worse: vomiting, diarrhea and lack of energy to do anything. It turned out that although the flu had subsided, she suffered from acetaminophen overdose and liver damage. However, the article did not explain why she was overdosed -- did she follow prescription or not? In fact, FDA itself does not explain why Americans (and people in other nations of developed world) are overdosed with acetaminophen; FDA merely describes it as a fact. See (d).
(b) Both acetaminophen (accent on the syllable "mi") and paracetamol (the name used in en.wikipedia.org) share -- and indeed are contracted in different way from -- the same chemical name: N-acetyl-para-aminophenol. https://en.wikipedia.org/wiki/Paracetamol
(chemical structure; section 4 Pharmacokinetics: The drug " is metabolized primarily in the liver * * * [one metabolite NAPQI (N-acetyl-p-benzoquinone imine) is toxic] * * * final products that are inactive, non-toxic, and eventually excreted by the kidneys.
(i) It is a derivative of aniline (C6H5NH2; a liquid of a color varying from yellow to dark brown).
(ii) One trade name/brand name of acetaminophen is Tylenol (also contracted from N-aceTYL-para-aminophENOL), (name) owned by Johnson & Johnson.
(c)
(i) Paracetamol - Different Name in USA? Dublin, Ireland: Irishhealth.com, undated www.irishhealth.com/askdoc.html?q=5703
(ii) Cram101 Textbook Reviews, Just the Facts101 Textbook Key Facts: General, Organic, and Biological Chemistry, Structures of Life. 4th ed. Content Technologies, Inc, 2016, page number not shown https://books.google.com/books?i ... apanese&f=false
("Paracetamol is the International Nonproprietary Name (INN), Australian Approved Name (AAN)and British Approved Name (BAN), while acetaminophen is the United States Adopted Name (USAN) and Japanese Adopted Name(JAN)" )
(iii)
(A) Stephen H Curry and Robin Whelpton, Introduction to Drug Disposition and Pharmacokinetics. Wiley, 2017 at page 3 https://books.google.com/books?i ... inophen&f=false
("Generally a drug will have at least three names: a full chemical name, a proprietary name, ie, a trade name registered to a pharmaceutical company, and a non-proprietary name INN) and/or an approved or adopted name")
(B) drug nomenclature https://en.wikipedia.org/wiki/Drug_nomenclature
("Drugs, in the majority of circumstances, have 3 types of names: chemical names, the most important of which is the IUPAC name; generic or nonproprietary names, the most important of which are the International Nonproprietary Names (INNs); and trade names")
(d) Acetaminophen Overdose and Liver Injury — Background and Options for Reducing Injury. FDA, May 22, 2009 https://www.fda.gov/ohrms/docket ... 9-4429b1-01-FDA.pdf
("Acetaminophen is one of the most commonly used drugs in the United States for treating pain and fever [it has no anti-inflammatory effect]; mechanism of action unclear, probably acting on brain] * * * Unlike other drugs commonly used to reduce pain and fever (e.g., nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen), at recommended doses acetaminophen does not cause stomach discomfort or bleeding")