PSA: Don't take 4 packets of paracetamol in one day

American here: I know paracetamol is acetaminophen, but how much is a packet?

paracetamol packet
It looks like it's a sheet of 6-8 pills
https://www.nps.org.au/news/paracetamol-ibuprofen-combinations-for-acute-pain
according to the acetaminophen i've got at home, dangerous dosage is >4g per day. that means that if 4 packets was 20x that, each packet would be 20g, which, if they're normal 500mg pills, would be 40 pills per packet.
- you should stick to 3g a day if you’re overall a small person, some bottles will recommend this as the max to be safe
- And a maximum of 2g/day if you weigh under 50kg (which not a lot of people know).
Various countries limit painkillers to small packet sizes (e.g. 20 pills here in Germany) and pharmacies only hand them out one at a time, so you can't overdose as easily/spontaneously, either like the person in the post did due to pain, or for suicidal purposes.
It's not perfect protection, as you can just go to multiple pharmacies to buy multiple packets, but yeah, you will have to actually go do that and will get told at the pharmacy that you shouldn't take more, if you're not aware.
- Yikes! The use of the term "packet" was initially confusing to me. Here in the States it's not uncommon to see small packets of a single dose of over the counter medicines in gas stations and convenience stores for when you're not at home and something comes up. The directions for extra strength Tylenol are 2 every 6hrs (1000mg dose) not exceeding 3 doses per day.
  I was thinking "4 packets over 3 days, what's the big deal?"
- America... I remember seeing "value packs" of Tylenol containing 300 pills... that's their idea of freedom... to allow people the choice of slow and agonizing suicide by liver failure
Well, generally you're only supposed to take ~2 tablets at a time, so 10? 40 pills a day is 13,000mg of acetaminophen, or 20,000mg if they're extra strength.
That's, uh, bad. You're recommended to take under 4000mg per day, so that'd be a bit over a packet? Makes sense to me.
For the record, mixing two painkillers without consulting a doctor is also usually a bad idea but way fucking less of a bad idea than taking 13000mg of tylenol in a day. Afaik, acetaminophen with other stuff is probably fine but napoxen, ibuprofen, and aspirin all work roughly the same way and shouldn't be mixed.
- For the record, mixing two painkillers without consulting a doctor is also usually a bad idea but way fucking less of a bad idea than taking 13000mg of tylenol in a day.
  Basically, if something hurts so much that you might take enough paracetamol/acetaminophen to fuck with your liver then you yes, you should be under a doctor's care. That said, between my wife and me, we've had three or four doctors over the years all be very chill with the idea of alternating Tylenol and Ibuprofen after surgery or the like. I guess they work on such different chemical pathways that they don't have much interaction potential, and keeping under the daily dose of Tylenol in particular is incredibly important, as we've seen in this thread.
- Don't take my word for it but I think paracetamol and ibuprofen with added codeine can be taken together despite the double codeine as the amount they have is low enough that double is still safe.
  Check with a pharmacist first, dosages are going to vary and I am just some guy on the internet.
I don't think there's a standard size, but I know they sell them in packages of 3x10 where I live. Eating 4 full packets of those in a day would put you at 15 times the upper recommended daily dosage, for what it's worth, which is calculated slightly conservatively to not be lethal for any adults
- You can also often get high-strength pills for chronic pain that are 665mg instead of the regular 500mg.
Depends on the country I guess.
Here, a packet is 16 tablets of 500mg (acetaminophen) or 200mg (ibuprofen).
We're limited to 2 packets combined per purchase to reduce the chances of severe overdose.
Package dosing generally suggests 2 tablets per dose, with at least 4 hours between.
Or one tablet for children between 10 and 14.

Not "even paracetamol". ESPECIALLY paracetamol.

Tylenol/acetaminophen/paracetamol is both weak ass painkiller and really dangerous because the overdose line is low. Here they put it in synthetic opioid drugs, it doesn't help with pain but does make them more dangerous.

oh yea it isnt as good as other otc nsaids, like ibuprofen and naproxen, or aspirin. oh and that fake pseudoephedrine mimic(phenyleprine) for cogestion, they already said it has no effect whatsoever. its mostly the 1st generation antihistamines doing all the work for your sinuses when you have the cold anyways.
- isnt as good as other otc nsaids, like ibuprofen and naproxen, or aspirin
  The do different things. It all depends on the type of "pain".
It’s good at reducing fever
Opioids are fir suffering whereas acetaminophen is for pain signals. A combination of ibuprofen and acetaminophen have been demonstrated to be the most effective pain killer we currently have.
Pain and suffering are different things.
It might not get you high, but it absolutely does help actual pain when combined with opioids.

