How does Tylenol relieve pain without making me drowsy?

How does Tylenol relieve pain without making me drowsy?

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So I have a crown that popped out and has been killing me, I've lived on a steady diet of Tylenol since it popped out. I've noticed that aside from killing most of the pain from the tooth, the tylenol hasn't made me particularly drowsy, which to my understanding was how most pain killers work. If it doesn't just put me to sleep, how does tylenol work to numb pain?

Opiate pain killers or pain killers that act on opioid receptors have a different mechanism of action than NSAIDs. They tend to act as receptor agonists which exert their effect on the CNS (oxycodone as an example). Opioid receptors are associated with analgesia, CNS depression, sedation, etc. Tylenol on the other hand is thought to exert its effect by downmodulating cyclooxygenase, and therefore inhibiting the production of prostaglandins like H2, which is a precursor to lots of pro-inflammatory compounds.

Surprising Tylenol Side Effects

Have you ever popped a Tylenol to push through that annoying headache and get on with your day? Most of us have. Each week, millions of Americans take one of the 600 medicines that contain acetaminophen, Tylenol’s active ingredient, for various aches and pains. Acetaminophen is the most common drug ingredient in the US, but this ‘harmless drug’ is linked to over 110,000 injuries and deaths per year.

How can Tylenol, which is doled out like candy, be bad for you? Amazingly, no one really knows how acetaminophen works 1 , but people do know that this drug gets to your brain. Tylenol in your brain is concerning because it depletes glutathione 2 , an antioxidant that is especially necessary for brain health. Our bodies depend on antioxidants to balance oxidative damage and inflammation. If you’re popping a Tylenol with your morning antioxidant-rich KB Smoothie, Tylenol may rob you of the smoothie’s benefits!

Tylenol Side Effects: Beyond Liver Damage

Most people have heard that Tylenol can damage the liver (has anyone ever drunkenly warned you to take a Motrin, not a Tylenol, to prevent a hangover?). But since everything in our bodies is connected, it’s not surprising that Tylenol can do damage beyond your liver. A recent study showed that people who took Tylenol had increased risks of death, heart toxicity, gastrointestinal bleeding, and kidney damage 3 . Importantly, people who took more Tylenol suffered more damage.

It’s also scary how Tylenol affects mood. After swallowing 1000 mg of Tylenol, people exhibited less empathy and blunted positive emotions. For reference, 1000 mg is two extra-strength Tylenol tablets, and the ‘safe’ range is 3000 mg per day. This means that popping two Tylenols can affect you physically and emotionally!

If you’re pregnant or looking to become pregnant, please be especially careful about taking Tylenol. Research has shown that children exposed to acetaminophen in the womb had behavioral, communication, and motor skill problems. Another study linked prenatal acetaminophen exposure with increased ADHD-like behaviors and medication use.

What about other painkillers?

Hopefully you’re convinced to think twice before taking a Tylenol, but what about other pain-relievers like Motrin, Aleve, or Advil? These non-steroidal anti-inflammatory drugs (NSAIDs) must be safe, since thirty million people take them every day! Not so fast…

Women who recognize the importance of hormonal balance should be wary. NSAIDs can mess with ovulation, especially progesterone levels, after only 10 days of use 4 . Additionally, NSAIDs injure the small intestine in one study, 71% of NSAID users showed small intestinal damage, compared to 10% of non-users 5 . Damaged intestines can lead to intestinal permeability, or “leaky gut.” Leaky gut has been linked to depression, ADHD, and allergies. NSAIDs can cause leaky gut 6 and harm your microbiome, the trillions of beneficial bacteria that live in and on us. Disrupting our bacteria can do more damage than we realize!

How can I relieve my headache?!

