A question for the doctors: how many Tylenol can I take?

[rduncan]

As the title says. I have two long rides coming up this year. One 240 and another 320. I’m anticipating back pain and was thinking Tylenol may assist. How many and how often would be a good amount?

Thanks in advance.

[Claire]

Hi. I'm almost a doctor and happen to have good knowledge of Tylenol dosing. You can take up to 1000mg (that's one gram) at a time, up to four times in a 24hr period. So a max of four grams/24hrs. You can also take whatever the daily dose of Advil/ibuprofen is concurrently, if you're so inclined.

[Claire]

* by "almost" I mean I hang around doctors a fair bit and have seen this amount prescribed countless times. But I'm really just a nerd with a fascination with all things medical. I believe there may be issues with taking Advil and high-intensity exercise, so stay away from that combination unless someone with actual medical training says otherwise.

[rduncan]

Awesome. Thanks Claire! How long does it take to kick in? I’m wondering if I should take it preemptively or just when pain shows up.

[Alan]

I am not a doctor, though I think George Clooney played one on TV, nor would I ever give prescribing advice but you should know that, like any drug there is a dose-response related to ibuprofen that can influence its toxicity. Health Canada and numerous other drug regulators around the world have issued drug safety warnings related to ibuprofen as well as other non-steroidal anti-inflammatory drugs.

http://healthycanadians.gc.ca/recall-al ... 5a-eng.php
https://www.fda.gov/drugs/drug-safety-a ... flammatory

I am not sure where Claire came up with the 4000 mg per day but Health Canada says that oral ibuprofen taken at high doses (at or above 2400 mg per day) increases the risk of heart attack and stroke.

Now a highly athletic guy like yourself using lots of ibuprofen to get through a few long rides is unlikely to increase your risk of anything, but the principle of drug safety is simple: don't use the highest dose you think (and hope) is safe; use the lowest dose, for the shortest period of time that is effective for you.

[rduncan]

Thanks Alan, super helpful.

I've heard (but haven't researched) that Ibuprofen impacts performance so I'll be staying away from that but apparently Tylenol is a blood thinner (which supposedly aids in performance) and also acts as a pain killer. Claire was talking about Tylenol not Ibuprofen.

[JTyre]

(I'm a doctor but not the variety you need.)

I often have back issues on long rides (> 100 km). Sometimes I take IBU preventively, sometimes as-needed, and sometimes not at all. For me, IBU is probably more a crutch than anything else. It certainly does not stop the pain, and may not even diminish it. To know that, my doppelgänger would have to ride beside me as a control. Anyways for the reasons that Alan mentioned, I suggest staying away from IBU all together.

As far as acetaminophen is concerned, Claire appears correct on the maximum daily dosage for an adult (i.e. 4000 mg). But from what I can find out on the internet, Alan is also correct. It's wise to stay under the maximum daily dosage (say 3000 mg total).

Finally, one thing I learnt from long distance triathlon training, never try anything out for the first time on race day.

Nice riding with and behind you yesterday,
John

[Rolf]

Hi Rob. I'm almost a lawyer and happen to have good knowledge of really very little—next to nothing, actually.

But one way to avoid the back pain you anticipate would be to ride fewer kilometers.

As much as I love our dear forum, I'll suggest it's maybe not the best place to seek this kind of information. Without proper qualification and a competent investigation of your personal health circumstances, nobody can ethically give you the answer you seek. If any (actually-licensed) physicians pipe up on here with a definitive answer for you, they may need to review some of the College's related utterings...

But by all means keep listening to our caring friends/charlatans—or just read the first related Google search result (carefully bought and paid for by "Harvard Health Publishing"), cuz your doctor's probably going to be wrong anyway, right?

[JTyre]

But by all means keep listening to our caring friends/charlatans.

Did you just call me a charlatan, Rolfy? Lets take this over to the TSCX Subforum,

[rduncan]

Way to get all Lawyery on me Rolf.

Sheesh.

Anyways. I was actually wondering about cocaine. Surely someone can give me good advise on whether its a useful performance enhancer.

[Bosie]

Im a doctor who prescribes these things :

My 2 cents- just for information and a word of caution:

You can safely take 4g of Tylenol a day without any issues. You can probably take more, but you may run into issues with your liver. This is highly unlikely though in a fit healthy person with a good metabolism. Im not going to give anyone advice to take more than 4g, but I myself, being bigger than most have, on occasion taken more. Acetaminophen may even offer a legal modest performance enhancing effect if taken before exercise according to some studies.

NSAIDS are a different story (Ibuprofen, Naproxen, Ketoralac etc.).
These are anti inflammatories and are probably more effective for musculoskeletal pain than Tylenol. The max suggested dose is 400mg 8 hrly for Ibuprofen (but I know an anesthesiologist who takes 600mg occasionally with 1.5g of tylenol for headaches to get on top of them and he hasnt had any side effect yet that I know of:)). He does not go riding his bike after taking these doses though.
IN general for "day to day" severe musculoskeltal pain, Id take the two drugs together, on a regimented dosing regime of tylenol 1g q6hrly and Ibuprofen 400mg q 8 hrly.

BUT...NSAIDS have nasty effects on the kidneys and can contribute to acute renal failure and even cause it in high doses! In the circumstances of ultra endurance events where rabdomyolysis (break down of muscles into renal toxic proteins) is a possiblity and acute renal failure secondary to that is a risk, Id be VERY careful of NSAIDs personally. I would maybe take one dose in a crisis, but Id probably avoid them altogether in that setting.
So for an ultra endurance event, if it was me, Id take a tylenol if I needed it, but Id avoid NSAIDS altogether. Get a massage. Live with the back pain and if it got too much, pull out. Acute renal failure is no joke.....