PSA: stupidity is dangerous

Yeah, how long until this idiot cooks this liver too?
Honestly, getting a liver transplant in a week is the most unbelievable part of this story.
- Happened to me. It was actually 6 days. Listed on a Friday, transplant was done the following Wednesday.
Someone didn't get a live because it was used for this dumbass
- People who make mistakes deserve to live too. Don't be like that. We've all done stupid shit, he just happened to kill his liver with this one.
Stupidity? The dude is living in constant pain from dental issues and was just trying to not suffer.
Desperation is not stupidity.
- It isn't "natural selection" when it was caused by systemic issues preventing the man from receiving adequate dental healthcare.

It's bizarre to me that someone can make it to adulthood without knowing that paracetamol specifically is no fucking joke.

People look up resources on them and see that the recommended max dose of ibuprofen is lower than paracetamol per day in weight of the active ingredient and stop reading.
They don't get to the part about how the effect per weight isn't the same. Or how damaging paracetamol can be for the liver if you take it regularly or go over the recommend limit. Heavy drinkers especially don't take into account the extra stress on their liver, which is a contributor to the 400-500 deaths it causes every year in the US alone.
Meanwhile ibuprofen makes you feel sick and want to vomit once you start to go over the recommended limit. And if you reach that stage, you basically just stay hydrated to keep your kidneys going and wait for it to pass. Since it usually takes another 2-3 times as much to for the severe effects to occur.
To quote Scrubs:
Dr. Cox: Did you just page me to ask me how much ibuprofen to give Mrs. Lenzner here?
Sunny: Well, I was worried it would exacerbate the patient's
Dr. Cox: It's ibuprofen! Here's what you do. When she wakes up, get her to open her mouth nice and wide, then get some of those ibuprofen pills in your hands and throw them at her. Whatever sticks in there, that's the correct dosage.
- And in the pilot episode, it was J.D. and regular strength Tylenol.
not everyone studies drugs
- there is a stark difference between "studies drugs" and "does the bare minimum research on the pharmaceuticals one puts into their body"
- It is absolutely imperative that you understand the safety profile of ANY substance entering your body.
- I was taught this as an actual child because it's so important and paracetamol is so common. It's nothing to do with "studying drugs".
I would say most people are like this. Knowing it's super dangerous in high doses is the minority because it's sold OTC and everyone knows and trusts it.

I mean this is just dumb. Like I’m sorry but this would happen with basically every medicine or drug. They aren’t made to be taken at higher doses than advised.

(Imagine you took 8 liters of beer per day for 3 days, you’d be half dead too.)

Moderation people…

You haven't seen the ridiculous quantities that some alcoholics will consume
- Tolerance is a different beast. But 8 liters of beer is ridiculous.
  Humans drink 2-3 liters a day. Of water.
- Paramedic here, once brought someone in who ended up having a blood alcohol of .64. Dude got to sober up in the ICU.
- On the medical board exams, you get questions talking about patients that drink pints or liters of liquor every day and you're expected to know all the various health problems that come with alcohol use disorder.

You know what else is stupid? Pain management in the US. I get that you need to be careful about addiction, but the idea that people should have to suffer pain because we're having a pain medication "reefer madness" spasm is idiocy.

The guy just kept taking them until his teeth stopped hurting. Why is the alternative that he just has to put up with being in pain?

