- Acetaminophen safety: Be cautious but not afraid
- I take Tylenol every day for a headache. Is this safe?
- How Bad Is Acetaminophen for the Liver?
- What is Acetaminophen?
- Acetaminophen Liver Damage
- Acetaminophen as a Recreational Drug
- Risks Associated with Acetaminophen Abuse
- Acetaminophen with Alcohol Effects
- Acetaminophen Toxicity and Overdose
- What is acetaminophen?
- What is it used for?
- How do I take this medication?
- Is this drug safe?
- How do I know if it is working?
- How do I know if something is wrong?
- How do I store my medication?
- What do I do if I miss a dose?
- 1. What other conditions do I have?
- 2. What other medications am I taking?
- 3. Why do I need the medication?
- Commonly used brand name(s)
- Uses for Tylenol
- Before using Tylenol
- Proper use of acetaminophen
- Precautions while using Tylenol
- Tylenol side effects
- Further information
- More about Tylenol (acetaminophen)
- Tylenol Extra Strength Side Effects
Acetaminophen safety: Be cautious but not afraid
Acetaminophen safe dosage basics
Acetaminophen controls pain and fever but does not reduce inflammation, as does aspirin and the other widely consumed nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin, generics) and naproxen (Aleve, generics). But unlike NSAIDs, acetaminophen does not irritate the stomach and intestinal lining. That means a person who cannot tolerate NSAIDs can still take acetaminophen. It’s an important drug for controlling chronic pain in older adults.
The hitch is that acetaminophen also has a narrower window of safety compared with ibuprofen and naproxen. NSAIDs can make you sick, too, but it takes a larger amount to reach a dangerous overdose. Taking too much acetaminophen can damage the liver, sometimes leading to a liver transplant or death.
The body breaks down most of the acetaminophen in a normal dose and eliminates it in the urine. But some of the drug is converted into a byproduct that is toxic to the liver. If you take too much—all at once or over a period of days—more toxin can build up than the body can handle.
For the average healthy adult, the generally recommended maximum daily dose is no more than 4,000 milligrams (mg) from all sources. But in some people, doses close to the 4,000 mg daily limit for adults could still be toxic to the liver. It’s safest to take only what you need, and to not exceed 3,000 mg a day whenever possible, especially if you use acetaminophen often.
How to stay within limits
If you ever have concerns about how much acetaminophen you can tolerate based on your age, body size, and health status, talk to your doctor or pharmacist. Here are some general precautions for avoiding an accidental overdose of acetaminophen.
Cold and flu remedies count. When you reach for an over-the-counter cough, cold, or flu product, take a look at the label. Does it contain acetaminophen?
Know the milligrams in your pills. In acetaminophen products available over the counter, each pill may contain 325, 500, or 650 milligrams of the drug. Be extra cautious when taking 500 or 650 milligram pills.
Stick to recommended doses. When taking acetaminophen, don’t be tempted to add a little extra to the recommended dose. A small-bodied person should stay on the low end of the recommended dose range (3,000 mg).
Easy on the alcohol. Drinking alcohol causes the liver to convert more of the acetaminophen you take into toxic byproducts. Men should not have more than two standard drinks per day when taking acetaminophen (one drink per day for women).
Know if your medications interact. Ask your doctor or pharmacist if any of your prescription medications could interact badly with acetaminophen.
How much should you worry?
Tens of thousands of people become ill every year from taking too much acetaminophen. In a smaller number of cases—several hundred per year—it leads to death. But it need not happen to you. “Read the labels and stick to the guidelines,” Dr. Lai Becker advises.
Acetaminophen: How much can you take safely?
650 mg extended release
Take how many pills at a time?
1 or 2
1 or 2
1 or 2
Take how often?
Every 4 to 6 hours
Every 4 to 6 hours
Every 8 hours
Safest maximum daily dose
for most adults
Never take more than this in a 24-hour period
12 pills (3900 mg)
8 pills (4000 mg)
6 pills (3900 mg)
The maximum daily dose for a healthy adult who weighs at least 150 pounds is 4,000 milligrams (mg). However, in some people, taking the maximum daily dose for extended periods can seriously damage the liver. It’s best to take the lowest dose necessary and stay closer to 3,000 mg per day as your maximum dose. If you need to take high doses of acetaminophen for chronic pain, check with your doctor first.
For therapy options beyond the standard approaches to managing pain, buy the Harvard Special Health Report Pain Relief: Natural and alternative remedies without drugs or surgery.
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
I take Tylenol every day for a headache. Is this safe?
Maybe not. Tylenol, which is acetaminophen, can cause liver injury. It depends on how much you are taking, if you have liver disease, and if you drink alcohol. If you have no liver disease and don’t drink, the total labeled daily dose for a healthy adult is 3,250 mg, spaced over 24 hours. Your doctor may prescribe as much as 4,000 mg in divided doses. If you take other medicines that have acetaminophen in it, such as sleep or allergy remedies, be sure to include those amounts when figuring the total Tylenol dose.
The other issue is the daily headache. First, persistent headaches need medical attention. Second, you may be having a persistent headache because of the Tylenol. Pain relievers such as aspirin and Tylenol may help in the beginning, but over time can cause a condition known as a rebound headache.
June is Migraine and Headache Awareness Month. Find out more about headaches here. For more about safe use of acetaminophen, there is good information in the Over-the-Counter Remedies and Hepatitis C section at Hep.