Now that you know the surprising dangers of Tylenol and other NSAIDs, what should you take for headaches and other aches and pains? Turmeric, the yellow root found in curry powder, contains a powerful anti-inflammatory and pain reliever called curcumin. This has been used in Ayurvedic and Chinese medicine as a treatment for pain, digestive disorders, and wound healing for centuries. Many studies show the beneficial effects of curcumin curcumin works as well as ibuprofen to alleviate pain from knee osteoarthritis 7 and PMS 8 . Next time you have a headache, try 1-2 grams of curcumin – or a turmeric latte!

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7 ways to fix foot pain

Pain is a symptom common to many foot conditions, and pain medications can often help relieve foot pain. You also can try other approaches, either before resorting to pain relievers or in conjunction with them. For example, you can try an ice pack or a warm foot soak before reaching for the pain pills.

In general, if your skin feels warm to the touch (indicating that your foot is inflamed and possibly swollen), apply ice. Don't apply warmth to an inflamed area because it will only increase the blood flow and make the inflammation worse.

If your feet are tired and sore and your skin feels normal or cool to the touch, try soaking your feet in a warm bath to relax and soothe them. Pharmacies sell gel packs that you can either freeze or heat in the microwave, then apply to your feet. You can also try massage (see "Foot massage," below). Gently rubbing sore muscles and joints can often provide needed relief. But don't massage a foot that is inflamed or that you think might be injured.

Foot massage

When you think of massage, you may think of a neck or back rub. But your feet also benefit from a regular rubdown. And you may even be able to do it yourself. Massage improves circulation, stimulates muscles, reduces tension, and often alleviates pain. It also provides a time for you to examine your feet, giving you the chance to notice a problem before it gets worse. To do a massage:

  • Sit in a comfortable chair. Bend your left leg and rest your left foot gently on your right thigh.
  • Pour some skin lotion or oil into your hand. Rub it gently into your foot and massage your whole foot — toes, arch, and heel.
  • Do a deeper massage. Press the knuckles of your right hand into your left foot. Knead your foot as you would bread. Or work the skin and muscles by holding a foot with both hands and pressing your thumbs into the skin.
  • Using your hands, pull the toes back and forth or apart. This gently stretches the muscles underneath.
  • Repeat on the other foot.

To enhance your massage, you can buy massage devices in local drugstores or health stores. Look for foot rollers these can provide fast foot massages at home or at work — take off your shoes and roll your feet over the massagers for a quick pick-me-up.

When it comes to pharmaceutical treatment, there are a number of different options. Some medications are topical — that is, you apply them to the skin. Others are systemic these are usually taken in pill form. A summary of the major categories of pain relief medications follows.

1. Oral analgesics. This class of medications encompasses pain relievers, such as acetaminophen (Tylenol), which relieve pain without relieving inflammation. Be sure to follow directions because taking too much acetaminophen can cause liver failure.

2. Topical analgesics. Topical pain medications are available in lotion, cream, or gel form. They are spread on the skin and penetrate inward to relieve some forms of mild foot pain. Some topical preparations — such as those containing menthol, eucalyptus oil, or turpentine oil — reduce pain by distracting the nerves with a different type of sensation. Another group delivers salicylates (the same ingredient as in aspirin) through the skin. A third group counters a chemical known as substance P, which is a neurotransmitter that appears to transmit pain signals to the brain. These creams contain a derivative of a natural ingredient found in cayenne pepper. For that reason, they may burn or sting when first used.

3. Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are available both with and without a prescription. Popular over-the-counter NSAIDs include aspirin (Bayer, Bufferin, others), ibuprofen (Advil, Motrin, others), and naproxen (Aleve). If you are taking an NSAID solely to relieve pain, expect to take a low dosage for a limited amount of time — usually until the pain is gone. If you have a condition that involves inflammation as well as pain, such as Achilles' tendinitis or a sprain, your doctor may advise you to take an NSAID at a higher dose and for a longer period, sometimes as much as several weeks. Why the difference? You can feel the pain-relieving effects of NSAIDs almost immediately, but you do not experience the full anti-inflammatory effects until a sufficient amount of the medication builds up in your bloodstream. Be aware that NSAID medications have a variety of side effects, so it is important to discuss your personal health risks with your doctor when considering their regular use.