I should add that this is posted purely for information and is not intended to be advice, just a perspective.

For professional advice Rob should seek advice from his own health care provider who knows him and his medical history and can offer more appropriate guidance than the forum:)

[Rolf]

I should add that this is posted purely for information and is not intended to be advice, just a perspective.

For professional advice Rob should seek advice from his own health care provider who knows him and his medical history and can offer more appropriate guidance than the forum:)

Shall we parse the difference between advice and a perspective? Glad you added this, Craig.

See, after all that scary stuff about failing renals you should just stick with blow, Rob. Or methamphetamine. (They don't call it speed for nothin'.)

[rduncan]

Thank you Craig. I’ll need to consult my legal counsel to determine whether your “perspective” should be taken as valid information worth acting on.

Rolf as for the meth and other substances which clearly are mined from the renal cavities of Satan himself, I’ll be following my role model Nancy Regan and just saying no.

But seriously. Thank you Craig and Claire. Very helpful.

[John D]

To quote Mark Shepard from a few years ago, "I prefer IPA" to IBU (or EPO for that matter).

As for the other "hard stuff", I find it hard to joke about given the current opioid epidemic in Victoria.

JD

[Andrew]

4g a day means per 24 hours and not every day. I limited safe use to 3g per day. There are 475 medications in Canada that contain acetaminophen which frequently is a contributor to inadvertent overdose and severe and often fatal liver toxicity. Acetaminophen and alcohol don’t mix (no more than 3 drinks per day) and pediatric doses are much lower.

[GarthC]

Hi Rob,

Back when I ran, I knew of one guy that almost died from acute renal failure and heard of others that had the same experience.
They were taking NSAIDS (not sure the doses) to get them through their ultra marathon running events.

Bosie describes below really well what happens if you take too high of doses while participating in a ultra event (I think it goes for both running and cycling). This scare me enough not to take any during a long ultra event.

"BUT...NSAIDS have nasty effects on the kidneys and can contribute to acute renal failure and even cause it in high doses! In the circumstances of ultra endurance events where rabdomyolysis (break down of muscles into renal toxic proteins) is a possiblity and acute renal failure secondary to that is a risk, Id be VERY careful of NSAIDs personally. I would maybe take one dose in a crisis, but Id probably avoid them altogether in that setting.
So for an ultra endurance event, if it was me, Id take a tylenol if I needed it, but Id avoid NSAIDS altogether. Get a massage. Live with the back pain and if it got too much, pull out. Acute renal failure is no joke....."

[Chris Watt]

Rob - I'm a doc AND have occasional low back pain on really long rides (12-14 hours daily for 27 days ina row on the GDMBR last summer) so I empathize...the better question isn't what/how much pills should you take but rather "what's the best way to prevent/manage back pain on long rides?" And it probably ain't pills but building up your core strength/endurance. Especially your posterior core chain- all the supporting the muscles that run from the base of your skull down to your achilles tendon and keep you upright against gravity.

Simple test of bike-specific core strength (taught to me by some bike-fit guru): somewhere safe (or better, on your trainer), start riding in your usual position- then, keeping that forward position, take your hands off the bars and ride with your hands at your side. Time yourself. Can you go 2-3 minutes no problem?- congrats, you're core strength animal. Less? Opportunity improvement!

One of the best exercises I've found to help with post. core strength endurance is foundation training- try this simple but incredibly effective 12-minute exercise in graduated torture: https://www.youtube.com/watch?v=4BOTvaRaDjI
Do every day for at least 90 days- start with a couple of minutes daily the increase based on next-day soreness. No soreness? Bump it up another minute or two.

Caution: this is easy to screw up so listen to the very specific verbal cues and watch the two dudes doing it- by the end they're in a world of (beneficial) pain.

Leave the pills at home- you can't out-drug a weak core. Good luck with the rides.

- Chris
PS. You've prob done this already but maybe get a bike fit AND check for leg-length discrepancies- if your butt wiggles from behind while pedalling you've prob got a short leg- and simple lift should fix that.

[Bosie]

Chris' answer is, IMHO, the best.

[rduncan]

Super helpful Chris. The great divide is quite an undertaking.

I hear you re: core development. Over the Past year back strength has improved considerably due to ashtanga yoga. I do have a leg discrepancy of 5/8” (due to a broken femur) which has been somewhat compensated for with my bike fit. It’s not that I’m relying on drugs but rather I know that things will eventually hurt like hell on a longer ride so I’m anticipating the need for drugs. The goal is to be completely drug free.

1.5 years ago I couldn’t put on my socks or bend over to put my boots on without grimacing in pain and multiple ibuprofen was my daily reality. I lived that way for years and thought that’s how I’d be the rest of my life until I found a good chiro who got me pain free in 4 months. That’s when cycling started. Prior to that there was no way I could ride a bike. Riding made me realize how weak my core was so that let to ashtanga.

I still have days where I’m laid up in pain and twingy as hell but my daily pain is a distant memory. I still am in a bit of shock that it was a simple shift in belief that allowed the transformation and I’m grateful to be where I’m at now. It’s been a focus on slow progression and trust in my body that’s brought me here and i still have a ways to go to get my core to the level it needs to be.

In the meantime I’ll be using crack to help me through. Um. I mean Tylenol.

[Chris Watt]

Rob- I love resurrection tales like yours; I bow deeply to your stubborn-ass, knuckle-headed persistence. Where the mind goes the body frequently follows. For worse- or better. Keep us posted on your hero's journey.