The fact that the drug companies lied about the addictiveness of their product so doctors were handing them out like candy didn't help.
Yes it is. I have had, over my 40 years as migraineuse (they started in my teens) 5 intractable migraines. Meaning less than once every 5 years I get one that lasts days, I cannot eat or drink, just puke. I used to be able to go to my doctor and get shot up with opiates and Phenergan, so much of it, they would do one dose, come back later, another, another, another, until finally I would say "it still hurts but I don't care" and go home nodding like a junkie, sleep and wake up with no headache, and, importantly, NO desire for more drugs.
Now the opiates are not allowed because they didn't work. But nothing works on the status migraine. Now they give you a cold cocktail IV of some sort of Advil and nausea medicine and it doesn't work either, and costs $2,000 because it can only be done in the emergency room not the doctor office.
It's adding insult to injury. There has to be some way to make these available for acute situations at least.
- I worked with a middle-aged women once who had a variety of health problems - she wheeled an oxygen tank around the office with her - who told me she got a migraine during puberty and had had it ever since.
  My wife has gotten migraine with aura since her teens, but thankfully only once every couple of months, and they tapered off to a couple times a year when she hit around 40. Her mom was opposed to allopathic medicine, so my wife never got anything stronger than sugar pills. They were bad; she'd last in bed crying and screaming, if she wasn't at the toilet dry-heaving.
  Sometime after we married, she started trying all of the various migraine meds, like Imitrex; nothing worked reliably after the first couple of times, and now she keeps Vicodin in her purse. She uses, maybe, 20mg once every couple of months, and it mostly does like you say: she says it still hurts some, but she doesn't care.
  I will hurt the person who tries to take that from her.
We have never had good pain management here. Claiming babies can't feel pain, black people hace higher pain tolerance, etc etc. then we swung into really permissive use with oxycodone for a while.
Yeah, I've dealt with massive tooth pain before. Given a choice between going through a week of that pain, and maybe killing myself with pills, I'll take my chances with the pills.

Is this real? Who gets a liver donor in 4 days?

The liver damage is very believable but a liver transplant after 4 days is absurd.
Or even need a liver transplant in this situation.
The liver heals itself so removing the paracetamol that caused the failure would allow the liver to begin that healing process.
- Four packs of Paracetamol will fuck up your liver beyond repair. Downing a blisterpack in one go can already kill you, let alone four.
- No organ magically heals itself, you're not Wolverine. Liver damage is permanent, any dosage over 4 grams of paracetamol per 24 hours (typically four doses of two 500mg tablets) can cause liver damage. Let the damage accumulate, and you'll go into liver failure. If the liver fails, you'll have to hope you're lucky enough to get a donor, or you'll be counting down hours left in your life. Take good care of your body and be healthy, your older self will thank you.

I think what's extra dangerous about Tylenol is that it doesnt feel like it's doing anything. When it works, some minor pain goes away, or maybe your fever goes down. But there's no side effects that you really feel, so I bet people get a false sense of security with it. Like, oh it isn't giving me opioid euphoria, or knocking me out. And you can just buy as much as you want, no restrictions. It must be perfectly safe.

Nothing is perfectly safe. You can kill yourself with water poisoning, and that's pumped directly into your house.
Tylenol: that's a brand of paracetamol for non US people.
I think paracetamol/acetaminophen being barely perceptible is why I'll always feel safer with opioids, THC, or even NMDA antagonists like ketamine in a pinch--as someone who is extremely informed with this particular subject.
I blame autism.
If a compound is barely effective, causes liver damage (particularly with other compounds metabolised in the liver), and has a bunch of negative interactions.. sorry, it's garbage. I genuinely would rather go darknet than CVS or Walgreens, and test for purity. Besides, dealers are generally way cooler than corpos anyway.
I hope that nobody takes it as an invitation, though--I said I'm informed. If you're not informed, don't.
I will add this; Paracetamol? Almost placebo. Phenylephrine? Actually placebo. Guaifenesin? Placebo if taken orally. Practically the entire counter is placebo, except for the antihistamines (first/second generation like diphenhydramine/Benadryl and cetirizine/Zyrtec) and nasal cleaners and such. With that in mind, I would encourage people to research absolutely everything they ingest, regardless of how safe the product may seem.
They are certainly not 100% safe.
This should go without saying (probably preaching to a choir), but legal ≠ safe, indeed. Still waiting on that thesaurus to prove me wrong. It's been 3 years.
Stay smart, and stay safe.
- There is a brand mixing acetylsalicylic acid and koffein which works wonders as a quick relief for migraine while my standard naproxen usually requires a few hours of darkness to start working, so I can't agree that all over the counter meds are garbage. I can't refute your placebo claims since the effect cant be measured by myself

It's people like this who make other people think any amount of painkillers is bad, and seem to get a sense of superiority about them for never taking any.

Even a little acetaminophen makes my liver feel funny the next day. Ibuprofen actually works for pain relief for me (migraines mostly) but it can cause stomach ulcers. Painkillers are definitely not something you can just use without thinking, and daily use especially can fuck your body up, ibuprofen is also hard on your kidneys.
Take the minimum effective dose as infrequently as possible.
- did you ever check your liver? that doesnt sound normal. with a small dose.
  nsaids can cause bleeding and ulcers if itsa high dose. its because it inhibits cox 1 and 2, for clotting, and it works on your stomach by turning off inflammation, so your stomach can combat the acid with more mucus and cell turnover(inflammation increases cell turnover), thats why h pylori is a thing.

