Home   >   Dr. Ruman's Newsletters  >  The Dangers of Acetaminophen (aka Tylenol)

The Dangers of Acetaminophen (aka Tylenol)
What you don't know can kill you, really!

  |     |  

Here is a typical scenario. You have had a very rigorous work out. As you leave the gym you begin to feel your muscles tightening.  By the time you get home you are stiff and achy.  After a long hot shower you open your medicine cabinet and take out a bottle of Tylenol to soothe your tired and sore muscles.

Did you know that you just took an over the counter medication that can be potentially harmful or even fatal? One only has to look as far as the over the counter medication aisle of their local grocery store to find this potential danger, and it is called acetaminophen (the best known brand is called “Tylenol”).

All in all, the numbers of people who use acetaminophen do so safely.  However, each year acetaminophen overdoses account for more than 56,000 emergency room visits, 2600 hospitalizations, and an estimated 458 deaths due to acute liver injury and failure.

When acetaminophen overdoses are discovered in time, an antidote called n-acetylcysteine (Mucomyst) can be given to prevent liver damage.  Unfortunately, acetaminophen levels tend to accumulate over a course of days and often go unrecognized until liver failure is well underway and irreversible.

While there are warning signs on all acetaminophen products not to exceed the maximum recommended dosage, oftentimes there are so many kinds of acetaminophen products from cold and flu preparations to arthritis formulas to prescription containing narcotics like vicodin that often the warnings go unheeded or unrecognized. 

While acetaminophen itself isn’t toxic it’s breakdown product by the liver is.  Usually this productN-acetyl-p-benzoquinone imine (or NAPQI) is shuttled away by a substance called glutathione.  Too much acetaminophen consumed can overwhelm the glutathione stores allowing the build up of NAPQI leading to liver damage.  Concomitant use of alcohol with acetaminophen ingestion can further deplete glutathione levels which is one reason it should not be taken with acetaminophen.

How can you protect yourself?  First and foremost read labels.  For healthy adults the maximum recommended intake in 24 hours is 4 grams or 4000 milligrams.  This is equivalent to 12 regular strength acetaminophen tablets of 325 milligrams or 8 extra-strength tablets of 500 milligrams.  Other products like “Tylenol 8 Hour, Tylenol Cold and Flu, and Tylenol Arthritis Pain contain even more milligrams per tablet so read labels.

In addition acetaminophen is found in many over the counter combination medications such as Alka-Seltzer, Excedrin, NyQuil, and TheraFlu.  It is also found in prescription painkillers such as darvocet, percoset, and vicodin. So checking the labels of all the medications you take to make sure you are not exceeding the maximum allowable acetaminophen daily intake is paramount.


Lastly as alcohol can deplete glutathione levels, alcohol consumption should be avoided or minimized during acetaminophen ingestion.


So remember: the take home message is that while medications are labeled as “over the counter” they should be used as directed and wisely.

As always, if you have any questions or concerns I am happy to help.  Until we speak again in person or via email newsletter, stay well!


Andrea Ruman MD


If there are other topics which you would like to see addressed in subsequent newsletters, please feel free to email me at newsletter@DrRuman.com  and let me know about them.


Selected resource: National Council on Patient Information and Education.

Back to Top
Get Dr. Ruman's free newsletter!

Andrea Ruman, M.D. - Doctor of Internal Medicine
© 2006 - 2019 All Rights Reserved • Site concept, design & development by A Far Site Better
Dr. Andrea Ruman: Female medical doctor, physician, internist for Marina Del Rey, Santa Monica, West Los Angeles (LA), and Culver City in California. Specialties include women's health (including physical examinations, pelvic exams and pap smears), weight loss support and preventive medicine.