What is L484?

L484 is a white capsule shaped pill that is commonly available as an over the counter medicine without prescription. It contains acetaminophen 500 mg as an active agent and has anti-pyretic and analgesic effect. L484 is manufactured by Kroger Company. Other brands of this drug include Tylenol, panadol, etc.

Acetaminophen has two different mechanism of action for relieving pain and helping in lowering the temperature of the body. Its analgesic action comes through inhibition of nitric oxide pathway. Nitric oxide pathway is mediated by release of many neurotransmitters mainly substance P and N-methyl-D aspartate. When nitric oxide pathway is inhibited there is minimal release of pain mediating neurotransmitters so pain is relieved. Anti-pyretic action of Acetaminophen is brought into action by inhibition of prostaglandins which are pyrogen and effect on hypothalamus.

After oral administration of L484 tablet almost 90% is absorbed through small intestine and peak plasma concentration is reached within 90 minutes of administration. Half life of L484 is around 3 hours and is metabolized in the liver. Metabolism of the drug occurs either through conjugation (with glucuronide or sulphate) or oxidation through p450 cytochrome pathway. It is minimally secreted in the breast milk and therefore can be used in safely in lactating mothers as an analgesic.

L484 is a safe and effective analgesic that can be used in a variety of medical conditions that need pain relief. It has fewer side effects and is better tolerated than non-steroidal anti inflammatory drugs in patients with acid reflux disease. Even on long term use L484 has minimal chances of gastric erosion and ulceration. The only thing to be kept in mind is that it is extremely hepato toxic drug at high doses and may result in liver failure. Patients who have underlying liver disease and who abuse alcohols are at particularly higher risk of sever liver damage and should not use this medication. To avoid serious side effects L484 should be used in prescribed doses for the duration advised by the doctor.


What is this medicine for?

L484 is used as an analgesic in the management of mild to moderate pain arising from muscles, joints and ligaments as well as common headache. L484 is effective in relieving pain in the following conditions,

  • Headache: L484 is a common remedy for headaches of all types including migraine, tension headache, cluster headache and headache arising in association with fever and other ailments. Two tablets of L484 are sufficient to abort an attack of mild headache. For severe headache frequent doses may need to be taken and in severe cases other painkillers are also added.
  • Joint pain: L484 is effective in relieving pain of osteoarthritis of knees, shoulder, ankle, wrist and other joints. Mild joint pain in rheumatoid arthritis, systemic lupus erythmatosis, sero-negative arthritis (reactive arthritis, psoriatic arthritis, etc) is also ameliorated with acetaminophen. Acetaminophen combinations with opioid analgesics are often more effective. At usual dosages, L484 is a safe drug that can be used on short term, long-term and on as needed basis
  • Myalgias body aches or muscular aches: L484 is used to relieve body aches or myalgias associated with flue, pneumonia and other viral, bacterial and protozoal diseases.
  • Backache: both acute and chronic back ache is an indication to use of L484. Mild to moderate backache is often relieved with administration of L484 either alone or with anti-spasmodics like orphenadrine and tizanindine.
  • Flu and common cold
  • Menstrual cramping
  • Toothache, earache
  • Ligament sprain for example ankle sprain
  • L484 is also an effective remedy for relieving fever and is used for management of fever in infection, connective tissue disorders, cancer, stroke and others. The beauty of the drug is that at usual prescribed dosages, it is generally safe and devoid of side effects. It has more gastric safety and unlike non-steroidal anti-inflammatory drugs, can be used off and on without side effects of gastric erosion and ulcers.

Above mentioned are some of the conditions where L484 can provide effective pain relief. In addition, it is also prescribed in a number of other conditions by the doctors

Side effects on L484

L484 is a safe drug at prescribed dosage and only a few people experience side effects with its uses. Side effects particularly appear on over dosage and in patients who have underlying liver damage. Children, elderly population, alcoholics and patient with liver damage should use this drug carefully and avoid over dosage to prevent serious side effect of liver failure that may necessitate liver transplantation. The most common side effects that appear on using L484 include,

