EXTRA-STRENGTH TYLENOL: AN EXTRA HEADACHE?
The Medical Letter Says No Proof That More Is Better

NEW ROCHELLE, NY -- November 4, 2002 -- True or false? Extra-strength Tylenol (acetaminophen) gives greater relief from pain and headache than regular strength Tylenol.

More like not proven. According to a report in the October 28 issue of The Medical Letter® on Drugs and Therapeutics, there are no published data showing that 1000 mg of Tylenol (two extra-strength tablets) is more effective than 650 mg (two regular-strength tablets) in treating everyday causes of pain such as headache or osteoarthritis.

The Federal Food and Drug Administration has recommended that a stronger warning about potential serious liver injury at higher-than-recommended doses be added to the labeling for acetaminophen products. The Medical Letter says that usual doses of acetaminophen are not likely to cause hepatoxicity even in people who drink moderate amounts of alcohol. Recommended doses can be dangerous, however, when people take Tylenol with one or more of the many "combination products" containing acetaminophen, or take any two of these products simultaneously.

Some common over-the-counter acetaminophen combinations include various products of brands such as Alka-Seltzer, Benadryl, Comtrex, Contac, Coricidin, Dimetapp, Drixoral, Excedrin, Goody's, Midol, Percogesic, Robitussin, Singlet, Sinutab, Sudafed, Tavist, TheraFlu, Triaminic, Vanquish and Vicks.
Since acetaminophen turns up in so many of these products, why take extra-strength Tylenol when regular strength may do just as well?

ARE DRUGS TAKEN AFTER THEIR EXPIRATION DATE DANGEROUS?

Is it ever safe to take prescription drugs after the expiration date on the label?
According to a report in the October 28 issue of The Medical Letter® On Drugs and Therapeutics, the expiration date doesn't mean that the drug will go bad after that date, but only that it will still be good on that date. In the last 40 years, surprisingly, there has only been one report of toxicity due to a breakdown of the products in outdated drugs. Even that drug (tetracycline) has been reformulated and would not have that effect today. The amount of potency a drug retains depends on the drug and the storage conditions, especially humidity. The Medical Letter reports that many drugs stored under reasonable conditions retain 90% of their potency for at least five years after the expiration date found on the label. And some drugs have been found to retain potency for 25 or 30 years!

Liquid medication is not as stable as solid forms. Solutions that become cloudy or discolored should be discarded. Specifically, The Medical Letter reports that epinephrine in EpiPen injections, used to treat serious allergic reactions, loses potency after its expiration date.

About The Medical Letter
The Medical Letter Inc., a nonprofit organization founded in 1958, offers health care professionals objective, independent analysis of new drugs. In addition to its biweekly newsletter, The Medical Letter on Drugs and Therapeutics, it also publishes handbooks and software on topics such as adverse drug interactions and antimicrobial therapy. The Medical Letter is supported entirely by subscriber fees and is based in New Rochelle, NY. For more information about The Medical Letter call (800) 211-2769 or visit their Web site at www.medicalletter.org.