DH regularly ignoring paracetamol max dosage

[itsabongthing]

My DH regularly takes double dose of painkillers.
Eg 4 ibuprofen or paracetamol tablets instead of 2, or 2 sachets of Lemsip at a time.
His reasoning is that his headache is really bad.
He’s an intelligent bloke but I think he’s being an idiot and potentially harming his liver but am not medical so don’t really know.
He’s also quite a big chap at 6’4” and 110kg. Could he need more medicine to be effective because of his size? Or is he doing himself harm?

Taking a double dose (2g) of paracetamol on the odd occasion is very unlikely to do any harm. Exceeding the maximum daily dose of 4g is a bad idea.

This only goes up to 100kg but you can see it's 1000mgs every 4 hours. Most paracetamol tablets are 500mgs per tablet (the ones on my bedside table right now are). That means 2 x 500mgs every 4 hours NOT 2000mgs! Show him a weight by dosage paracetamol calculator and prove him wrong.

Pharmacist here. Taking 4 x 200mg ibuprofen instead of 2 is unlikely to do any harm on an occasional basis. Higher doses than the standard 400mg are sometimes used clinically in certain situations. If he was taking this dose regularly he would be more likely to cause damage to his stomach, kidneys and heart.
Taking more paracetamol than recommended is extremely dangerous. There is no higher dose recommendation for larger people. Paracetamol is metabolised by a pathway in the liver that becomes saturated. The alternative metabolic pathway that the body uses produces a toxic byproduct hence the maximum dose. He definitely shouldn’t do this. It is possible to damage your liver with even quite small paracetamol overdoses. Slight overdoses over a long period of time can also be very dangerous.

It sounds like he might be physically addicted to painkillers, he will be getting horrendous migraines if he's been taking them for a while.

He needs to read up on the effects of long term use, or more usefully, have a chat to a local substance misuse service (its a well known and really hidden problem!). He needs to give them a call and talk.

’the recommended dose is for people my size of 5ft 4 and about 8 stone...’

Oh so no.
A criticism of historic drug trials is that women are not included in the test groups.

Nothing quite like making it up as you go along to cover up either getting it wrong or distracting from a dependency.

Paracetamol is dangerous, and the margins between safe use and permanent bodily damage are pretty narrow.

Yes, size matters - but you need proper qualifications to calculate a weight-related dose safely. It is not safe to just increase by a random amount.

It wouid be considerably safer to have normal dose of paracetamol, alternating with ibuprofen and with an aspirin chaser than to change doses. If all that is not holding the pain, then swop planned paracetamol doses for paracetamol/codeine, and if that still isn't working then see a doctor.

Lemsip is a bit of a red herring - it's just paracetamol and antihistamine. As it doesn't seem to be working, I'd suggest he stops taking it, and just has hit drinks and eucalyptus (sweets or inhalations) instead.

And next time he does this, ask him if he has made a Will and where it is, plus his views on being resuscitated when in extremis. Only moderately joking - you can do yourself a lot of damage by doing what he's doing.

I knew someone whose wife died after taking 12 paracetamol in a day, with severe toothache.

It can be so dangerous

I am a Codeine addict - I've been in recovery for 7 years, but at my worst I would take around 90 Nurofen Plus tablets every day (they contain Codeine and Ibuprofen).

Apart from lots of gastric discomfort (bloating, constipation etc.), I was 'fine' for several years. And then one day, I wasn't.

I was a passenger in a car on a long journey, I felt 'car sick', so we stopped at the Services. DH went in to grab a coffee and I waited, sitting in the passenger seat with the door open to get some fresh air. I had a carrier bag and managed to throw up directly into it.

What came up was terrifying; huge clots of thick, red blood. Then more blood. And more. It was later estimated that I'd lost over 2 pints.

I was terrified my DH would see what had happened (my addiction was very much a secret at that time), so I staggered from the car to a bin a few yards away and disposed of the bag, then managed to get myself back to the car and lie across the back seat. My vision was going, I had ringing in my ears and I could feel myself fading out of consciousness.

We got to a hospital and several transfusions and an endoscopy later, I felt much better, but was told I could never take any NSAIDs ever again.

Taking too may paracetamol in one go can have an immediate, deadly impact. Taking too many NSAIDs (such as Ibuprofen) in one go tends to have a cumulative effect and can also kill.

OP your DH needs to be aware that no matter what his stature, our insides are built pretty much the same and anyone can die as a result of a stomach ulcer perforation at any time as a result of taking too many NSAIDs.

