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Geriatric Care and Managing Drug Store Meds

Acetaminophen (Tylenol) is everywhere within mainstream medicine these days.  It is used by itself for fever or pain as well as in combination with other medicines for flu, moderate to severe pain, cold symptoms or insomnia. 

But acetaminophen and a lot of other medications don’t simply go from the mouth to where they are needed in the body; they must be absorbed through the digestive tract and into the blood stream.  Acetaminophen along with many other meds are then metabolized through the liver.  If too many medications are being processed through the same site in the liver, liver function can be compromised.  It does not have to be multiple agents that create this liver logjam; it may simply be the amount of a single agent like acetaminophen that can cause problems.  Older patients will be able to process even less through their “slower livers.”

Historically, patients have been cautioned not to exceed 4,000 mg of acetaminophen a day as the potential for liver failure can follow from that daily dosage even in otherwise reasonably healthy individuals.  I hear from some doctors that the number should be closer to 3,000 mgs, especially for older patients. 

Pain killers start with as much as 500mg or more per dose taken every six to eight hours.  And then there is Tylenol “extra strength” which can bump an individual dose even higher.  Some individuals may be tempted by the “if one is great, then more is better” syndrome.  And then a person may take an OTC sleep aid that also contains acetaminophen or use a cold formula containing acetaminophen. 

Remember also that older patients can become confused, because they have multiple pills to track.  They can accidentally take another dose beyond what their regimen would dictate.  As a geriatric care manager, I have a client whom I tell to set her acetaminophen tablets out in a medication tray like her other meds so that she knows how much is left of the total amount she can safely take each day.

The FDA has recently convened to determine just how much acetaminophen should be allowed as a daily limit to avoid problems of liver toxicity, but the jury is still out.  So, if you are watching your older parents’ meds, don’t focus just on their prescriptions (which can contain acetaminophen); look in their medicine chest for the rest of the drugs they buy at the store without a prescription.  Then do the math.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families throughout metropolitan Chicago. Please email your questions to Charlotte Bishop.


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