If these over-the-counter options don't solve your foot pain problems, your doctor can prescribe a variety of prescription medication and treatment options, as described below.

4. COX-2 inhibitor. A type of prescription NSAID known as a COX-2 inhibitor — such as celecoxib (Celebrex) — relieves pain and inflammation and may reduce the risk for gastric ulcers and bleeding, which sometimes make older NSAIDs difficult to tolerate. COX-2 inhibitors have their own side effects, though, so it is important to discuss your personal health risks with your doctor when considering the long-term use of these medications.

5. Nerve pain medications. Pain caused by nerve damage (neuropathy) may not respond well to acetaminophen or NSAIDs. Three commonly prescribed medications for neuropathy are amitriptyline (Elavil), gabapentin (Neurontin), and pregabalin (Lyrica).

6. Nerve blocks. A nerve block is an injection that numbs a particular nerve to prevent pain signals from reaching your brain (much as lidocaine does in a dentist's office). It's effective for severe pain or for use during a surgical procedure.

7. Corticosteroids. These medications are synthetic forms of naturally occurring hormones produced by the adrenal glands. Corticosteroids may be given in the form of pills or injections to decrease inflammation and thus relieve pain. Topical corticosteroids, applied directly to the skin, are useful only in treating rashes, not for pain due to musculoskeletal injuries.

For more information on caring for your feet, buy Healthy Feet: Preventing and treating common foot problems, a Special Health Report from Harvard Medical School.

There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.

Most spiders in the United States are harmless however, black widow and brown recluse spider bites may need medical treatment. Symptoms of a harmless spider bite generally include pain, redness, and irritation. Signs and symptoms of black widow spider bite include pain immediately, redness, burning, and swelling at the site of the bite. Sometimes the person will feel a pinprick or double fang marks. Brown recluse spider bite symptoms and signs are a mild sting, followed by severe pain and local redness. These symptoms usually develop within eight hours or more after the bite. Black widow and brown recluse spider bites have similar symptoms, for example, nausea, vomiting, fever, headache, and abdominal or joint pain. Generally, brown recluse and black widow spider bites need immediate medical treatment. If you think that you or someone you know has been bitten by a brown recluse or black widow spider, go to your nearest Urgent Care or Emergency Department for medical treatment.

Risks: Overdose, Addiction, Victimization

Opiates come with multiple risks, some medical, some not.

Overdose can be fatal. It's sometimes the result of people taking an extra dose because the first one didn't relieve their pain satisfactorily. The cognitive dysfunction (fibro fog) associated with FMS and ME/CFS may also make it hard for you to keep track of when you took medication and lead you to take more too soon.

Drug tolerance also contributes to your overdose risk. Many people who take opiates long term develop a tolerance, meaning the drug is not as effective for them as it once was. However, just because it takes more for you to feel the effect doesn't mean your body can actually handle more. It's important to always take opiates as directed.

Symptoms of Opiate Overdose

Symptoms of opiate overdose include:

  • Depressed level of consciousness (e.g., confusion, drowsiness, coma)
  • Slow and/or shallow breathing
  • Slow heart rate
  • Convulsions
  • Dizziness and/or fainting
  • Nausea
  • Vomiting
  • Constricted pupils
  • Cold, clammy skin

If you suspect you or someone else has overdosed on opiates, it's important to get emergency medical help right away.

Addiction is also a risk with opiates. This has gotten a lot of attention from law enforcement and media in recent years, which has made some doctors reluctant to prescribe opiates and makes some people worry about taking them.

However, some studies show that the risk of addiction is lower than commonly thought, and the greatest risk appears to be in people with a history of drug abuse and addiction  .

To address doctors' fears overprescribing potentially addictive drugs, the American Pain Society in 2009 published this paper: Guideline for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain.