  • Nausea
  • Vomiting
  • Gastric disturbance although minimal as compared to non steroidal anti-inflammatory drugs but still using L484 on long term basis and at high doses may cause acid peptic disease and reflux. To avoid gastric disturbance L484 should be taken at minimum possible doses and after meals.
  • Constipation or diarrhea is not common but some patient may experience these side effects too
  • Sedation/drowsiness may appear in some patients who use L484 and are particularly evident in initial days of its use.
  • Drug induced hepatitis and acute liver failure: at usually dosage L484 does not cause significant liver damage but symptoms of jaundice and liver damage may appear on over dosage of drug and patients with underlying liver diseases. Patients having cirrhosis of liver and at risk of hepatic encephalopathy should not use L484 otherwise tilt of balance may be towards overt liver failure
  • Analgesic abuse nephropathy is one side effect that appears on taking L484 for prolonged period of time on high doses. Analgesic abuse nephropathy may cause renal damage and in severe cases renal failure may occur.
  • There is no addiction potential for L484 and patient who use this drug for longer period even don’t experience drug dependence or drug addiction.

Above mentioned side effects are those which are most common but any patient using L484 who develops any new symptoms related to any body system should contact his doctor.

Precautions on L484

Use of L484 in some medical conditions may produce untoward side effects like wise if it is used concomitantly with some drugs, may result in some unfavorable effects or even serious outcomes. Before starting L484, patient should be asked about some medical conditions. If he or she is suffering from any of the below mentioned medical conditions, use of L484 is not safe,

Previous known allergy to acetaminophen, food allergy or other drug allergy

Pregnant and breast feeding women should use it carefully especially if they have underlying liver disease. Although it is secreted in up to 2% in breast milk still, it should be used in minimum possible dose in both conditions.

Binge drinking or more than three alcoholic drinks per day; if someone abuses alcohol then he should use L484 in minimal doses and preferable avoid its use. Acetaminophen is metabolized through liver when liver is damaged with binge drinking the chances of liver injury increase with use of acetaminophen.

Extreme of ages: children less than 12 years and people with age more than 60 years should use L484 should use L484 carefully as chances of over dosage are greater in this specified population.

Acetaminophen although is safer than non-steroidal anti-inflammatory drugs still its use in acid peptic disease and gastric ulcer should be done carefully.

Patient having liver disease especially marked liver damage should avoid using acetaminophen as it is metabolized through liver, when liver is damaged over dosage and adverse effect appear at even small dosage of acetaminophen.

Use of L484 with following drugs may cause drug interactions and adverse outcomes so patient should inform his or her doctor if taking any of the following medicines,

  • Acetazolamide and other Carbonic anhydrase inhibitors reduce effectiveness of L484 when used concommitantly
  • Corticosteroids, heparin, warfarin, ketoralac, SSRIs, NSAIDs and clopidogrel when used with acetaminophen increase chances of bleeding
  • Side effects of theophylline, valproic acid, insulin, oral hypoglycemic agent, ciprofloxacin and methotrexate are increased when used together with L484
  • Effectiveness of probenicid and sulfinpyrazone is reduced when used concomitantly with L484.

Conditions that are not suitable for L484 use

L484 or acetaminophen is generally a safe remedy for mild to moderate pain management but it has got some contraindications. Below listed conditions are not suitable for use of L484,

  • Known allergy to acetaminophen: even mild allergic symptoms appeared previously on using acetaminophen are harbinger of future severe anaphylactic reaction in the future if acetaminophen is used again. So it is absolutely contra-indicated if there is history of hypersensitive to this drug.
  • Children having influenza infection or chicken pox infection are not good candidate for uses of acetaminophen as it may result in severe liver damage if used in these conditions especially in very young children.
  • Liver disease especially with significant liver damage is a contraindication to use of acetaminophen. Patient having liver cirrhosis as a result of alcohol abuse, hepatitis B&C, hemochromatosis, alpha one anti-trypsin deficiency, should not use acetaminophen.
  • Binge drinking or more than three alcoholic drinks per day; if someone abuses then he should use L484 in minimal doses and preferable avoid its use. Acetaminophen is metabolized through liver when liver is damaged with binge drinking the chances of liver injury increase with use of acetaminophen.
  • Acute hepatitis and acute liver failure as a result of hepatitis B,C,A&E, fatty liver disease of pregnancy, aflatoxin toxicity, alcohol, mush room poisoning and other causes.
  • Use of acetaminophen in bleeding disorders like hemophilia and von willibrand disease as well as in low platelets is not fully safe.
  • Use of L484 with other drugs containing acetaminophen should not be done as chances of toxicity/over dosage and liver damage are increased. If patient is using any herbal medicine, prescribed and non-prescribed medicines should tell his or her doctor/pharmacist before using L484 so that possibility of interaction and liver damage can be excluded.
  • Analgesic abuse nephropathy and renal failure are the conditions in which dose of acetaminophen should be reduced so because drug excretion through the kidneys is impaired. Both these condition increase chances of drug toxicity and over dosage occur even at smaller dosage of the drugs which are safe in healthy people.

