Acetaminophen, marketed under many brand names, including Tylenol, is the most commonly used drug for pain and fever by pregnant women. But a new study has linked this use to Attention Defecit Hyperactivity Disorder (ADHD). . . .

There are lots of reasons to think twice before popping Tylenol. And now there's a new reason for pregnant women.

A large study looked at 64,322 children and mothers. Disturbingly, it found that children whose mothers used acetaminophen during pregnancy were at higher risk of being on ADHD medication and of being diagnosed with Hyperkinetic Disorder (HKD), a particularly severe form ADHD characterized by hyperactivity and difficultly concentrating.

The association between taking acetaminophen while pregnant and having a child with ADHD or HKD was strongest for women who used acetaminophen during more than one trimester. The more frequently they used it, the greater the risk (JAMA Pediatr 2014;168:313-20).

The researchers point out that other recent research has suggested that acetaminophen is a hormone disruptor and that abnormal exposure to hormones during pregnancy may influence the development of the child's brain .

And there has been other bad news for Tylenol and the brain lately. A recent study discovered that acetaminophen blunts emotions.

This double-blind study gave either 1,000mg of acetaminophen or a placebo and then waited one hour for the Tylenol to enter the brain. The researchers then showed pictures of positive and negative events to the people in the study. People who took the Tylenol evaluated unpleasant events less negatively and pleasant events less positively than did people who really just took a placebo. The Tylenol takers also rated positive and negative events as less emotionally arousing than did the people who got the placebo.

The researchers of the study concluded that acetaminophen has a general blunting effect on people. That means that Tylenol has psychological as well as physical side effects.What makes the picture worse for Tylenol is that it has considerable physical side effects and doesn't even work that well. As we reported recently, double-blind research has shown that acetaminophen, despite being the most recommended drug for back pain, is no more effective than a placebo for treating back pain (Lancet 2014;doi:10.1016/S0140-6736(14)60805-9). This disappointing result has now been confirmed in a meta-analysis (BMJ 2015;350:h1225).

Researchers conducted a systematic review and meta-analysis of thirteen controlled studies that compared acetaminophen to placebo for back pain or osteoarthritis.They found that, despite the fact that Tylenol is the first line painkiller recommended by doctors for back pain, there is, in fact, "high quality" evidence that it is ineffective for reducing pain, for reducing disability or for improving quality of life. For osteoarthritis, though there is"high quality" evidence that there is a statistically significant effect on pain and disability, that effect is not clinically important, meaning that the benefit is real, but not with enough real world significance to help you.

What's worse than Tylenol not helping back pain or osteoarthritis is that it does harm. The meta-analysis found "high quality" evidence that people taking acetaminophen are more than four times more likely to have abnormal results on liver function tests.

This important dark side to Tylenol should no longer be a surprise. Earlier research concluded that acetaminophen is the most common cause of acute liver failure in the U.S. and U.K. The studies authors said in their conclusion that acetaminiphen "far exceeds other causes of acute liver failure in the United States (Hepatology 2005;42:1364-72).

 

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