According to the Centers for Disease Control and Prevention, 150 Americans die every year from ingesting too much acetaminophen, the active ingredient in Tylenol. Despite its reputation as a safe, over-the-counter medication, an increasing number of liver toxicity cases have caused serious concern in health care workers and consumers.
“If you are taking [Tylenol] for long periods of time you run into problems like liver failure and transplants,” said Matt Staples, a PharmD who works for the University Medical Center’s outpatient pharmacy and Elson Student Health.
Staples said pharmacies try to reconcile a patient’s prescriptions for more serious pain-killers — like Vicodin — with over-the-counter medications to make sure a person is not getting more than the recommended amount of acetaminophen per day.
“Often you’ll have three or four medications in one drug, but if it doesn’t have Tylenol written in the title, people may not realize there is acetaminophen in it,” he said. “Not everyone knows to keep an eye out for ingredients on the back of the box. Take Vicodin for example — it’s acetaminophen and oxycodone. When people don’t check the labels and take both Vicodin and Tylenol, they are doubling up.”
In the fall of 2011, to address rising concerns about the safety of Tylenol, Johnson & Johnson lowered the maximum daily dose from 4,000 mg to 3,000. For Tylenol Extra Strength, this decision dropped the maximum number of pills per day from eight to six. They also added a new cap to their bottles reading ‘Contains Acetaminophen, Always Read the Label’.
One remaining problem is the excessive number of products Tylenol has available to consumers, all with different dosage amounts. While Tylenol Extra Strength contains 650 mg of acetaminophen, Tylenol 8-hour Muscle Aches and Pains contains 500, and the Sinus and Allergy variety contains 325.
“A lot of people can’t necessarily figure out how much they are taking with extra strength products, or they will take more than 2 tablets, more than four times a day,” said Staples. “It comes down to being able to add it all up properly. There is a large population that are illiterate, they are ashamed of not being able to read, and they don’t always look for the help they need.”
Alcohol consumption can also create problems for those taking acetaminophen. Tylenol is metabolized by the liver and broken down into substances that are excreted in the urine — when more Tylenol is consumed than the liver can metabolize, these substances become toxic. Because the liver processes both Tylenol and alcohol, the two can interact causing increased liver damage.
“The liver processes alcohol, so when you are drinking and taking Tylenol, you are giving your liver double whammy,” Staples said.
But Staples also suggested that interactions between alcohol and acetaminophen are more problematic when habits are chronic. In other words, taking the recommended dose of Tylenol and going out to drink that night is not going to lead a person to experience toxicity symptoms and liver problems. People run into problems when they regularly consume several alcoholic drinks a day and take large doses of Tylenol.
Although the FDA requires alcohol warnings on products like Tylenol, consumers should be aware that taking Tylenol while consuming three or more alcoholic drinks per day puts them at an increased risk of damage.
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