Allergy symptoms of L484

Allergy or hypersensitivity to L484 is a serious problem as with other drugs and patients who have allergy to other drugs and atopic disorders are more likely to have allergy to acetaminophen. Any allergic symptoms on using of L484 warrant urgent contact with emergency medical service to avoid any serious outcomes. Hypersensitivity may be mild or severe; mild hypersensitivity usually settles on discontinuing the drug but serious hypersensitivity may be life threatening.

Mild symptoms of allergy to L484

Symptoms of mild hypersensitivity to L484 include itching over the body, hives, redness of skin and swelling. In mild hypersensitivity no breathing problem and hypotension occurs. Symptoms usually settle on discontinuing the drug and use of anti-histamines proves beneficial in ameliorating the skin manifestations. Even a mild hypersensitivity reaction to L484 is a contraindication to its use in future.

Severe allergy symptoms of L484

Severe allergic reactions to L484 may be life threatening and appears within minutes to hours after using L484. Symptoms of anaphylaxis or severe allergy reaction to L484 include

  • Skin rash/redness of skin
  • Hives and urticaria
  • Angioedema symptoms like swelling of lips, throat, face and larynx that causes respiratory obstruction and patient is unable to breath in severe cases
  • Drowsiness leading to unconsciousness and coma
  • Pallor, cold and clammy skin with increased sweating
  • Increased heart rate and very low blood pressure
  • Decreased urine output

These symptoms of anaphylaxis need urgent management in medical emergency or intensive care unit otherwise patient may die. Management of severe hypersensitivity to L484 includes

  • Anti-histamine drugs
  • Intravenous steroids
  • Subcutaneous adrenaline injection
  • Maintaining the airway with endotracheal intubation or in case of severe laryngeal edema, trachestomy
  • Supportive measures like artificial respiration and cardiovascular support to treat hypotension.

All this management should be carried in intensive care or emergency setting and close monitoring of the patient should continue until symptoms are completely settled. Anaphylaxis to L484 is an absolute contraindication to its use in future.

Dosage of L484

L484 is a generally a safe drug however, it should only be used in prescribed dosage and duration. In adults usual starting dose of L484 is two tablets every 8 hours that can be increased to 2 tablets every 4-6 hours. Dose should not be exceeded to 12 tablets per 24 hours other wises serious side effects including liver damage may result. Dose of acetaminophen in children is 10 mg per kilogram of body weight per dose that can be repeated every 4-6 hours. Safe upper limit of the drug is much lower in children so extreme caution should be exercised while using L484 in children and only it should be used in prescribed dosage.

If a dose of L484 is missed

Missing a dose of L484 (acetaminophen) does not create problem; patient should take it as early as remembered. If the time for next dose is reached the usual next dose of the drug should be taken. No two doses of L484 should be taken together.

Over dosage of L484

Over dosage of L484 may occur if prescribed dosage is exceeded or drug is taken as a suicidal attempt. An adult taking more than 12 tablets of L484 and a child taking more than 5 doses at once should be admitted to hospital for management of over dosage. In case of suspected over dosage of the drug urgent contact with local poison control service or emergency medical service should be made. Symptoms of over dosage include nausea vomiting, retching, headache, jaundice (usually appears after 24 hours), confusion and coma. Patient may be completely asymptomatic after over dosage of L484 and only the strong suspicion of over dosage by the family may save the life of the patient.

Management of L484 over dosage

Management of L484 over dosage includes,

  1. Gastric lavage and administration of activated charcoal if patient reaches hospital in less than 4 hours and preferably in one hour may sufficiently reduce the chances of adverse effects.
  2. Administration of acetyl cystein and methionine as an antidote
  3. Supportive measure; glucose infusion, fresh frozen plasma
  4. Liver transplantation in case of acute liver failure

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