Grim Legacy of A Banned Pill

Even seemingly harmless medications sometimes turn out to be delayed-action disasters. Millions of people who once relied on the pain killer phenacetin to soothe headaches and aching joints have an increased risk of developing kidney disease and other life-threatening ailments, according to a report in last week’s New England Journal of Medicine. The study also raises questions about the safety of another popular analgesic, acetominophen.

Phenacetin — the common term for the compound acetophenetidin — is best known as the P in so-called APC pills, the now discontinued pick-me-ups that also contained aspirin and caffeine. Although phenacetin is still available primarily by prescription in some European nations, including Germany, Belgium and France, it has been banned in the U.S. since 1983 because of its suspected links to anemia and kidney disease.

Researchers say anyone who used the drug regularly should probably have a thorough medical checkup. The new study, led by Dr. Ulrich Dubach of the Basel University Polyclinic in Switzerland, compared the health records, over a 20- year period, of 623 women, 30 to 49, who took phenacetin daily for at least a year with those of 621 women who used the drug less often or not at all. The researchers found that women who took phenacetin regularly had an increased risk of high blood pressure and cardiovascular disease; they were also more likely to die from urologic or kidney disease. Aspirin posed no such risks.

Chronic users of acetominophen, a close chemical relative of phenacetin, may also have cause for concern. Considered preferable to aspirin because it rarely produces side effects or allergic reactions, does not irritate the stomach and is thought to be safe for children and pregnant women, acetominophen is sold under such brand names as Tylenol and Anacin-3.

“There has already been one study suggesting a link between acetominophen and kidney failure,” notes Dr. Paul Stolley, of the University of Pennsylvania, who wrote a New England Journal editorial about the phenacetin study. “The relationship between the two drugs makes us want to know more about the possible risks.” A spokesman for McNeil Consumer Products, manufacturer of Tylenol, denies that the new study points to any problems with acetominophen.

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