Acetaminophen, also known as paracetamol and APAP, is the most common
analgesic (painkiller) present in cough suppressant formulas. It is closely
related to the NSAIDs (non-steroidal anti-inflammatory drugs) of which
aspirin and ibuprofen are the two most common examples. Unlike the OTC
NSAIDs, however, acetaminophen/paracetamol does not tend to irritate the
stomach, and thus its inclusion in cough syrups.

An acetaminophen overdose is very dangerous. Normally, acetaminophen is
metabolized (broken down) in the body by two separate pathways, both of
which lead to harmless metabolites. However, these two pathways can only
handle so much before saturating. At that point, the remaining
acetaminophen is metabolized by a cytochrome P450 liver enzyme. The
metabolite via the P450 pathway is toxic to the liver (2,8).

Furthermore, this doesn’t happen right away; it can take 16 hours before
any signs of liver damage show up. This delayed toxic effect has been
responsible for the rather painful deaths of some people who (accidentally
or not) overdose on acetaminophen, and then think they are fine when no
immediate problems occur. There is an antidote (acetylcystine), but it must
be administered within the first 12 to 16 hours.

The toxic dose of acetaminophen can be as low as 50mg/kg; for a 60kg person
this is only six acetaminophen tablets. This is unlikely but possible. DO

As for aspirin and ibuprofen, the other two most common OTC painkillers,
both tend to irritate the stomach at high doses. I recommend against them,
especially if you have an irritable stomach. Never take large doses of
aspirin or ibuprofen if you have an ulcer.

Conclusion: avoid any product containing an analgeisc.

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