- #liver damage
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Less than half of patients read the ingredients of OTC pain relievers, and many don’t recognize the consequences of exceeding the recommended maximum daily dosage.
A surprisingly large number of patients still don’t know what is in the OTC pain relievers they take, and how much is too much.
Despite the fact that the label on every bottle of OTC painkillers contains not only the active ingredients, but also directions on how many pills can be taken within a specific time period, there is still a lack of awareness among patients in terms of proper adherence. In the United States, acetaminophen overdose has surpassed viral hepatitis as the leading cause of acute liver failure, and misuse contributes to more than 30,000 hospitalizations annually, according to a study published in the American Journal of Preventive Medicine (AJPM).
In the report, researchers propose a number of solutions to help prevent overdoses going forward. In the meant time, it is critical that patients develop a better understanding of what is in the pills they pop to get rid of headaches or soothe muscle pain.
The Facts About Acetaminophen Overdose
Acetaminophen is one of the most commonly used pain medicines in the United States, with 25 billion doses sold in 2008, a New England Journal of Medicine study found. Taken primarily to reduce pain or fever, it is found in several prescription and OTC products. When used as labeled acetaminophen is “generally safe”; however, “the ubiquity of the drug and its relatively narrow therapeutic index create the potential for serious harm from both inadvertent and intentional overdoses,” the NEJM article stated.
According to the AJPM study, half to two-thirds of overdoses are unintentional, suggesting that the root cause is likely poor understanding of medication labeling, or failure to recognize the consequences of exceeding the recommended maximum daily dosage. Although many patients might think they know how many pills can be taken within a 24-hour period, the margin between a therapeutic and a dangerous dose is actually quite small.
The FDA recommends that adults not take more than 1 gram (1000 mg) of acetaminophen per dose or 4 grams (4000 mg) per day. Anything more, even over a period of just a few days, can put patients in serious danger.
What that amount translates to, however, differs by product. For example, with Regular Strength Tylenol, patients can take 2 tablets, caplets, or gelcaps (each of which contains 325 mg of acetaminophen) every 4 to 6 hours while symptoms last, and should not exceed more than 12 tablets in a 24-hour period. With Extra Strength Tylenol, patients can take 2 pills (each of which contains 500 mg of acetaminophen) every 4 to 6 hours; however, they should not take more than 8 pills in a 24-hour period. Another commonly used product, Excedrin Extra Strength, contains 250 mg acetaminophen and 250 mg aspirin in each tablet, and patients are not to exceed 8 tablets in 24 hours.
In terms of active ingredients, all OTC pain medications are not the same (Table).
Prescription Products Containing Acetaminophen
OTC Products Containing Acetaminophen
Source: FDA List of Marketed Acetaminophen-Containing Prescription Products
Source: National Pain Foundation
The Root of Nonadherence
However, although all of this information is clearly marked on the products’ packaging, many patients either don’t read it or don’t understand it, according to the AJPM study, which was led by researchers at Northwestern University Feinberg School of Medicine in Chicago.
The study reported that just 31% of participants knew that Tylenol contained acetaminophen. In addition, 75% of participants knew that Bayer contained aspirin; 47% knew that Motrin contained ibuprofen; 19% knew that Aleve contained naproxen sodium; and 19% that knew Advil contained ibuprofen.
Overall, participants demonstrated limited knowledge of the concept of an active ingredient, noted the researchers, adding that some had heard of acetaminophen and ibuprofen but could not describe the difference.
“It’s incredibly alarming,” said Michael Wolf, PhD, MPH, an associate professor of medicine at Northwestern University Feinberg School of Medicine and senior author of the study. “People may unintentionally misuse these medicines to a point where they cause severe liver damage. It’s easy to exceed the safe limit if people don’t realize how much acetaminophen they are taking. Unlike prescription products, there is no gatekeeper, no one monitoring how you take it.”
Few participants in the lower-literacy groups had heard of acetaminophen. In general, patients paid attention to the active ingredient in the medicine only if they knew of a contraindication for one of their other medicines, and relatively few participants mentioned this as a factor, the authors stated. Most participants, even those who had heard of acetaminophen, generally expressed surprise in learning that acetaminophen, or what they know as Tylenol, can cause liver damage.
Perhaps most surprisingly, the study found that just 41% of participants read the ingredients on drug labels.
“When you have pain, you aren’t paying attention to what’s in a medicine, you just want relief,” said Jennifer King, lead author of the paper and project leader for medication safety research in Feinberg’s Health Literacy and Learning Program. “People think ‘If I can buy it without a prescription, it can’t be harmful.’ They don’t realize exceeding the maximum dose can cause liver damage.”
Fixing the Problem
In the study, King and colleagues proposed the development of a universal icon for acetaminophen that would appear on all medicine labels, along with images such as a stop sign and simple wording such as, “Stop at 6 in 24 hours.” Because they believe that both health literacy and age are factors in comprehending label information, the authors also suggest including a more clear warning about the potential liver damage. Finally, they emphasize that language should be concise and easy to understand.
In the meantime, it is important for pharmacists to remember that “patients do not understand that acetaminophen is Tylenol,” said Rebecca Snead, executive vice president and CEO of the National Alliance of State Pharmacy Associations. “When their doctor or pharmacist tells them to avoid acetaminophen- or Tylenol-containing products, consumers are not aware that there are lots of acetaminophen-containing products without the Tylenol name on the package.”Information given to patients should be as specific as possible, she noted.