He's not the first one to 'kill his liver' with paracetamol/ acetominophen (tylenol). First case I recall, the person was taking tylenol nightly with a glass of wine. Here's some links on the current understanding of Liver injury and paracetamol:

Apparently it's not always overdosing: Paracetamol-induced hepatotoxicity at recommended dosage (https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2796.2003.01097.x)

Acetaminophen-Induced Hepatotoxicity: a Comprehensive Update (https://pmc.ncbi.nlm.nih.gov/articles/PMC4913076/) "...in the United States, in particular, it accounts for more than 50% of overdose-related acute liver failure and approximately 20% of the liver transplant cases."

Risk Factors for Hepatotoxicity Due to Paracetamol Overdose in Adults (https://www.mdpi.com/1648-9144/57/8/752) "In the univariable analysis, significant hepatotoxicity risk factors were male gender, alcohol abuse, an ingested paracetamol dose, and a timespan from ingestion to hospital admission. The later one was the only significant risk factor in the multivariable model (adjusted odds ratio 1.08; 95% CI: 1.03–1.12)."

Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (https://pubmed.ncbi.nlm.nih.gov/37436926/) "Where data were available, we estimate that paracetamol is involved in 6% of poisonings, 56% of severe acute liver injury and acute liver failure, and 7% of drug-induced liver injury."

Understanding paracetamol-induced liver failure (https://link.springer.com/article/10.1007/s00134-014-3293-9)

It's why in the UK shops won't sell more than 2 packets at a time. It's statistically reduced the amount of people killing themselves with them (intentionally or by mistake).

It’s OTC right? What’s stopping people from visiting multiple pharmacies?
- Inconvenience
- Nothing. However it adds a layer of difficulty to acquiring more. That, for a lot of people, is enough.
- Technically nothing but even the fact that it is limited is a deterrent for buying too much, plus people are too lazy to visit multiple pharmacies.

I mean... Yeah. There are instructions on the packet. They aren't supposed to be eaten like candy.

even vitamin gummies can be overdosed to a dangerous degree. Hell, even too much water can kill you, it's difficult to achieve but it can flush out all the nutrients from your body. Always make sure to know how much of anything is safe to put in your body
- Yup. I had a buddy give himself Vitamin A poisoning from eating gummy multivitamins like they were candy.
- vitamin A specifically is toxic. not so much for vitamin D, since people are very deficient in vitamin d.

Everyone's discussing ODing on OTC pain meds but the bigger part of this story is why he's in so much pain for so long without being able to see a Dr and receive treatment for chronic pain.

Some people are just stubborn about seeing doctors. My guess is that this is a british guy, and dental coverage under the NHS is spotty at best

My brother in Christ, the paracetamol box LITERALLY says to never go more than 4 grams (4000 mg) in a 24hs period on any mg pills presentation

And as far as I see, that's a general rule with everything. Even those caramels for sore throat or reflux pills, where you'd need to eat thousands in a day to overdose, say the same

Don't fuck with medicine dudes

How big is a packet?

Off the shelf in the UK, they're sold in packs of either 8 or 16 tablets, and shops are legally only allowed to sell you two packs at once. Pharmacies can of course supply larger quantities with a prescription.
The recommended dose is one or two 500mg tablets every 4 hours with a maximum of 8 tablets per day.
- ok that helps. Over here you can get a bottle of 100 or more at one.
Yeah, I think this is what's causing the confusion here. We don't measure pills in "packets" in the US, so I think some people are taking "4 packets" to mean that they only took four pills and of course that's absurd.
I think in UK paracetamol is sold over the counter in 28 x 500mg tablets most commonly. Larger packs or higher strengths are prescription only I think.
So 1 pack should last 3.5 days at the max adult dose of 8 per 24h - but I think it'd recommend seeing your doctor if you get into a second pack and you're still using that maximum dosage.
Generally shops will limit sales to 2 packs, but it's easy to shop around so that's no limit.
- I don't know where you'd get packets of 28x500mg.
Asking the real questions.
- Kinda surprised you didn't give some it answer

How much is a "packet"? edit: never mind, I found several conflicting answers in the other comments, no need to add even more and add to the confusion.

Too much

Isn't this why they specifically put acetaminophen in opioid+nsaid prescription painkillers, instead of ibuprofen or aspirin or naproxen? Just to discourage abuse because if you take too much it'll destroy your liver. Has always seemed a bit fucked up to me.

