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New worries over non-aspirin analgesics.


A 20-year study of factory workers in Switzerland links chronic use of phenacetin, a once-popular painkiller, to increased risks of high blood pressure, heart attacks and death from kidney disease, cancer and heart disease. Phenacetin - no longer available in many countries, including the United States - bears a strong chemical resemblance to acetaminophen, and some scientists say phenacetin's dangers hint at possible hidden risks for chronic users of its still-opular analgesic cousin.

In 1967, a team headed by Ulrich C. Dubach of the Medizinische UniversitatsPoliklinik in Basel, Switzerliand, began following 623 healthy female factory workers who regularly took phenacetin-based painkillers and 621 women who did not. The researchers had established that many factory workers, especially women, consumed large quantities of analgesics daily to dull work-related aches and pains.

Compared with phenacetin abstainers, the chronic phenacetin users went on to suffer 12.5 times more deaths from urologic or renal disease, 1.8 times more cancer deaths and 2.5 times more deaths from heart disease, the team reports in the Jan. 17 NEW ENGLAND JOURNAL OF MEDICINE. Phenacetin users, especially those taking high doses, also sustained roughly twice as many nonfatal heart attacks, strokes and heart failures.

In addition, the high-dose subgroup experienced a 2.5-fold increased risk of high blood pressure, compared with abstainers. Statistics indicate that this hypertension apparently accounted for about half" of the nonfatal heart disease effects seen among the phenacetin users, says the study's biostatistician, Bernard Rosner of Harvard Medical School in Boston.

Phenacetin's makers pulled the drug from all U.S. products - including many popular over-the-counter remedies when the FDA threatened in 1982 to ban the analgesic because of its link to kidney disease. In an editorial accompanying the new report, physician Paul D. Stolley says the Swiss data suggest that phenacetin's removal "is advisable in countries that still allow use of the drug." Dubach argues that phenacetin, like alcohol, "is not dangerous if you don't take it in large amounts."

Stolley, of the University of Pennsylvania School of Medicine in Philadelphia, contends the new findings should also raise a red flag on chronic use of acetaminophen. More than 130 FDA-approved drugs contain this related analgesic, including nonprescription products such as Tylenol, Anacin-3, Extra-Strength Excedrin and Comtrex. Acetaminophen's relationship to phenacetin raises a "fairly urgent" need to investigate its risks, both in animals and humans, Stolley says.

Epidemiologist Dale P Sandler of the National Institute of Environmental Health Sciences in Research Triangle Park, N.C., echoes that concern. Sandler, who uncovered phenacetin-like renal disease in chronic acetaminophen users (SN: 5/13/89, p.294), says phenacetin and acetaminophen may not work in an identical fashion, but "we suspect that they will."
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Title Annotation:phenacetin and acetaminophen
Author:Raloff, Janet
Publication:Science News
Date:Jan 19, 1991
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