Unintentional overdose with acetaminophen, found in Tylenol and over 200 over-the-counter and prescription medicines, is the leading cause of acute liver failure in the U.S. and United Kingdom. Acetaminophen liver toxicity is an active area of public health concern by the FDA and a number of initiatives are planned or under consideration to reduce this risk. These initiatives include stronger warnings on over-the-counter acetaminophen-containing products, eliminating acetaminophen from certain combination prescription pain products, and reducing the maximum daily and individual dose recommendations. Acetaminophen liver toxicity is influenced by a number of factors including maximum daily dose, alcohol intake, nutritional status, and co-administration with certain other drugs. Here is what you need to know:
1. The maximum daily recommended dose in adults is currently 4 g per day. Take no more than 1 g per individual dose. To be safe adults should take less than this, but never more than directed. Consult your pediatrician for appropriate dosing information in infants and children.
2. Look for the generic name acetaminophen (not the brand name Tylenol) on labels of all medicines you take. Toxicity can easily occur by unknowingly combining multiple acetaminophen-containing prescription and over-the-counter medicines. Acetaminophen is found in hundreds of medicines including many prescription pain products (like Vicodan and Percocet) and over-the-counter (OTC) cold and flu medicines (like NyQuil, DayQuil, and Therflu). Acetaminophen is known as paracetamol in European countries.
3. Chronic alcohol ingestion, prolonged fasting, and poor nutritional status can greatly reduce the daily amount of acetaminophen needed to cause significant liver injury in patients.
4. Consult your pharmacist about whether any of the prescription drugs you take might interact negatively with acetaminophen.
The importance of reading the labels of all OTC products you take cannot be over emphasized.
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