I think the reason is that both acetaminophen and opioids are processed by the liver and that acetaminophen will overwhelm it allowing more time for opioids to be effective.
You can take acetaminophen and nsaids together because they work differently and are processed differently.
But, if you're a heavy drinker, both are dangerous for very different reasons. Liver vs digestive tract.
This is one aspect which is stupid, agreed, and based on a terrible and possibly willful misunderstanding of how addiction works. It’s also based on an assumption that the average person is educated on medicine in a way that is wholly out of touch with reality (“you mean the average person doesn’t know the max dose of acetaminophen off hand and keep meticulous track of dosage? But I do that, of course, I’m a doctor/pharmacist”)
but in addition there is added pain relief from the combo of acetaminophen + hydrocodone/oxycodone vs the opioid on its own so there is some justification for it outside of punitive approach for addicts. If you’re going to prescribe both anyway after something like a broken arm or wisdom tooth extraction there are also benefits to this: cheaper overall to just have one pill, easier to manage for the patient, etc
not sure what you mean by opioid+nsaid prescription painkillers, so I'll assume it's a mix of opiods plus NSAIDs. wouldn't make much sense to add aspirin/naproxen/ibuprofen on top of that, as they are also NSAIDs and that role's already been filled
paracetamol is also a fairly good painkiller so my guess is they're probably going for some synergy there as well
- They probably mean stuff like Tylenol2, which is acetaminophen and codeine.

holy fuck how did that guy make it to adulthood without braincells...

ITT: People who don't know the difference between acute and chronic ODs and how a smaller amount over a long period can hurt you. 325mg APAP x4 will not kill you short term.

The problem was taking it every day over a long period.

Its still fucking stupid though.

I think the problem here is the word "packet" and what that means here exactly. Would be much more clear if they listed the amount of mg, or at the very least, how many pills are in a "packet"
I'm like 99% sure they took way more than just 4 Tylenol.
- I've only ever seen "packets" contain two pills or capsules. 325x2x4= 2,600mg or 2.6g, well below the 8g average one time adult OD dose.
  Taking less than 3g a day for <3 days is fine, although if you're needing that much you probably should see a medical professional about something more tailored to your type of pain.
  Really though way too many people in general have the idea pain killers of any type should remove all pain and in many cases, that's not realistic without long term health complications.
  Edit: lemmy did not like me using asterisks for multiplication.
325mg APAP x4 will not kill you short term.
Yeah I'm p sure the daily maximum on the package is 4k

In the US, the FDA tried to limit how strong the individual capsules can be (325mg), but you can still buy it in 500mg strength. There are mandatory warnings on the label, but you can buy it in 500-tablet (at 325 or 500) bottles over the counter. It took almost 60 years before the FDA did anything, so a lot of people grew up thinking it was harmless.

My daughter's dog that is a climber got on a shelf and knocked a basket off that had a large bottle of Tylenol in it. She chewed the bottle up.

I got home and saw some pills and a demolished bottle on the ground. Vet tech friend said to induce vomiting with hydrogen peroxide.

Didn't have any of that, but I did have some minty mouthwash with peroxide and no xylitol in it. Dog willingly drank it, puked with foam, drank a bit more, puked more foam, then I dug through the mess.

No pills or any sign of the color on the pills. She's still kicking.

induce vomiting with hydrogen peroxide.
Didn't have any of that
how are you alive? H2O2 is like the basic necessity of every first aid kit. when you get a cut or scrape at home do you just like, ignore it?
do you even have bandaids or triple antibiotic ointment?
- As far as I understand it, you shouldn't put peroxide on most, or maybe even any, wounds. It indiscriminately kills good and bad bacteria as well as your body's cells. So it can make the wound take much longer to heal.
  Similar, but I think different, with iodine. You shouldn't use it in most cases.
  The recommendation is to use warm soapy water to rinse/clean the wound really good. That's all.
  If the wound is deep enough or gnarly enough that this doesn't seem reasonable? Well, peroxide wasn't gonna help you anyway, go to the doctor.
  I'm happy to be wrong here, to be corrected. But this is how I understand it.
  Also I do keep peroxide in my cupboard, as well as rubbing alcohol. Their uses just aren't for wounds.
- Peroxide is actually a pretty terrible wound cleanser. Does as much damage to the healing tissue as to any bacteria, which is why you seldom see it used in the hospital. Honestly you are better off with lots of clean warm water and mild soap. If you really want to get wild, find some true antibacterial soap with chlorhexidine (hibiclens is the big brand name in the US) and wash the wound with that. Just don't use it on the face bc it's really bad for the eyes.
- What a completely unnecessary comment

Hah, im a psycho so i usually rawdog everything you would have to take painkillers for. Also i prefer not to get addicted to painkillers but thankfully that is pretty rare here in europe especially compared to the us.