With opiate abuse, overdose, and death rising across the country, the CDC in 2016 issued Guidelines for Prescribing Opioids for Chronic Pain to address the problems.

It's also possible that, over time, opiates may heighten pain. Some research suggests that opioid medications may lead to an increased sensitivity of some types of pain, similar to the way FMS amplifies pain signals. This effect is called opioid-induced hyperalgesia.

Because some people take opiates recreationally, possessing these drugs can make you the target of thieves. The more people who are aware that you possess these drugs, the more you may be at risk for victimization. You may want to use a drug safe, avoid throwing away pill bottles in garbage that's accessible by the public, and, if you get refills by mail, replace your mailbox with a locking one.

Is it safe to take acetaminophen daily for arthritis pain?

Question: I suffer from osteoarthritis. My doctor says I should keep exercising even though my joints hurt. He says it’s okay for me to take a pain medication like Tylenol in order to remain active. But I’ve read that Tylenol can damage my liver. What am I to do?

Answer: You are right to be concerned about medication safety. But your doctor’s also right that you need to be physically active. So how do you balance these seemingly competing objectives?

I posed your question to two specialists at Sunnybrook Health Sciences Centre: One is a surgeon who performs joint replacement operations and the other is an expert in drug safety.

Let’s start with the surgeon. Dr. Jeffery Gollish, Medical Director of Sunnybrook’s Holland Orthopaedic and Arthritic Centre, says he sees lots of people who feel the same way you do.

Many patients, he says, fear that exercise will lead to additional damage of their joints. The fact that it hurts when they move is taken as a sign that they are doing harm to themselves. And they worry medications that mask their pain will simply allow them to do even more harm.

“The issues of exercise and medication are two areas where the public has misconceptions,” says Dr. Gollish. “They think both are harmful. In fact, both are beneficial.”

Exercise, in general, is good and won’t harm the joints. “The only thing we tell people to stop doing is running – and avoiding any impact activity.”

Patients who are waiting for knee or hip replacement surgery need to keep up their strength and remain flexible, he adds. Patients in better shape tend to have smoother recoveries than those who are out of condition. “If people exercise before surgery, and maintain their flexibility, the likelihood is that their post-operative range of motion will also be better.” And, likewise, “the worse they are pre-op, the harder it is for them to get better post-op.”

At Sunnybrook’s Holland Centre, the assessment process for knee and hip surgery includes patient education about exercise. Indeed, even before patients are referred to a surgeon, they see a specially-trained Advance Practice Physiotherapist.

“The therapist spends time with them, assessing their problem and educating them on what they can do to help themselves from the standpoint of exercise, activity modification and over-the the counter non-prescription medications,” he explains.

“Our experience is that people are coming into the hospital much better prepared for surgery than they were before we adopted this approach… a decade ago.”

And, he says, if medication can relieve pain and enable patients to exercise, that is a good thing.

So let’s now address the safety issue of using drugs in this fashion. Acetaminophen, commonly known by the brand name Tylenol, tends to be the most recommended pain reliever for patients like you who have osteoarthritis. There is ample justification for choosing it, according to Dr. David Juurlink, head of Clinical Pharmacology and Toxicology at Sunnybrook.

“It is an exquisitely safe drug so long as you don’t take too much of it,” says Dr. Juurlink, who is also a researcher at the Institute for Clinical Evaluative Sciences.

“There is a reason why it’s been on the market for decades and is available in so many over-the-counter products.”

He says most patients can safely consume three or even four grams of acetaminophen day-after-day for long periods. “It is when you get to six, seven or eight grams a day that you get into trouble.”

An extra-strength tablet contains 500 milligrams.

“If you take two extra-strength tablets, three times a day, you are consuming a total of three grams a day,” he notes. “You can’t get liver damage from that amount.”

Furthermore, Dr. Juurlink says acetaminophen tends to result in fewer negative reactions than the alternative non-prescription pain relievers. For instance, regular use of non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen (Advil), naproxen (Aleve) and acetylsalicylic acid (Aspirin) – can damage the lining of the stomach, cause gastro-intestinal bleeding and lead to kidney problems.