Finally, for patients, it is critical to remember that just because acetaminophen is sold over the counter, it does not mean that it is completely safe. Patients should always read the labels to make sure they are taking the proper amounts, and carefully monitor use of acetaminophen by children and adolescents.
How Bad Is Acetaminophen for the Liver?
Acetaminophen, commonly recognized by the brand name of Tylenol, is an over-the-counter pain reliever and fever reducer. It is also an active ingredient in many cold and flu medicines. It is used to treat simple conditions such as headache, arthritis, toothaches, colds, fevers, and muscle aches and pains.
What is Acetaminophen?
Acetaminophen was approved for use by the Food and Drug Administration in 1951. Even though it has a long history of being widely used, experts do not know exactly how acetaminophen works on the body. It is thought to reduce the amount of chemicals in the brain that cause inflammation and swelling.
Additionally, it reduces the sensation of pain by elevating one’s pain threshold. The part of the brain that regulates heat is impacted by acetaminophen, as it is told to lower the body’s temperature when it is too high.
In general, acetaminophen is a well-tolerated drug, so few side effects are frequently experienced. Normal side effects of the drug include nausea, stomach pain, loss of appetite, headache, yellowing of the skin or eyes, and dark urine.
While most people don’t have problems with acetaminophen when taken as directed, it is possible to experience serious adverse reactions. An allergic reaction marked by difficulty breathing, hives, severe itching, peeling or blistering skin, and swelling of the face, lips, throat or tongue are all reasons to seek immediate medical attention.
Acetaminophen Liver Damage
It is possible to experience acetaminophen poisoning in the form of severe liver damage when too much of the drug has been consumed. Whether intentionally or accidentally, acetaminophen overdose requires immediate medical attention to prevent further damage to the body. Symptoms of liver damage include:
- Yellowing of skin or eyes
- Pain in abdomen
- Nausea and vomiting
- Loss of appetite
- Excessive sweating
- Dark urine and stools
- Pale skin color
- Unusual bruising
- Unusual bleeding
Further complications can arise with acetaminophen as it interacts with other drugs. Antibiotics, antifungals, sulfa drugs, nonsteroidal anti-inflammatory drugs, and birth control pills, as well as medications for the treatment of high blood pressure, cancer, high cholesterol, arthritis, HIV/AIDS, seizures, and psychiatric disorders can all be affected by acetaminophen.
Acetaminophen as a Recreational Drug
Recent studies suggest that acetaminophen isn’t addictive and people don’t take it to get high. It is, however, an active ingredient in many painkillers, such as Vicodin or Percocet, which are abused for their highs. It is the acetaminophen contained in these drugs that is often the most damaging.
Overdose from acetaminophen causes about 60,000 people each year to go to the hospital, several hundred of which die from associated liver failure.
Acetaminophen is most commonly misused as a recreational drug in conjunction with other drugs. On its own, acetaminophen is widely accepted to be a safe drug and is easily accessible.
People who abuse painkillers, such as Tylenol 3, are often in search of a calm and relaxed high.
More potent forms of acetaminophen, however, such as Tylenol 3, can only be obtained through a doctor’s prescription, as it also contains a significant amount of codeine, another painkilling drug. Acetaminophen alone is not particularly habit-forming, but the codeine in Tylenol 3 can lead to dependency.
The codeine in Tylenol 3 can cause feelings of euphoria, which leads some people to misuse the drug. Tylenol 3 has also been shown to enhance the effects of other drugs, such as narcotics, alcohol, general anesthetics, tranquilizers, sedative-hypnotics, and other central nervous system depressants. Combining acetaminophen with any of these drugs increases the risk of experiencing the adverse side effects of each drug.
In addition to the complications posed by acetaminophen abuse, chronic overuse of painkillers can lead to physical and psychological dependence, as well as the associated withdrawal symptoms when drug use is stopped.
Risks Associated with Acetaminophen Abuse
Healthcare professionals warn against overuse of acetaminophen. An overdose can cause severe liver damage and even death.
Safe dosages for adults include no more than 1000 mg taken at one time or no more than 4000 mg taken within a 24-hour period. The recommended therapeutic dose of acetaminophen ranges from 325 mg to 625 mg, depending on the person and condition being treated. Any amounts greater than these can cause serious side effects. Additionally, mixing acetaminophen with other substances can cause fatal overdoses.
Acetaminophen with Alcohol Effects
Chronic alcohol use combined with acetaminophen use can increase the risk of liver damage and stomach bleeding. Any substance, for that matter, that puts increased stress on the kidneys and liver poses significant health threats, especially when combined with acetaminophen. The Food and Drug Administration recommends not consuming more than three alcoholic beverages in one day if you are planning on using acetaminophen.
Acetaminophen Toxicity and Overdose
Acetaminophen toxicity, also known as acetaminophen overdose, is a well-known cause of acute liver failure. A person may knowingly take more of the drug than is safe, or they may accidently consume too much acetaminophen, which can happen when taking multiple cold medicines that each contain acetaminophen.
Whether intentional or accidental, the symptoms and treatment of liver damage are the same. Supporting measures, such as IV fluids and anti-nausea medication, can help someone recover from acetaminophen toxicity. Most people do recover from the effects of an acetaminophen overdose. In rare cases, however, toxicity can progress to liver failure, which would require a liver transplant. Death can also occur following an acetaminophen overdose if not treated promptly.
