This Over-the-Counter Medication is Not as Safe as You Think

When you grab an over-the-counter pain reliever, the assumption is that it’s reasonably safe, but the line between a safe dose of acetaminophen and a toxic one is scarily narrow.

A new study, published in the Journal of Hepatology, found that acetaminophen is responsible for a shocking 46 percent of liver failure cases and 100,000 calls to Poison Control every year. What is going on with acetaminophen?

What is a safe dose of acetaminophen?

Acetaminophen Safety

This isn’t the first study looking at the danger of acetaminophen—the active ingredient in pain relievers like Tylenol, which also goes by the names paracetamol and APAP. A paper published in The Lancet back in 1975 questioned the drug’s safety. “If paracetamol was discovered today,” the paper says, “It would not be approved by the Committee on Safety of Medicines and it would certainly never be freely available without a prescription.”

Why a prescription? Because of how easy it is to take too much, which results in serious liver damage.

The 2017 acetaminophen safety study seems to agree with that assessment. The authors write that its “toxicity dwarfs all other prescription drugs as a cause of acute liver failure in the US and Europe, but it is not regulated in any significant way.”

Related: Acetaminophen Makes You Less Capable of Empathy

I first learned about how unsafe acetaminophen can be from an episode of Adam Ruins Everything. The episode title is Adam Ruins Security, and he explains that part of the problem is that Tylenol isn’t the only medication containing acetaminophen.

More than 600 medications contain acetaminophen, so you may already be taking the drug without knowing it. That makes it easy for people to accidentally double up on acetaminophen-containing medicines. Here are a few medications—over-the-counter and prescription—that you may not know contain acetaminophen:

  • Alka-Seltzer Plus
  • Dimetapp
  • Sudafed
  • Percocet
  • Vicoden

Before you pop a Tylenol for your next headache, make sure you’re not already taking another medication with acetaminophen in it.

What is a safe dose of acetaminophen?

The National Library of Medicine says that acetaminophen is perfectly safe at low doses. The problem is that the difference between the recommended dose and a toxic dose of Tylenol is a little as two to three pills.

Tylenol recommends a maximum daily dose of 3,000mg, or six pills a day, spaced four hours apart. According to The National Library of Medicine, taking 4,000mg (that’s eight pills per day) for three to seven days is enough to begin damaging your liver. The good news is that if you stop taking the drug within this time period, your body will most likely bounce back.

Know Your Dose—a coalition of healthcare providers and consumer advocacy groups—says that taking more than 4,000mg in a day is considered an overdose and can damage your liver. That’s just three daily pills more than the recommended dose. Below is an infographic laying out some important acetaminophen safety facts. You can click the graphic below to view it larger.

Acetaminophen Safety Graphic

The best way to protect yourself from acetaminophen overdose is to take as little as possible. If you have a headache, take one Tylenol instead of two, and see if that helps. Better yet, take a different pain reliever that has a better safety record, or try some natural pain relieving methods before popping a pill at all.

It’s also important to know what other medications you’re taking contain the drug. If you’re not sure, call your pharmacy. A pharmacist can tell you exactly what is in the medications you’re taking.

Related at Care2

When you grab an over-the-counter pain reliever, the assumption is that it's reasonably safe, but the line between a safe dose of acetaminophen and a toxic one is scarily narrow.

All images via Thinkstock.


heather g
heather g9 days ago

don't know why people don't read labels and instructions....

Elizabeth C
Elizabeth C10 days ago

Read labels of OTC drugs and prescribed drugs.they tell you if there's acetaminophen and how muchis in them .No need to guess.

Kerrie G
Kerrie G11 days ago

Shared, thanks.

Paola S
Paola S11 days ago

Good to know. Thank you.

GGmaSAway D
GGmaSAway D11 days ago

Tylenol is the most doctor recommended OTC pain reliever...I've never had a doctor recommend anything else. It has never worked for me so don't take it, but didn't know that it was in other drugs. Why don't doctors tell us what's in the medications they want to prescribe...before we spend the money so we know what we are taking? My doctor is always so rushed I don't get the time I need to find out everything I need to know.

Marija M
Marija M11 days ago

tks for sharing

Virginia Miller
Virginia Miller11 days ago

Good info, thanks.

Janis K
Janis K11 days ago

Thanks for sharing.

Fred Campbell
Fred Campbell12 days ago

Learned something. Thanks.

Mostapha Z
Mostapha Z12 days ago

Than you for sharing this important public awareness article.