(It’s important to mention that acetaminophen is a good pain and fever reliever, but it doesn’t have anti-inflammatory properties. If a patient has an inflammatory condition, such as Rheumatoid Arthritis, then acetaminophen won’t be their drug of choice.)

“The NSAIDs have more toxicities at recommended doses than acetaminophen,” he adds. “Put another way, if everyone who was taking acetaminophen became concerned about its safety and switched to an anti-inflammatory drug such as ibuprofen, we’d see a major increase in drug-related problems.”

Dr. Juurlink says, “people shouldn’t be afraid to take acetaminophen, provided they are mindful of the dose.”

That is a very important caveat. He warns that it’s fairly easy for people to unknowingly take too much acetaminophen in part because it is an extremely common ingredient in numerous over-the-counter products including many of the best-selling cold and flu remedies.

For patients who are already consuming three or four grams daily for pain control, they can quickly move into the danger zone simply by self-medicating for a cold or flu.

“The message for people who are taking acetaminophen regularly is check the ingredients on the other products they are using to make sure they don’t include more of it,” he advises.

So, to recap, the message from our Sunnybrook specialists is two-fold: Exercise is good for patients with osteoarthritis. And you can safely take acetaminophen so long as you’re mindful of the dose.

If you are still reluctant to take the pain reliever, that’s fine too, says Dr. Juurlink. “There are no rules that say people with pain have to take a drug for it. Some people choose to live with discomfort rather than risk taking medication. That is a personal choice, and I respect that. ”

Just don’t let the pain be a reason to forego physical activity.

Click here to download our Personal Health Navigator ebook for free.

Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families. His blog, Personal Health Navigator, is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Follow Paul on Twitter @epaultaylor.

Best First-Line Defense: Tylenol Regular Strength Tablets

When people approach Butler looking for an over-the-counter pain reliever, he says his first line of defense is acetaminophen. Acetaminophen can be useful for treating headaches, muscle aches, menstrual cramps, sore throats, cold symptoms, and fevers. It’s the active ingredient in a number of name-brand drugs (like Tylenol and DayQuil) and according to Butler, tends to present fewer side effects than some of its alternatives.

When seeking out OTC pain relievers, Butler says you’ll want to pay attention to the active ingredient, as well as its recommended and maximum doses. According to Butler, the recommended regular-strength dose for acetaminophen is 325 milligrams (mg). He recommends taking one to two tablets, as needed, every four hours. The maximum dose for acetaminophen is 3,000 mg per day—that’s about nine regular-strength tablets. To make dosing easy, Butler recommends looking for an OTC medication that offers the active ingredient at its recommended dose. Tylenol’s Regular-Strength Pain Reliever does exactly that, offering 325 mg of acetaminophen in each tablet.

If you have liver issues, Butler recommends consulting with your doctor before you take acetaminophen. They may instruct you to take a pain reliever with a different active ingredient, or they may recommend a lower maximum dose of acetaminophen.

Butler says that in many cases, there is no real difference between a name-brand pain reliever and its generic alternative. Often, when the active ingredients and doses are the same, the options are virtually interchangeable. For this reason, he recommends seeking out generic options whenever possible, as they tend to be less expensive than their name-brand counterparts.

The SteadyHealth team reacts

Period pains can have a profound impact on a woman's quality of life, but because they're not always taken seriously and because women who live with them may not have considered that their doctor can help, many women will simply try to treat them at home. Over-the-counter painkillers are often a feature in this treatment plan, and ibuprofen is a common choice. Indeed, were you to seek medical attention for menstrual cramps, your doctor is quite likely to suggest it to you — alongside birth control pills, pain relievers are the only scientifically-proven way to reduce menstrual pain.

It is important, however, to know how you can use ibuprofen responsibly, what the possible side effects are, and when it's time to let your doctor know about possible side effects you're experiencing.