As the mostly commonly used drug in the United States, acetaminophen is hard for many people to imagine as a substance of abuse. Used for everyday treatment of common aches and pains, the over-the-counter accessibility of the drug makes it a prime candidate for self-medication. When used as directed, acetaminophen is safe and unlikely to cause adverse side effects. When misused or overused, however, acetaminophen toxicity can quickly lead to liver damage.
Liver damage associated with acetaminophen use sends thousand of Americans to the hospital each year. The side effects of acetaminophen use are rarely permanent, but if not addressed appropriately, they can lead to serious liver injury and even death.
Patient guide to acetaminophen
What is acetaminophen?
Acetaminophen is a medication that is readily available over-the-counter (which means you can buy it without a prescription) in many different dosage forms as seen in the table below. It can be used in patients of all ages and with varying underlying medical conditions. Other names that you may recognize are Tylenol, Excedrin, and Feverall. Sometimes acetaminophen is just one of the medications in a combination medication such as Percocet, Vicodin, Nyquil, Coricidin, Midol, and others!
What is it used for?
It is commonly used to reduce a fever and to treat both acute pain (such as headache, toothache, sprains or muscle strains) and chronic pain (back pain and osteoarthritis). Acetaminophen may be purchased over-the-counter (without a prescription).
How do I take this medication?
Ask your pharmacist and follow instructions shown on the product packaging or prescription bottle. For adults, acetaminophen can be taken 4 to 6 times throughout the day as long as the total amount taken is not more than 3,000 mg for the whole day. Under the supervision of a prescriber, up to 4,000 mg a day of acetaminophen can be taken.
Acetaminophen is dosed by weight for children—ask the pharmacist or doctor for dosing assistance. For an infant or a child less than 2 years old, acetaminophen cannot be used without instruction from a prescriber.
Do not take higher than recommended doses, extra doses, or take it longer than recommended. Carefully check the labels of other medications you are taking to make sure they do not also contain acetaminophen. Your pharmacist can help you with this as well.
Acetaminophen can be taken with food or on an empty stomach (but always with a full glass of water). Sometimes taking with food can lessen any upset stomach that may occur.
If you are taking the oral solution or suspension, or giving a dose to a child, use a calibrated measuring spoon instead of a household teaspoon to measure the dose.
Is this drug safe?
Based on current research, doses up to 3,000 mg per day, or 4,000 mg per day under a doctor’s supervision, are considered safe. However, taking more than 4,000 mg per day may cause liver damage, either as one large dose, or excessive doses over weeks or months. If you already have liver problems, acetaminophen may not be the right drug for you. It can be taken with most medications, foods, and drinks.
Do not take acetaminophen if you have a history of alcohol abuse, or consume alcohol while using acetaminophen. You should also avoid acetaminophen if you have a history of liver disease (including hepatitis), severe kidney disease, or phenylketonuria. If you are taking a blood thinner such as warfarin you should talk with your prescriber before starting this medication.
The Food and Drug Administration is also now requiring makers of acetaminophen to warn patients of the potential risk of developing severe skin conditions while taking the medications. These skin conditions are exceedingly rate, including Stevens-Johnson Syndrome, toxic epidermal necrolysis, and acute generalized exanthematous pustulosis, but can be fatal. Call you doctor if you experience reddening of the skin, rash, blisters, and detachment of the upper surface of the skin.
How do I know if it is working?
If taking this medication for pain or to lower a fever, then you should feel better! It usually takes about 45 minutes for oral, liquid, or tablet acetaminophen to start working. The oral disintegrating tablets start to work in about 20 minutes. Rectal suppositories can take a little longer to start working—up to 2 hours. Acetaminophen usually lasts about 4 hours for pain relief and fever reduction, so you shouldn’t take it more often. If your pain does not get better or your fever does not start to come down after 1 to 2 hours, you may want to call your pharmacist or prescriber to see if you need a larger dose or if a different medication may be right for you.
How do I know if something is wrong?
You should contact your prescriber if you have any swelling, rash, or trouble breathing. If you become nauseated, try taking acetaminophen with food or milk.
How do I store my medication?
Store in a cool, dry place, such as your nightstand. Don’t store acetaminophen or any medications in a humid place such as the kitchen or bathroom. All medications should be stored in a location in your house that is out of reach from pets, children, or adults who could accidently take or misuse this medication.
What do I do if I miss a dose?
If you are taking acetaminophen on a regular schedule take it as soon as you remember. However do not take another dose until the appropriate time has passed (such as 4 hours for a regular tablet or capsule). If you are unsure what to do, contact your pharmacist. Importantly, you should never take double the recommended dose. If you are taking acetaminophen occasionally for pain or fever, then you can just take the medication when you need it, but no sooner than directed on the box.
Updated on: 01/12/17 View Sources
- Tylenol 325mg acetaminophen tablet. Fort Washington, PA: McNeil-PPC, Inc; 2013. NDC 55154-1918-0.
- Acetaminophen Preparations. Pediatric & Neonatal Lexi-Drugs. Hudson, Oh: Lexicomp, Inc; 2014.
- Guggenheimer J, Moore PA. The therapeutic applications of and risks associated with acetaminophen use: a review and update. JADA. 2011;142:38-44.
- The Acetaminophen Hepatotoxicity Working Group. Recommendations for FDA Interventions to Decrease the Occurrence of Acetaminophen Hepatotoxicity. http://www.fda.gov/downloads/UCM164898.pdf. Accessed January 30, 2015.
