Tylenol contraindication with GI bleed?

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The other day I was taking care of a patient admitted for rectal bleeding. He had a history of chronic pain and took an opiate and a separate dose of Tylenol. I called the doctor for orders for his home pain meds, and she said he can't have the Tylenol because of the bleeding. When I was reporting off to the next shift, the oncoming nurse echoed that.

I have no knowledge of this and can't find any contraindication or precautions in that setting. Can someone explain this to me? Thanks!

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Good question.

Acetaminophen (TYLENOL®) Safety Data

Tylenol's own site quotes studies that show that Tylenol doesn't cause GI irritation at therapeutic levels.

However, the study below seems to indicate that there is some risk of GI bleeding at high doses.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC128885/

Acetaminophen Side Effects | Ibuprofen GI Bleeding | Arthritis Today Magazine

Another important finding was that acetaminophen - long believed not to irritate the GI system - also can cause GI bleeding at very high doses.

Honestly, I wouldn't immediately associate Tylenol with a GI bleeder, either. If it was an NSAID, sure. But not Tylenol. And despite the second study, I'd think that'd be the exception, not the rule.

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Specializes in Complex pedi to LTC/SA & now a manager.

Is it possible since many clotting factors are produced by the liver and Tylenol at even moderate doses can be hepatotoxic, someone with chronic Tylenol use, rectal bleed and elevated liver enzymes would be at higher risk for continued GI bleed?

I recall some GI bleeds with a history of long term moderate to high dose Tylenol use (3000g/day back when max daily dose was 4000g/day) had clinically significant elevated liver enzymes. And a young adult Vicodin plus Tylenol (15 Vicodin ES plus 50 extra strength Tylenol 500 mg) overdose had started with signs of bleed & clotting issues at about 5hrs post ingestion. The hydrocodone was easily reversed with IV Narcan but mucomyst plus charcoal was a little more challenging to get on board as they fought the OG then NG tubes. Liver enzymes were climbing with the Tylenol level. I think this one ended up on the liver transplant list.

I know Tylenol is contraindicated with alcohol use or abuse due to the effects on the liver.

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JustBeachyNurse nailed it.

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Specializes in Complex pedi to LTC/SA & now a manager.
JustBeachyNurse nailed it.

Thank you. I was just thinking out loud.

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