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Pharmacy and Medications

Tylenol PM

10/28/2010

Question:

I have been taking tylenol pms for about 2 yours at nite about 2-3 tablets a nite do i need to worry that this has damaged my liver? And what can i get over the counter to help me sleep that i can take on a nitely basis that dosent have side effects?

Answer:

Thank you for contacting NetWellness. Insomnia is a common complaint. Some symptoms of insomnia are difficulty falling asleep, difficulty staying asleep, and difficulty with early morning awakening. Sometimes insomnia only lasts for a short time and can be easily managed. Persistent insomnia is more troublesome and can affect work, school, social relationships, and health.

Many conditions are associated with insomnia such as depression, anxiety, allergies, and pain. Much of the time, insomnia is simply the result of poor sleep habits. Maintaining a sleep diary for one to two weeks is a good way to start. Keeping track of sleep times, caffeine and alcohol ingestion, etc. may provide clues as to the cause of insomnia.

Behavioral changes are often all that's needed to improve sleep. By maintaining good sleep habits (sleep hygiene) the need for medication may be avoided. Good sleep hygiene includes:

1. Stick to a regular sleep schedule; exercise regularly.
2. Go to bed only when sleepy.
3. Put your worries away when you go to bed.
4. Do something relaxing and enjoyable before bedtime.
5. Make your bedroom quiet and comfortable.
6. Avoid large meals just before bedtime.
7. Use your bedroom only for sleep and sexual activity.
8. If you cannot sleep within 15 to 20 minutes, get up and go to another room. Return to bed only when drowsy.
9. Remove the clock from eyesight.
10. Do not nap during the day; if you must nap, limit it to 30 minutes in the early afternoon.
11. Avoid alcohol, nicotine, and caffeine use.
12. Avoid frequent use of sedatives.
13. Schedule outdoor time at the same time each day.
14. Have your pharmacist check your medications for potential sleep effects.
15. Avoid bright lights (e.g. from TV, computers, video games) before bed. Relaxation therapy and stimulus control therapy can also be tried for insomnia.

For the treatment of insomnia, long-term use of Tylenol PM (acetaminophen and diphenhydramine) is not recommend. There is little evidence that it improves insomnia, and it causes sedation and fatigue the next day. With that, taking Tylenol pm on a nightly basis may be putting extra strain on your liver. However, since there are other causes of liver damage (i.e. alcohol), there is no way to know if your liver has been affected solely from the Tylenol pm. I suggest that you work with your primary care provider to assess your liver functions via lab values.

Most medications, even over-the-counter medications, have side effects associated with their use. The above lifestyle modifications may be the best remedy to rid insomnia , but I suggest talking with your primary care provider to select a therapy that works best for you and to address your sleeping problems.

Shelley Otsuka, PharmD. Pharmacy Practice Resident, Martha Morehouse Internal Medicine

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Response by:

Sarah Hudson-DiSalle, PharmD, RPh
Specialty Practice Pharmacist of Outpatient Pharmacy
College of Medicine
The Ohio State University