- Food and Drug Administration, HHS. Organ-specific warnings; internal analgesic, antipyretic, and antirheumatic drug products for over-the-counter human use; final monograph. Final rule. Fed Regist. 2009;74(81):19385-19409.
- Sharma CV, Mehta V. Paracetamol: mechanisms and updates. Contin Educ Anaesth Crit Care Pain. 2014;14(4):153-158.
- Whaba H. The antipyretic effect of ibuprofen and acetaminophen in children. Pharmacotherapy. 2004;24(2):280-284.
- Moller PL, Norholt SE, Ganry HE, et al. Time to onset of analgesia and analgesic efficacy of effervescent aceta-minophen 1000 mg compared to tablet acetaminophen 1000 mg in postoperative dental pain: a single-dose, dou-ble-blind, randomized, placebo-controlled study. J Clin Pharmacol. 2000;40(4):370-378.
Continue Reading: Morphine
In your medicine cabinet right now, you probably have bottles of over-the-counter pain relievers, such as acetaminophen, aspirin, ibuprofen or naproxen. But do you know whether you can safely take these drugs? For many people, if you follow dosing instructions, the answer is yes.
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However, the U.S. Food and Drug Administration (FDA) has issued warnings about pain relievers, and research often calls their safety into question.
Most recently, the FDA boosted its warning that non-steroidal anti-inflammatory drugs (NSAIDs) may raise the risk of heart attack and stroke, even as early as the first few weeks of use. That applies to ibuprofen and naproxen, but not aspirin or acetaminophen.
Warnings such as these don’t mean you should clear out your medicine cabinet. Acetaminophen and NSAIDs are valuable in a lot of cases for relieving aches and pains and bringing down your fever or your child’s.
But before you reach for relief, have a chat with your doctor — and consider the following questions.
1. What other conditions do I have?
Your current health plays a big role in the risks that come with drugs.
If you suffer from digestive diseases, consult a doctor before taking a NSAID. NSAIDs, such as Advil and Aleve, can be hard on the digestive system. Risks can be short-term (upset stomach) or long-term (severe ulcers).
And because NSAIDs can decrease blood flow to the kidneys, consult your doctor first if you have kidney disease too.
A little expert advice on drug interactions can help you get the pain relief you need while avoiding unwanted side effects.
The latest FDA warning about NSAIDs specifically mentions those who have recently had bypass surgery or a heart attack. If you fit into those categories, it’s all the more reason to consult a doctor before taking a pain medication. Acetaminophen might be a better choice than NSAIDs for you.
On the other hand, if you have liver disease, you might need to avoid taking acetaminophen (drugs such as Tylenol), because of its potential effects on the liver.
These are just a few examples among many. If you’re in good health, such concerns may not apply to you. But any chronic conditions you have will play a part in drug safety.
2. What other medications am I taking?
Your other treatments play a part, too.
For example, if you are taking a blood thinner such as warfarin, adding NSAIDs into the mix can increase your risk of bleeding. Although acetaminophen in higher doses may have a mild interaction with warfarin, it may be a better choice if your doctor advises it.
The main point is this: When you are managing a chronic condition, such as heart disease, don’t be afraid to ask doctors and pharmacists for advice.
Also, be sure to check whether any other over-the-counter drugs you’re taking contain acetaminophen or ibuprofen. That way, you won’t exceed the maximum dose.
It’s hard to process all the information on the inserts that come with prescription medications and the labels on over-the-counter drugs. A little expert advice on drug interactions can help you get the pain relief you need while avoiding unwanted side effects.
3. Why do I need the medication?
As a rule, you want to take the lowest dose of any medication to treat your symptoms. You also want to take the most effective medication possible.
For example, studies suggest acetaminophen is highly effective at relieving headaches and the aches and pains of osteoarthritis. And it doesn’t come with the same concerns regarding cardiovascular or digestive diseases.
On the other hand, NSAIDs may pack a punch against certain muscle aches for some patients, as well as menstrual cramps.
For fighting fevers, there’s debate about what’s most effective. Ibuprofen may work for longer in single doses, but you can achieve similar results with acetaminophen by taking it more frequently. Because it comes with fewer risks overall, I typically recommend acetaminophen for children’s fevers. The same goes for elderly patients, for whom kidney function is often a concern.
The bottom line: Once you know you can safely take an over-the-counter medication, pick the one that works best for you. Even then, take it only when you need to — and take the least amount that controls your symptoms.
Generic Name: acetaminophen (Oral route, Rectal route)
Medically reviewed by Drugs.com. Last updated on Feb 20, 2019.
- Side Effects
Commonly used brand name(s)
In the U.S.
- Actamin Maximum Strength
- Anacin Aspirin Free
- Arthritis Pain Relief
- Children’s Mapap
- Children’s Nortemp
- Comtrex Sore Throat Relief
- Mapap Arthritis Pain
- Pain-Eze +/Rheu-Thritis
- Actimol Children’s
- Actimol Infant
- Children’s Acetaminophen
- Children’s Acetaminophen Bubble Gum Flavor
- Children’s Acetaminophen Cherry Flavor
- Children’s Acetaminophen – Grape
- Children’s Acetaminophen Grape Flavor
- Children’s Acetaminophen Suspension Bubble Gum Flavor – Ages 2 To 11
- Children’s Acetaminophen Suspension Cherry Flavor
Available Dosage Forms:
- Capsule, Liquid Filled
- Tablet, Chewable
- Tablet, Extended Release
- Tablet, Disintegrating
Therapeutic Class: Analgesic
Uses for Tylenol
Acetaminophen is used to treat minor aches and pain and to reduce fever. It may also help treat pain from mild forms of arthritis.
