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Paracetamol mix-up?

nabanga

Kava Enthusiast
Does anyone know if it's safe to take paracetamol (1000mg every 4 hours) and a good session of kava at the same time? I cracked my foot and it's very sore, but am reluctant to skip my evenings imbibing.
Can I have my cake and eat it too?

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Zaphod

Kava Lover
Does anyone know if it's safe to take paracetamol (1000mg every 4 hours) and a good session of kava at the same time? I cracked my foot and it's very sore, but am reluctant to skip my evenings imbibing.
Can I have my cake and eat it too?

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Not recommended. Paracetamol is the same as acetaminophen/Tylenol and is really hard on the liver. 1000mg is also a really high dose:
https://en.wikipedia.org/wiki/Paracetamol#Liver_damage
 

The Kap'n

The Groggy Kaptain (40g)
KavaForums Founder
1g every 4 hours works out to 6g per day which is 85% of the way to a major overdose. I would STRONGLY suggest against the consumption of kava if your doctor has prescribed you this level of paracetamol/Tylenol dosage.

If you choose the paracetamol, I suggest adding a Milk thistle supplement or N.A.C. (N-Acetyl Cysteine) supplement to your diet while your're taking it.
 

SelfBiasResistor

Persist for Resistance!
I've taken pain pills with acetaminophen/paracetamol having doses ranging from 650-800mg, 2-3x a day for many months while drinking kava at night without issues. I always used NAC supplements when available.

Kava inhibits the P450 2E1 enzyme which converts acetaminophen in the liver to the toxic NAPQI metabolite. That would indicate to me that the toxicity of NAPQI would be lessened with kava since the enhanced toxicity is caused by substances like alcohol that up-regulalte the production of the P450 2E1 enzyme.
 

kastom_lif

Kava Lover
That's an awful lot of paracetamol/panadol/tylenol. If possible, I'd seek ibuprofen, naproxen, or even aspirin.

Be careful, get well soon.
 

verticity

I'm interested in things
I've taken pain pills with acetaminophen/paracetamol having doses ranging from 650-800mg, 2-3x a day for many months while drinking kava at night without issues. I always used NAC supplements when available.

Kava inhibits the P450 2E1 enzyme which converts acetaminophen in the liver to the toxic NAPQI metabolite. That would indicate to me that the toxicity of NAPQI would be lessened with kava since the enhanced toxicity is caused by substances like alcohol that up-regulalte the production of the P450 2E1 enzyme.
That is an interesting point. It is true that CYP 2E1 is involved in the metabolism of both kava and acetaminophen (as well as another CYP enzyme) so you might think the effect would cancel out like that, but in both cases the situation is complex: there are other mechanisms/second pass metabolism that could also potentially interact. (for instance, NAPQI itself is metabolized by glutathione, which it has been suggested kava can deplete...) So just knowing that, I think the only thing you could predict is that there could be an interaction, not whether the interaction would be "bad" or "good". And we actually know more than that because of this experiment where they found that kava aggravates the toxic effect of acetinophen in rat livers, meaning the same thing could possibly happen in human livers:
Yang, Xi, and William F. Salminen. "Kava extract, an herbal alternative for anxiety relief, potentiates acetaminophen-induced cytotoxicity in rat hepatic cells." Phytomedicine 18.7 (2011): 592-600.

So based on that I would still really recommend against the combination.
 
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Zaphod

Kava Lover
That's an awful lot of paracetamol/panadol/tylenol. If possible, I'd seek ibuprofen, naproxen, or even aspirin.

Be careful, get well soon.
I found that naproxen or ibuprofen work better for me than tylenol so I have dropped it altogether. Except for the time I really f'ed up my back those two have been able to take care of any issue I have had.
 

nabanga

Kava Enthusiast
Thanks for the replies and advice. I did end up taking 1000mg(standard adult dose from the packet instructions) para last night and this morning either side of a session, but will stop based on what you have said. 5 hours till the nakamal opens..


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SelfBiasResistor

Persist for Resistance!
That is an interesting point. It is true that CYP 2E1 is involved in the metabolism of both kava and acetaminophen (as well as another CYP enzyme) so you might think the effect would cancel out like that, but in both cases the situation is complex: there are other mechanisms/second pass metabolism that could also potentially interact. (for instance, NAPQI itself is metabolized by glutathione, which it has been suggested kava can deplete...) So just knowing that, I think the only thing you could predict is that there could be an interaction, not whether the interaction would be "bad" or "good". And we actually know more than that because of this experiment where they found that kava aggravates the toxic effect of acetinophen in rat livers, meaning the same thing could possibly happen in human livers:
Yang, Xi, and William F. Salminen. "Kava extract, an herbal alternative for anxiety relief, potentiates acetaminophen-induced cytotoxicity in rat hepatic cells." Phytomedicine 18.7 (2011): 592-600.

So based on that I would still really recommend against the combination.
It is a complex process with other variables. Clearly glutathione is absolutely critical in detoxing NAPQI which is why I always try to take NAC with anything containing acetaminophen (avoiding it whenever possible). If a water extracted kava beverage increases GSH levels enough to compensate for the reduction caused by KLs then it seems like there should be much less alarm around the interaction of the two compared to someone taking isolated KL extracts.

With that in mind, I'm really starting to wonder if it really is a good thing for the pharmaceutical companies to begin production of medicinal extracts without investing in a great deal of research to ensure that they will be made and administered safely and not cause more deaths, panic and bans.
 

SelfBiasResistor

Persist for Resistance!
I found that naproxen or ibuprofen work better for me than tylenol so I have dropped it altogether. Except for the time I really f'ed up my back those two have been able to take care of any issue I have had.
I've never really experienced Tylenol to be a very good pain reliever but added to NSAIDs, it seems to help a little. The bad thing is that it has the reputation of being very safe when it is in fact very dangerous for the benefit it provides and is added to so many OTC drugs. The vast majority of my Tylenol intake comes from prescription pain pills where I don't really feel like it adds any benefit. Fortunately we still have legal access to another herb that allows me to avoid it the majority of the time.
 
N

Nobody

I'm really late to this party, but just to put it out there, 1000 mg paracetamol every 4 hours would be a toxic dose. 4 grams (4000 mg) per day maximum.
 
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