It’s safe to assume that the vast majority of you have a bottle or blister pack of acetaminophen/paracetamol/Tylenol/Panadol in your home medicine cabinet, and an even vaster majority of you have taken the medicine at some point in your life. After all, acetaminophen/paracetamol is one of the most, if not the most, widely used medications worldwide. Despite its near ubiquity, many unanswered questions remain. How does it actually work? Should safe dosage guidelines be revisited? Why on earth does it have multiple names? And finally, who was responsible for the Tylenol murders in 1982? In this jam-packed episode, we do our best to make sense of the mysteries surrounding this drug, weaving our way from the pharmaceutical nitty gritty of acetaminophen/paracetamol to the bizarre story of its discovery, from the horrific crimes that shocked a nation and revolutionized consumer safety standards to the ongoing discussions of whether we’re under- or overestimating how safe this medication actually is.
| History | Biology |
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| Bertolini, Alfio, et al. “Paracetamol: new vistas of an old drug.” CNS drug reviews 12.3‐4 (2006): 250-275. | Ayoub, S.S., 2021. Paracetamol (acetaminophen): A familiar drug with an unexplained mechanism of action. Temperature, 8(4), pp.351-371. |
| Brune, Kay. “The early history of non-opioid analgesics.” Acute Pain 1.1 (1997): 33-40. | Ghanem, C.I., Pérez, M.J., Manautou, J.E. and Mottino, A.D., 2016. Acetaminophen from liver to brain: New insights into drug pharmacological action and toxicity. Pharmacological research, 109, pp.119-131. |
| Brune, K., B. Renner, and G. Tiegs. “Acetaminophen/paracetamol: a history of errors, failures and false decisions.” European Journal of Pain 19.7 (2015): 953-965. | Anderson, B.J., 2008. Paracetamol (Acetaminophen): mechanisms of action. Pediatric Anesthesia, 18(10), pp.915-921. |
| Jarrell, Kristin. “Tylenol and tamper-resistant packaging.” Journal of GXP Compliance 16.4 (2012): 6. | Ohashi, N. and Kohno, T., 2020. Analgesic effect of acetaminophen: a review of known and novel mechanisms of action. Frontiers in Pharmacology, 11, p.580289. |
| Prescott, Laurie F. “Paracetamol: past, present, and future.” American journal of therapeutics 7.2 (2000): 143-148. | Rumack, B.H., 2004. Acetaminophen misconceptions. Hepatology, 40(1), pp.10-15. |
| Roy, Jiben. An introduction to pharmaceutical sciences: Production, chemistry, techniques and technology. Elsevier, 2011. | Towheed, T., Maxwell, L., Judd, M., Catton, M., Hochberg, M.C. and Wells, G.A., 2006. Acetaminophen for osteoarthritis. Cochrane database of systematic reviews, (1). |
| Sneader, Walter. Drug discovery: a history. John Wiley & Sons, 2005. | Fisher, E.S. and Curry, S.C., 2019. Evaluation and treatment of acetaminophen toxicity. Advances in Pharmacology, 85, pp.263-272. |
| Spooner, J. B., and J. G. Harvey. “The history and usage of paracetamol.” Journal of International Medical Research 4.4_suppl (1976): 1-6. | Esh, C.J., Chrismas, B.C., Mauger, A.R. and Taylor, L., 2021. Pharmacological hypotheses: Is acetaminophen selective in its cyclooxygenase inhibition?. Pharmacology Research & Perspectives, 9(4), p.e00835. |
| Gutowski, Christy and St. Clair, Stacy. “The Tylenol murders: Read the Tribune investigation.” Chicago Tribune. 27 October 2022.https://www.chicagotribune.com/tylenolmurders/ct-tylenol-murders-investigation-listicle-20220922-kndriges6zgdpf5pvrxdjatah4-list.html | McCrae, J.C., Morrison, E.E., MacIntyre, I.M., Dear, J.W. and Webb, D.J., 2018. Long‐term adverse effects of paracetamol–a review. British journal of clinical pharmacology, 84(10), pp.2218-2230. |
| Gutowski, Chrsity and St. Clair, Stacy. “Unsealed: The Tylenol Murders.” 2022. https://unsealed-the-tylenol-murders.simplecast.com/ | Conaghan, P.G., Arden, N., Avouac, B., Migliore, A. and Rizzoli, R., 2019. Safety of paracetamol in osteoarthritis: what does the literature say?. Drugs & aging, 36, pp.7-14.q3 |
| Firsthand Account: Shoichet, Catherine E. “Transformed by Tragedy.” CNN.com. 24 September 2022.https://edition.cnn.com/interactive/2022/09/us/tylenol-murders-cnnphotos/?fbclid=IwAR0IxmGmSbjoLnSNH2RNlsSXeL5eFB9qGtJTT0W1aByC7EHmayMxm2P5QFQ | Bateman, D.N., Carroll, R., Pettie, J., Yamamoto, T., Elamin, M.E., Peart, L., Dow, M., Coyle, J., Cranfield, K.R., Hook, C. and Sandilands, E.A., 2014. Effect of the UK’s revised paracetamol poisoning management guidelines on admissions, adverse reactions and costs of treatment. British journal of clinical pharmacology, 78(3), pp.610-618. |
| Caparrotta, T.M., Antoine, D.J. and Dear, J.W., 2018. Are some people at increased risk of paracetamol-induced liver injury? A critical review of the literature. European journal of clinical pharmacology, 74, pp.147-160. | |
| Shadman, K.A., Edmonson, M.B., Coller, R.J., Sklansky, D.J., Nacht, C.L., Zhao, Q. and Kelly, M.M., 2022. US hospital stays in children and adolescents with acetaminophen poisoning. Hospital pediatrics, 12(2), pp.e60-e67. | |
| Nourjah, P., Ahmad, S.R., Karwoski, C. and Willy, M., 2006. Estimates of acetaminophen (paracetomal)‐associated overdoses in the United States. Pharmacoepidemiology and drug safety, 15(6), pp.398-405. | |
| ProPublica, Sept 2013. Overdose: Use Only as Directed. https://www.propublica.org/article/tylenol-mcneil-fda-use-only-as-directed#:~:text=Acetaminophen%20%E2%80%93%20the%20active%20ingredient%20in,or%20even%20destroy%20the%20liver. |
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