This medicine is available without a prescription.
Before using Tylenol
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of acetaminophen in children. However, do not give over-the-counter products to children under 2 years of age unless instructed to do so by your doctor.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of acetaminophen in the elderly.
Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.
Interactions with medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Pneumococcal 13-Valent Vaccine, Diphtheria Conjugate
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Interactions with food/tobacco/alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.
Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.
Other medical problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Alcohol abuse, or history of or
- Kidney disease, severe or
- Liver disease (including hepatitis)—May cause side effects to become worse.
- Phenylketonuria (PKU)—Some brands of acetaminophen contain aspartame, which can make this condition worse.
Proper use of acetaminophen
This section provides information on the proper use of a number of products that contain acetaminophen. It may not be specific to Tylenol. Please read with care.
Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Liver damage can occur if large amounts of acetaminophen are taken for a long time.
If you are taking this medicine without the advice of your doctor, carefully read the package label and follow the dosing instructions. Talk to your doctor if you have any questions.
Carefully check the labels of all other medicines you are using, because they may also contain acetaminophen. It is not safe to use more than 4 grams (4,000 milligrams) of acetaminophen in one day (24 hours), as this may increase the risk for serious liver problems. For Tylenol® Extra Strength, the maximum dose is 3,000 milligrams per 24 hours.
You may take this medicine with or without food.
For patients using the oral liquid with syringe (e.g. Little Fevers®):
- Shake the bottle well before each use.
- Measure the dose with the provided dose syringe (e.g., AccuSafe™) that comes with the package. Do not use any other syringe, dropper, spoon, or dosing device when giving this medicine to your child.
- Remove the cap, attach the syringe to the flow restrictor, and invert the bottle.
- Pull back the syringe until filled with the dose prescribed by your doctor.
- Slowly give the medicine into your child’s mouth (towards the inner cheek).
- Replace and tighten the cap.
For patients using the oral liquid with dropper:
- Shake the bottle well before each use.
- Measure the dose with the provided dropper. Do not use any other syringe, dropper, spoon, or dosing device when giving this medicine to your child.
- Remove the cap, insert the dropper and withdraw the dose prescribed by your doctor.
- Slowly give the medicine into your child’s mouth (towards the inner cheek).
- Replace the cap back tightly.
For patients using acetaminophen oral granules (e.g., Snaplets-FR):
- Just before the medicine is to be taken, open the number of packets needed for one dose.
- Mix the granules inside of the packets with a small amount of soft food, such as applesauce, ice cream, or jam.
- Eat the acetaminophen granules along with the food.
For patients using acetaminophen oral powders (e.g., Feverall® Sprinkle Caps ):
- These capsules are not intended to be swallowed whole. Instead, just before the medicine is to be taken, open the number of capsules needed for one dose.
- Empty the powder from each capsule into 1 teaspoonful (5 mL) of water or other liquid.
- Drink the medicine along with the liquid. You may drink more liquid after taking the medicine.
- You may also mix the powder with a small amount of soft food, such as applesauce, ice cream, or jam. Eat the acetaminophen powder along with the food.
For patients using acetaminophen suppositories:
- If the suppository is too soft to insert, chill it in the refrigerator for 30 minutes or run cold water over it before removing the foil wrapper.
- To insert the suppository:
- Remove the foil wrapper and moisten the suppository with cold water.
- Lie down on your side and use your finger to push the suppository up into the rectum.
The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For pain or fever:
- For oral and rectal dosage forms (capsules, granules, powders, solution, suppositories, suspension, or tablets):
- Adults and teenagers—650 to 1000 milligrams (mg) every 4 to 6 hours as needed. Dose is based on form and strength. Carefully follow the label instructions for the maximum dose per day.
- Children—Dose is based on weight or age. Carefully follow the label instructions for the maximum dose per day.
- Children 11 to 12 years of age: 320 to 480 mg every 4 to 6 hours as needed.
- Children 9 to 11 years of age: 320 to 400 mg every 4 to 6 hours as needed.
- Children 6 to 9 years of age: 320 mg every 4 to 6 hours as needed.
- Children 4 to 6 years of age: 240 mg every 4 to 6 hours as needed.
- Children 2 to 4 years of age: 160 mg every 4 to 6 hours as needed.
- Children under 2 years of age: Use and dose must be determined by your doctor.
- For oral and rectal dosage forms (capsules, granules, powders, solution, suppositories, suspension, or tablets):
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep the bottle closed when you are not using it. Store it at room temperature, away from light and heat. Do not freeze.
You may store the suppositories in the refrigerator, but do not freeze them.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Precautions while using Tylenol
It is very important that your doctor check the progress of you or your child while you are using this medicine. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it.
If your symptoms or fever do not improve within a few days or if they become worse, check with your doctor.
Many combination medicines contain acetaminophen, including products with brand names such as Alka-Seltzer Plus®, Comtrex®, Drixoral®, Excedrin Migraine®, Midol®, Sinutab®, Sudafed®, Theraflu®, and Vanquish®. Adding these medicines to the medicine you already take may cause you to get more than a safe amount of acetaminophen. Talk to your doctor before taking more than one medicine that contains acetaminophen.
