The Dangers of Acetaminophen: How to Protect Yourself

The Dangers of Acetaminophen

Catie was an intelligent, normal 20-year-old woman: full of life, vibrant, and looking forward to her future. Unfortunately, during Covid-19 she was taking Extra Strength Tylenol over several days. which began to damage her liver. She was unaware of the damage occurring. Feeling incredibly unwell, she went to the Emergency Room on a Sunday evening. She had googled her symptoms and started to put things together and was genuinely fearful. She was told in the ER that she had an unintended overdose of Acetaminophen, and her liver enzymes were off the charts and that she’d likely be in the hospital for a few days. By Monday morning she had been transferred to a hospital that had a liver transplant team. By Tuesday afternoon she seemed stable enough for a transplant, only to deteriorate by Tuesday evening and sadly, passed away on Wednesday. December 2, 2020. A nonprofit organization, Catie’s Cause, has been established in her name to educate the public about the acetaminophen dangers.

Unfortunately, Catie is not alone. Acetaminophen toxicity is the most common cause of liver transplantation in the United States and causes 56,000 ER visits, 2,600 hospitalizations and 500 deaths annually. More than 60 million Americans consume acetaminophen, also known as Tylenol, on a weekly basis, and many are unaware that taking too much can be dangerous and that it is contained in combined products.

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Older Americans, especially those with chronic pain or chronic illness, are more at risk for the following reasons:

They are more likely to be taking acetaminophen long term for chronic pain.
They are more likely to also be taking one or more of the more than 600 drugs that contain acetaminophen without being aware of it.
They are more likely to be consuming pharmaceuticals that compromise liver function.
They may be more likely to consume alcohol on a consistent basis, which also harms the liver, based on misinformation that this is a health-promoting practice. Medical researchers have concluded that there is no safe level of alcohol consumption.

Examples of Common Medications Containing Acetaminophen

Here are some well-known examples across different categories:

Single-Ingredient Acetaminophen Products

Tylenol (Regular Strength, Extra Strength, Arthritis Pain, etc.)
Panadol
FeverAll (rectal suppository)

Combination Medications with Acetaminophen

Cold and Flu Medications:
- NyQuil
- DayQuil
- Theraflu
- Coricidin HBP
Pain Relievers with Other Ingredients:
- Excedrin (with aspirin and caffeine)
- Midol (various formulas)
- Percocet (acetaminophen with oxycodone)
- Vicodin (acetaminophen with hydrocodone)
- Norco (acetaminophen with hydrocodone)
- Lortab (acetaminophen with hydrocodone)
- Fioricet (acetaminophen with butalbital and caffeine)
- Ultracet (acetaminophen with tramadol)
Allergy and Sinus Medications:
- Tylenol Sinus
- Sudafed PE Sinus + Pain

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Other Classes of Medications That Can Harm the Liver

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Antibiotics
Antifungal Medications
Antiepileptic Drugs (AEDs)
Cholesterol-Lowering Medications
Antidepressants
Antipsychotics
Antiretroviral Medications (HIV Treatment)
Anti-tuberculosis Drugs
Chemotherapy Agents
Anabolic Steroids
Antidiabetic Medications
Immunosuppressants
Anti-parasitic Medications

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Recognizing the Signs of Acetaminophen Overuse

It’s important to recognize the early warning signs of acetaminophen overuse or toxicity:

Nausea or vomiting
Loss of appetite
Fatigue or weakness
Upper abdominal pain
Dark urine or pale stool
Yellowing of the skin or eyes (jaundice)

If you or someone you know experiences these symptoms after taking acetaminophen, seek medical attention immediately.

Tips for Minimizing Risks

Here are some practical steps to ensure you use acetaminophen safely:

Follow Dosage Guidelines: Never take more than the recommended dose on the product label. For adults, the typical maximum dose is 3,000 to 4,000 mg per day, but it’s best to aim for the lower limit or avoid it entirely if possible.
Read Labels Carefully: Always check the active ingredients in over the counter and prescription medications to avoid accidental overdose.
Avoid Mixing Medications: If you’re already taking a medication that contains acetaminophen, don’t take another without consulting your doctor or pharmacist.
Limit or avoid alcohol Consumption: If you drink alcohol, limit your intake or avoid it altogether when using acetaminophen.
Consult Your Doctor: If you have liver disease, are pregnant, or take other medications, talk to your healthcare provider before using acetaminophen.
Use Alternative Pain Relief Methods: There are many safer alternatives than acetaminophen for acute pain. Longer duration of acetaminophen use adds to the risk. For chronic pain, there are even more non-medication approaches including:

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Taking Acetaminophen for a fever

Another common reason, in addition to pain, that people take acetaminophen is for a fever. Elevated body temperature plays an important role in the body’s normal response to fighting infection. Fever in an adult usually isn’t dangerous unless it registers 103 degrees F (39.4 degrees C) or higher, so it’s usually not necessary to take medication for most fevers. Fevers over 100 degrees F in infants or frail elderly people may be dangerous.

If the fever is accompanied by any of the following symptoms, it may indicate a serious or life-threatening illness. Seek immediate medical attention if your symptoms include:

Pain or tenderness in the abdomen
Nausea or vomiting
Severe headache
Stiff neck that resists movement
Light hurts eyes
Convulsions or seizures
Difficulty breathing
Strange behavior, altered speech
Mental status changes, confusion, difficulty waking, extreme sleepiness
Rash (particularly if it looks like small bleeding spots under the skin)

Be sure to drink plenty of fluids when you have a fever to prevent dehydration. Dehydration can increase discomfort and risk from an infectious illness, including causing fatigue, dizziness or lightheadedness, confusion or irritability, low blood pressure than can lead to fainting, seizures and unconsciousness. It can also exacerbate muscle aches and pains.

The Bottom Line

Acetaminophen is not without risks. By understanding how to use it safely and recognizing the warning signs of overuse, or using safer alternatives, you can protect your health while effectively managing your symptoms. If you’re ever unsure about the appropriate use of acetaminophen or any other medication, don’t hesitate to consult your healthcare provider.

If you’d like to help raise public awareness about the dangers of acetaminophen, please consider donating to or volunteering with Catie’s Cause.

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Cindy Perlin is a Licensed Clinical Social Worker, certified biofeedback practitioner, chronic pain survivor, author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free and the creator of the Alternative Pain Treatment Directory. She is in private practice in the Albany, NY area, where she has been helping people reach their health and wellness goals for over 30 years. You can schedule a phone consultation with Cindy HERE