Are you taking too much Tylenol without knowing it?

image courtesy of Jeff Golden (cropped)

Pretty much everyone experiences pain at some point in their lives. Sometimes it’s just a headache or a minor injury or brief illness — but for many, pain involves more chronic issues such as arthritis or back pain. Many medications can help manage pain, with the best known being over the counter pain relievers like Motrin (ibuprofen), Aleve (naproxen), or Tylenol (acetaminophen). These drugs (except Tylenol) — known as NSAIDs, short for nonsteroidal anti-inflammatory drugs — work remarkably well for a variety of conditions. But here’s the rub: They work so well that these products get tossed into many other medications, both over-the-counter or prescription-only formulations. That makes it surprisingly easy to take too much without even knowing it.

While not all-encompassing, these present some of the most commonly used medications for pain in the U.S.

The Problem

Tylenol is a common pain relief agent in the U.S. and Europe (where it’s known as Paracetamol), and can also be used to help reduce fevers. As such, it is often combined in multiple products for cough and cold and not just pain products. Tylenol’s generic name is acetaminophen and this is the name you should be looking out for in some medications. The FDA has released multiple safety warnings for excessive use of acetaminophen, based on data and research demonstrating that while it is a relatively tolerable drug with few side-effects (which is why it’s used so much and available over-the-counter), at certain doses it can be life-threatening. In my pharmacy work, I have seen many patients unintentionally taking too much Tylenol/acetaminophen because they just didn’t know what drugs they were taking had it in them. It’s an all too common mistake, as seen in this sample case, where someone may be taking Tylenol Extra Strength for pain, but now with a cold is also taking Dayquil:

The Cause

Acetaminophen is broken down via the liver. Overall, when taking the recommended doses on the bottle, the liver does its job just fine for the majority of the population. The issue is when taking too much of acetaminophen, you can overload the liver, leading to liver failure and possibly death. The other issue is mixing acetaminophen with alcohol. Because alcohol is broken down by the liver as well, these two will interact and overtax the liver in a short period of time. Acetaminophen will also build up in the liver which can lead to problems even if you didn’t take that much at once.

What can you do?

It’s wise to always check if the medication you’re taking or giving to someone has acetaminophen in it. Generally, if it’s used for pain, cough, cold, or allergies, there’s a good chance it contains acetaminophen. The FDA suggests 4000 mg (or 4 grams) of acetaminophen is the maximum safe amount to ingest in a 24 hour period . Some providers recommend the elderly to take less (2000 mg or 2 grams) only. Acetaminophen is often seen in common combination doses of 500 mg or 325 mg. For example, in Dayquil, each dose has 325mg of acetaminophen. Percocet and Vicodin are also combination pain drugs, with each having 5 mg of opioids and 325mg of acetaminophen.

The other issue is mixing alcohol and acetaminophen. The FDA warns against combining acetaminophen with 3 or more alcoholic drinks a day. So if you are out drinking heavily and reaching for Tylenol before you go to bed to keep that headache away in the morning, don’t do it!

Takeaways

• Tylenol/acetaminophen is a relatively safe medication used often to treat pain or fever. It’s found in many products over-the-counter and in combination with other prescribed agents for pain, cough, cold, and allergy.
• The FDA has set standards on how much Tylenol/acetaminophen should be taken based on risks of overdose that could lead to complications and possible death.
• Always check how much Tylenol/acetaminophen you are taking, both on its own or in a combination medication, especially if you already take it chronically for a condition.