Check with your doctor right away if you or your child have pain or tenderness in the upper stomach; pale stools; dark urine; loss of appetite; nausea; unusual tiredness or weakness; or yellow eyes or skin. These could be symptoms of a serious liver problem.
If you will be taking more than an occasional 1 or 2 doses of acetaminophen, do not drink alcoholic beverages. To do so may increase the chance of liver damage, especially if you drink large amounts of alcohol on a regular basis, if you take more acetaminophen than is recommended on the label, or if you take it regularly for a long time.
Acetaminophen may interfere with the results of some medical tests. Before you have any medical tests, tell the person in charge if you have taken acetaminophen within the past 3 or 4 days. You may also call the laboratory ahead of time to find out whether acetaminophen will cause a problem.
Acetaminophen may cause false results with some blood glucose tests. If you are diabetic and notice a change in your test results, or if you have any questions, check with your doctor.
If you think you have taken too much acetaminophen, get emergency help at once, even if there are no signs of poisoning. Treatment to prevent liver damage must be started as soon as possible.
Tylenol side effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
- Bloody or black, tarry stools
- bloody or cloudy urine
- fever with or without chills (not present before treatment and not caused by the condition being treated)
- pain in the lower back and/or side (severe and/or sharp)
- pinpoint red spots on the skin
- skin rash, hives, or itching
- sore throat (not present before treatment and not caused by the condition being treated)
- sores, ulcers, or white spots on the lips or in the mouth
- sudden decrease in the amount of urine
- unusual bleeding or bruising
- unusual tiredness or weakness
- yellow eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
- increased sweating
- loss of appetite
- nausea or vomiting
- stomach cramps or pain
- swelling, pain, or tenderness in the upper abdomen or stomach area
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Copyright 2019 Truven Health Analytics, Inc. All Rights Reserved.
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1. “Multum Information Services, Inc. Expert Review Panel”
2. Zimmerman HJ, Maddrey WC “Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: analysis of instances of therapeutic misadventure.” Hepatology 22 (1995): 767-73
3. Vitols S “Paracetamol hepatotoxicity at therapeutic doses.” J Intern Med 253 (2003): 95-8
4. Gursoy M, Haznedaroglu IC, Celik I, Sayinalp N, Ozcebe OI, Dundar SV “Agranulocytosis, plasmacytosis, and thrombocytosis followed by a leukemoid reaction due to acute acetaminophen toxicity.” Ann Pharmacother 30 (1996): 762-5
5. Kurtovic J, Riordan SM “Paracetamol-induced hepatotoxicity at recommended dosage.” J Intern Med 253 (2003): 240-3
6. McJunkin B, Barwick KW, Little WC, Winfield JB “Fatal massive hepatic necrosis following acetaminophen overdose.” JAMA 236 (1976): 1874-5
7. Cheung L, Meyer KC “Acetaminophen poisoning and liver function.” N Engl J Med 331 (1994): 1311-2
8. Minton NA, Henry JA, Frankel RJ “Fatal paracetamol poisoning in an epileptic.” Hum Toxicol 7 (1988): 33-4
9. Block R, Jankowski JA, Lacoux P, Pennington CR “Does hypothermia protect against the development of hepatitis in paracetamol overdose?” Anaesthesia 47 (1992): 789-91
10. Kumar S, Rex DK “Failure of physicians to recognize acetaminophen hepatotoxicity in chronic alcoholics.” Arch Intern Med 151 (1991): 1189-91
11. Lee WM “Acute liver failure.” Am J Med 96 (1994): 3-9
12. Hartleb M “Do thyroid hormones promote hepatotoxicity to acetaminophen?” Am J Gastroenterol 89 (1994): 1269-70
13. Mofenson HC, Caraccio TR, Nawaz H, Steckler G “Acetaminophen induced pancreatitis.” Clin Toxicol 29 (1991): 223-30
14. Kaysen GA, Pond SM, Roper MH, Menke DJ, Marrama MA “Combined hepatic and renal injury in alcoholics during therapeutic use of acetaminophen.” Arch Intern Med 145 (1985): 2019-23
15. Keays R, Harrison PM, Wendon JA, et al “Intravenous acetylcysteine in paracetamol induced fulminant hepatic failure: a prospective controlled trial.” BMJ 303 (1991): 1026-9
16. Bonkovsky HL “Acetaminophen hepatotoxicity, fasting, and ethanol.” JAMA 274 (1995): 301
17. Brotodihardjo AE, Batey RG, Farrell GC, Byth K “Hepatotoxicity from paracetamol self-poisoning in Western Sydney: a continuing challenge.” Med J Aust 157 (1992): 382-5
18. Keaton MR “Acute renal failure in an alcoholic during therapeutic acetaminophen ingestion.” South Med J 81 (1988): 1163-6
19. Lee WM “Medical progress: drug-induced hepatotoxicity.” N Engl J Med 333 (1995): 1118-27
20. Johnson GK, Tolman KG “Chronic liver disease and acetaminophen.” Ann Intern Med 87 (1977): 302-4