What are the side effects of ibuprofen?

Side effects of NSAIDs like ibuprofen include:

  • Gastroinestinal — Nausea, vomiting, abdominal bloating (which menstruation will also cause), constipation, and diarrhea
  • Kidney — Water retention and other kidney problems, including in extreme cases kidney failure
  • Cardiovascular — heart palpitations, a higher blood pressure, thrombosis, and even congestive heart failure
  • Miscellaneous — Bleeding, Reye's syndrome, hives, and asthma attacks
  • Nervous system — Headache, insomnia, seizures, vertigo, and yes, fatigue

It is important to let your doctor know right away if you experience any worrying symptoms that may have been caused by any medication you are taking.

How long can you safely take ibuprofen?

Not everyone can safely take ibuprofen, and it's also important to be aware that the long-term use of this NSAID and others may increase your risk of heart attack or stroke, as well as internal bleeding and stomach ulcers. It's always a good idea to ask your doctor or pharmacist what pain reliever is best for you, making sure to provide them with important information about your health and any other medications you may be taking. If ibuprofen is generally considered safe for you, it's usually OK to take it on an over-the-counter basis without consulting your doctor for less than 10 days.

Should you experience any side effects or just be worried that the symptoms you are having may potentially be side effects, however, let your doctor know and quit taking the drug in the meantime. Yes, I'm aware that's the second time I've said that, but it matters. Given the number of people on the thread who reported feeling groggy, drowsy, fatigued, or tired after taking ibuprofen, this response was quite surprising:

"I thought something was wrong with me glad to hear it happens to others and it's normal."

Other people reporting the same side effect doesn't mean the side effect is harmless or normal! It just means that other people have experienced the same side effect.

Is it normal to feel tired during menstruation?

Extreme fatigue during periods can be a sign of iron deficiency anemia, often related to menorrhagia, which is abnormally heavy or prolonged menstrual bleeding. It can also point to hypothyroidism, and in some cases even menstrual dysphoric disorder, a severe kind of PMS that sits on the depressive spectrum. See your doctor if you feel extremely tired while menstruating, whether you take painkillers or not.

What else can I do to relieve menstrual pain?

If you experience annoying but non-debilitating menstrual pains and have decided you would like to try to manage it without painkillers, you can see if these things do the trick for you:

When you have opioid use disorder, your brain uses opioids to manage mood, pain and other sensations instead of the hormones naturally produced by your body. As a result, you become reliant on opioids to function normally, and if not present significant withdrawal symptoms can be experienced. Suboxone activates your opioid receptors so that your brain feels satisfied enough to stop causing withdrawal symptoms. Like other buprenorphine medicines, Suboxone has a “ceiling effect,” meaning its ability to cause euphoria becomes limited at a certain amount and increasing the dose won’t increase its effects. This effect helps patients stay safe as they work toward recovery.

Since your opioid receptors manage your pain sensations, activating them with Suboxone could relieve pain in some patients. The research that scientists have so far on Suboxone’s painkilling effects shows promise. Compared to other opioid painkillers, Suboxone could involve:

  • Less immune system suppression
  • Easier usage among seniors and patients with renal issues
  • Lower tolerance development
  • Better effectiveness with neuropathic pain
  • A lower ceiling effect for respiratory depression

Suboxone’s ceiling effect could also make it safer to take. The naloxone included in the medicine causes it to create unpleasant withdrawal effects when someone tries to inject it and blocks the effectiveness of other opioids. As a result, the patient has less temptation to misuse their medication. When someone needs to relieve pain with an opioid and has a history of addiction, this feature could protect them.

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Please note that this content is not intended as professional medical or healthcare advice and is not intended as a substitute for professional healthcare advice, or services from a qualified healthcare provider such as a physician, pediatrician or other professional familiar with your unique situation. This content is intended solely as a general product and educational aid. If you have any questions, please consult your physician or pharmacist.

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Last updated: April 30th, 2020.


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