(WebMD) 

The FDA has issued a warning to consumers about the use of benzocaine, the main ingredient in over-the-counter liquids and gels used to reduce teething pain in very young children.

Benzocaine is associated with a rare but serious condition called methemoglobinemia, which greatly reduces the amount of oxygen carried through the bloodstream. In the most severe cases, the condition can be life-threatening.

Benzocaine by various names

Benzocaine gels and liquids are sold under numerous brand names, including Anbesol, Hurricaine, Orajel, Baby Orajel, and Orabase, as well as store brands. It also is sold as lozenges and in spray solutions.

The products are used to treat pain caused by teething, canker sores, and irritation of the mouth and gums.

The FDA says methemoglobinemia has been reported with all strengths of benzocaine gels and liquids, including concentrations as low as 7.5%. The federal agency says most cases occur in children aged 2 or younger who were treated with a gel for teething discomfort.

The FDA says people who develop the condition may become pale or gray, become short of breath, feel fatigued, confused, and lightheaded. It also may cause a rapid heart rate.

Immediately seek medical help for symptoms

Signs and symptoms of a reaction to benzocaine usually appear within minutes to hours of using it. The FDA says adults should seek immediate medical attention if symptoms show up after using benzocaine.

The FDA says benzocaine products should not be given to children younger than age 2 unless under the supervision of a health care professional. The American Academy of Pediatrics recommends giving children with teething problems a teething ring that has been chilled in a refrigerator, or gently rubbing the child’s gums with a finger.

Adults who use benzocaine gels or liquids in the mouth should follow recommendations on the label of the product, which should be stored where it can’t be reached by children, the FDA says.

However, the FDA says labels of marketed benzocaine products do not, as of yet, contain warnings about the risks of methemoglobinemia.

The FDA offers these tips for parents:

* if benzocaine products are used, watch carefully for signs and symptoms of methemoglobinemia, including pale, gray, or blue-colored skin, lips, and nail beds. also, shortness of breath, fatigue, confusion, headache, lightheadedness, and rapid heart rate are symptoms of a reaction. if any symptoms occur, seek medical attention immediately.

* Keep in mind that problems caused by benzocaine can show up after a single administration of the product.

* Use benzocaine gels and liquids sparingly, and only when needed, and not more than four times a day.

* side effects should be reported immediately to the FDA Medwatch program.

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Acetaminophen — the main ingredient in medications such as Tylenol® — is the most widely used pain reliever. while generally considered safe when taken occasionally and in small doses, acute overdoses and chronic consumption of acetaminophen can cause liver toxicity.according to research, 50 percent of all acute liver failure in the United States is attributed to acetaminophen consumption. while many of these cases result from an overdose, even “correct dosage” may cause liver damage, liver failure and death. In the United States alone, approximately 56,000 liver injuries requiring emergency treatment, 26,000 hospitalizations and 458 deaths per year are attributed to acetaminophen consumption. The Food and Drug Administration (FDA) is considering measures to decrease the number of cases of unintentional and intentional overdose leading to liver injury, including limiting the maximum adult daily dose in both prescription and over-the-counter medications and improving labeling.Initial signs and symptoms of acetaminophen toxicity are nausea and vomiting, so it’s hard to identify it immediately. In some cases, liver toxicity may develop without symptoms.Risks of accidental overdosingOne of the main problems with this popular medication is how easy it is to overdose unintentionally. In addition to being the primary ingredient in Tylenol, acetaminophen is also contained in almost 200 brand name and generic products — from headache and backache pills to cold and flu remedies and sore throat medications — most of which are available over the counter.It’s not uncommon for a patient to take several over-the-counter medications — for pain and fever and then for a sore throat, cough and cold, multiplying the risk of overdosing. Combining prescription medications and over-the-counter medications containing acetaminophen also increases the risk. Inadvertent overdosing can also happen from Children’s Tylenol being given to children to relieve a fever over a period of several days.Fasting (not eating because of illness), alcohol consumption or genetic predisposition to liver problems also increases the risk of liver toxicity, although the patient may be taking the prescribed dose of the medication.Avoiding damageTo avoid liver damage from acetaminophen:• Do not take more than 1 gram (1,000 mg) of acetaminophen at once.• Do not exceed 4,000 mg of acetaminophen in 24 hours. (The FDA is considering reducing the adult maximum daily dose to 3,250 mg, and even further reducing the amount for chronic alcohol users.)• Always check to see if over-the-counter or prescription medications contain acetaminophen.• for children, do not exceed 10-15 mg/kg/dose of acetaminophen, and do not exceed five doses or 2.6 grams in 24 hoursDrug-free pain reliefPatients often rely on medications to treat acute and chronic pain, but they should always check with a healthcare provider first to see if safer options are available. Talk to your doctor of chiropractic or your primary provider about conservative, medication-free pain relief. Depending on your individual needs, the treatment plan may include spinal manipulation, mobilization or massage, as well as procedures such as electric stimulation, rehabilitative exercises, advice on nutrition, and suggestions for posture modification.Incorporating daily exercise and stretches into your lifestyle can also prove effective. Walking, yoga and meditation can be beneficial in relieving pain. during exercise, our bodies release endorphins into our system. these powerful hormone-like substances produced in the brain function as the body’s natural painkillers.Dr. Matt Smith is a member of the American Chiropractic Society. his columns appear monthly in the Saratogian. 

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