If he's regularly taking pain killers he needs to see a doctor.

I have kidney problems and the consultant says it could be related to the ibuprofen I was taking. (Then again it may not doctors seems a bit unsure with out of the norm problems)

Better a visit to the doctor and get checked out than the possible consequences of overdoing the pills. Just because its non-prescription doesn't mean its safe.

There's 1000mg of paracetamol in Lemsip.
That's a lot.

He's an idiot.

He needs to see a doctor and get it all sorted out, sounds like an addiction to painkillers with a side of medication headache.

I've had one family member addicted to painkillers, she ended up having a stroke and passed away 10 days later.

Also had a couple of family members with medication heachaches, they were finally persuaded to go to the dentist to sort their teeth out, the root of the initial pain that caused them to keep taking painkillers.

He can take 2 paracetamol and 2 ibuprofen at the same time, but 4 paracetamol probably isn't the greatest idea, although I don't think it'd do too much harm- it's not worth taking the risk over

I've just asked DSis (doctor) who says if he does it regularly with paracetamol he'll most likely go into liver failure. It's extremely stupid and dangerous.

um, er... I doubt the capacity & resilience of his liver is determined by his size.

^ and this.

My friends aunt died as a result of paracetamol poisoning........and she was a nurse

He needs to have a mix, so two ibuprofen and two paracetamol together

Or

Get the chemist or doctor to advise/prescribe better pain meds

Paracetamol is SOOOOOO dangerous and kills people - he's got to stop

He is an idiot.

If he has proper migraine he should see his doctor and get proper analgesia prescribed for migraines - which is not paracetamol or ibuprofen.

Paracetamol is generally rubbish for headaches and especially for migraine which is why he finds it doesn't work.

If he is doing this regularly he may be making his migraines worse by triggering medication overuse headache which happens commonly in response to taking regular paracetamol for migraine - you end up having more migraines than you would otherwise.

And this is without addressing the potential damage he is doing to his liver.

And with a cold - no the first Lemsip didn't help because he has a cold. Nothing helps a cold except getting better from the cold. Lemsip is overpriced paracetamol with a bit of lemon. It will get your temperature down and stop you feeling quite as achy. But you will still feel like you have a cold. He is an idiot.

He needs to have proper medical advice about his migraines as a) his life will be much better and b) what he is doing is potentially dangerous.

It's not just potentially damaging his liver. Too much paracetamol and he could kill himself, it really is that serious. I doesn't take much at all to overdose.

A friend of mine died at 19 of paracetamol poisoning, probably caused by taking slightly too much over a period of months. Another friend accidentally combined lemsip type stuff and paracetamol at 33 and had to have a liver transplant, which in itself is usually life-limiting. Please listen to people's warnings on how serious this can be and get him to the GP for some advice.

Paracetamol overdose is so dangerous. My mum was a nurse when younger and had a patient in who had overdosed on paracetamol on purpose. It took about 3 days for him to die. Think he thought it would be instant but it isn't and there's nothing much they could do to help. You need to take the antidote within 8 hours of the overdose.

I know a chronic pain nurse who got into that job after being a nurse on the liver transplant ward.

She chose this career shift specially because she was horrified at the sheer number of people who came in needing a transplant due to regularly overtaking of paracetamol by only a small number of tablets to treat their chronic pain.
None of them had overdosed or needed hospital treatment and none of them knew there was an issue until the liver was too damaged to save.

These people were only taking a few extra but they did it regularly

If he's getting frequent migraines, get him to the GP. They may very well prescribe amitriptyline, which is taken daily. I was prescribed it for chronic pain and not having migraines any more is a fantastic bonus.

I once took an overdose of about 20 paracetamol on an empty stomach when I was a teenager and going through a horrible time.
I was sick about 60 times that day and luckily was sick within the first few minutes so think a lot of it didn’t get ingested. I was still very unwell though and I have suffered ever since with liver and stomach issues. I can’t drink alcohol as I feel so unwell from it. My liver enzyme blood tests are always high no matter what the doctor does. I almost permanently feel like I have a stomach bug and when I had an endoscopy done it showed I have chronic gastritis in my stomach lining. It’s definitely not a medicine to be messing around with!

My Dad in his early 70s is in late stage liver failure, mostly we reckon due to pain killers he took due to broken back and other ailments. He has been told he is not a candidate for transplant.

If the headaches are that bad he needs to see GP, get his eyes tested too. And yes alternate ibuprofen and paracetamol. I was once prescribed 600 ibuprofen but the amount you could take in one day was still the same.