21. Rumore MM, Blaiklock RG “Influence of age-dependent pharmacokinetics and metabolism on acetaminophen hepatotoxicity.” J Pharm Sci 81 (1992): 203-7
22. Smilkstein MJ, Douglas Dr, Daya MR “Acetaminophen poisoning and liver function.” N Engl J Med 331 (1994): 1310-1
23. Shriner K, Goetz MB “Severe hepatotoxicity in a patient receiving both acetaminophen and zidovudine.” Am J Med 93 (1992): 94-6
24. Whitcomb DC “Acetaminophen poisoning and liver function.” N Engl J Med 331 (1994): 1311
25. Block R “Liver failure induced by paracetamol.” BMJ 306 (1993): 457
27. Bonkovsky HL, Kane RE, Jones DP, Galinsky RE, Banner B “Acute hepatic and renal toxicity from low doses of acetaminophen in the absence of alcohol abuse or malnutrition – evidence for increased susceptibility to drug toxicity due to cardiopulmonary and renal insufficiency.” Hepatology 19 (1994): 1141-8
28. O’Dell JR, Zetterman RK, Burnett DA “Centrilobular hepatic fibrosis following acetaminophen-induced hepatic necrosis in an alcoholic.” JAMA 255 (1986): 2636-7
29. Wong V, Daly M, Boon A, Heatley V “Paracetamol and acute biliary pain with cholestasis.” Lancet 342 (1993): 869
30. Bray GP “Liver failure induced by paracetamol.” BMJ 306 (1993): 157-8
31. Singer AJ, Carracio TR, Mofenson HC “The temporal profile of increased transaminase levels in patients with acetaminophen-induced liver dysfunction.” Ann Emerg Med 26 (1995): 49-53
32. Whitcomb DC, Block GD “Association of acetaminopphen hepatotoxicity with fasting and ethanol use.” JAMA 272 (1994): 1845-50
33. Cheung L, Potts RG, Meyer KC “Acetaminophen treatment nomogram.” N Engl J Med 330 (1994): 1907-8
34. Nelson EB, Temple AR “Acetaminophen hepatotoxicity, fasting, and ethanol.” JAMA 274 (1995): 301
35. Halevi A, BenAmitai D, Garty BZ “Toxic epidermal necrolysis associated with acetaminophen ingestion.” Ann Pharmacother 34 (2000): 32-4
36. Settipane RA, Stevenson DD “Cross sensitivity with acetaminophen in aspirin-sensitive subjects with asthma.” J Allergy Clin Immunol 84 (1989): 26-33
37. Kalyoncu AF “Acetaminophen hypersensitivity and other analgesics.” Ann Allergy 72 (1994): 285
38. Doan T “Acetaminophen hypersensitivity and other analgesics – response.” Ann Allergy 72 (1994): 285
41. Leung R, Plomley R, Czarny D “Paracetamol anaphylaxis.” Clin Exp Allergy 22 (1992): 831-3
42. Van Diem L, Grilliat JP “Anaphylactic shock induced by paracetamol.” Eur J Clin Pharmacol 38 (1990): 389-90
43. Bougie DW, Benito AI, Sanchez-Abarca LI, Torres R, Birenbaum J, Aster RH “Acute thrombocytopenia caused by sensitivity to the glucuronide conjugate of acetaminophen.” Blood 109 (2007): 3608-9
44. Shoenfeld Y, Shaklai M, Livni E, Pinkhas J “Thrombocytopenia from acetaminophen.” N Engl J Med 303 (1980): 47
45. Guccione JL, Zemtsov A, Cobos E, Neldner KH “Acquired purpura fulminans induced by alcohol and acetaminophen – successful treatment with heparin and vitamin-k.” Arch Dermatol 129 (1993): 1267-9
46. Filipe PL, Freitas JP, Decastro JC, Silva R “Drug eruption induced by acetaminophen in infectious mononucleosis.” Int J Dermatol 34 (1995): 220-1
47. Thomas RH, Munro DD “Fixed drug eruption due to paracetamol.” Br J Dermatol 115 (1986): 357-9
48. Kondo K, Inoue Y, Hamada H, Yokoyama A, Kohno N, Hiwada K “Acetaminophen-induced eosinophilic pneumonia.” Chest 104 (1993): 291-2
49. Brown G “Acetaminophen-induced hypotension.” Heart Lung 25 (1996): 137-40
50. Koulouris Z, Tierney MG, Jones G “Metabolic acidosis and coma following a severe acetaminophen overdose.” Ann Pharmacother 33 (1999): 1191-4
It is suggested that you stop taking acetaminophen and talk with your doctor if:
- You still feel pain after 10 days (adult) or 5 days (children)
- Your still have a fever after three days
- You get a skin rash, redness, or swelling, or an ongoing headache
- Your symptoms get worse, or you feel new symptoms
You may suffer liver damage if you take too much acetaminophen. To lessen the risk, it is suggested that you:
- Only take one product containing acetaminophen at a time
- Take acetaminophen exactly as directed by your doctor or the package label
- Do not take more than 4,000 mg of acetaminophen per day
- Let your doctor know if you have or have had liver disease
- Tell your doctor if you drink three or more glasses of alcohol per day
- Contact your doctor if you think you’ve taken too much acetaminophen
Acetaminophen may cause an allergic reaction. Symptoms may include:
- Itching or hives
- Swelling or tingling in your mouth or throat
- Swelling of your face or hands
- Tightness of the chest
- Trouble breathing
Other serious side effects of acetaminophen may include:
- Nausea, vomiting, loss of appetite, or severe stomach pain
- Trouble passing urine or change in the amount of urine
- Light-headedness, sweating, fainting, or weakness
- Unusual bruising or bleeding
- Yellowing of the skin or whites of your eyes
Contact your doctor immediately if you experience any of these side effects of acetaminophen.