Not treating pain can lead to chronic pain.
- I mean if my doctor says that i have to take something i do but i usually ask if taking pain killers are necessary and its usually only for the pain. There are also painkillers that are anti-inflammatory and of course i take those.
- Painkillers are no treatment
I’m mostly the same way.
Opioids make me physically ill and do not interact with my system well at all so I avoid them as much as I possibly can. I take it as a blessing that it puts me away from addiction risk, but it sucks when the rare Tylenol (acetaminophen/paracetamol) doesn’t cut it as my asthma makes NSAIDs a no-go.
Still, I’ll take swearing-pain over dizziness and breathing issues. Been tempted to take a knife to the problem areas myself though.

I had intense tummy aches for 15 days where I couldn't walk and needed to keep heat to my belly to even function, once my pain killers didn't work, I didn't push it, I just tried to handle the pain

I cried a lot in that time, it fucking sucked, but it sure was better than liver failure.

don't be an idiot and 2) read the leaflet

Sounds like a messaging problem, despite the idiocy (or rather, because idiocy is the default). Like, I'm not silly enough to eat 4 boxes of paracetamol a day, but I've also read maybe 3 medication leaflets in my entire life, and I've been on literally dozens of antidepressants and antianxiety meds. I basically scan over the leaflet to see what sort of dick problems I can expect 😆

It's like the Terms of Service of an iTunes update. No cunt is reading that shit. People just know "i make click i get music", and "i swallow lump of chalk i feel better".

The leaflets aren't even written for laypeople to really understand them. Besides being in a 1pt font, they're written in something bordering on legalese but with medical terms. "Contraindications"?? The fuck am I, Beatrice Pharmacist the inventor of pharmacism? I don't blame people for getting 2 sentences in and giving up.

That said, the dosage is on the front of the box, and that should be enough for even the most imbecilic person. But if you lose the box and just have loose blister packs lying around for a year, you might go off the rails a little when the tooth pain kicks in.

It's also the case that something as "basic" as paracetamol being such a widespread and easy-to-buy medication causes a strange lack of respect for its potential danger. Like "pop a pill when you have a headache" is so second nature to us. It becomes a non-threatening intervention that only becomes less threatening the older you get, because it's just... there. So you don't even feel the need to check the leaflet for side effects and such, because it's 'part of the furniture' of our lives. This is the messaging problem I alluded to. You really gotta think about the dumbest person alive, and then aim for someone twice as dumb as that.

I try and avoid painkillers whenever possible for two reasons:

They're crazy addictive
They build tolerance, and when it comes time where taking them is unavoidable, I want them to work as well as possible.

Neither of these are true for acetaminophen/paracetamol though?
- Not that I would know, but don't all medications build up tolerance?
  Like, I was under the impression that medicinal benefits are like a side-effect to what the body might otherwise consider a foreign pathogen. Does acetaminophen not trigger any immune response?
You wont build a tolerance unless you're using it constantly. A few days for a pain a few times a year is meaningless for tolerance. As long as you RTFM, the hospital dose will always exceed your tolerance.
This doesn't apply to opioids but I'd argue people make too big a deal about those as well, just don't do them outside a prescription nor recreationally. You're probably more addicted to taking a shit every now and then unless your life is already in the drain.

Well that is a permanent solution to some kinds of pain

Let's say the maximum recommended dose is the "dangerous dose." That's 4 grams. 20x4=80 grams of paracetamol/acetaminophen. That's like 160 goddamn pills

The maximum recommended dose is generally much below the LD50 of a drug.
It also tends to be the maximum recommended dose for short term dosage for painkillers.
His issue was taking this for a long period.

https://nitter.net/onehappyfellow/status/1929498609373925519

https://x.com/onehappyfellow/status/1929498609373925519

Just tell them you believe a billionaires earn their money, climate change is a hoax to sell books, and the solution to mass shootings is to sell more guns to more people.

You know, express the nonsensical opinions only a well deluded American is propagandized from birth to express with a straight face when they should be embarrassed at their belligerent ignorance.