Too Much of a Good Thing

Acetaminophen is the generic name for the commonly used over-the-counter (OTC) product Tylenol®. Since acetaminophen is most often used to reduce pain and fever, it is found in many combination OTC and prescription medications. Many consumers have the misconception that acetaminophen is extremely safe because it is so easily available and unlike ibuprofen, aspirin, or naproxen, it does not cause stomach pain or bleeding.

Acetaminophen can be most dangerous when the daily recommended total dose of 4 grams is exceeded. An overdose of acetaminophen can lead to liver damage. Patients with liver disease should probably receive less than 4 grams of acetaminophen per day, but should consult their physician for the recommended daily maximum dose.

A study in 2005 showed that acetaminophen poisoning accounted for 42 percent of acute liver failure cases. Many of these cases were caused by unintentional acetaminophen overdose. The FDA held a meeting in June 2009 to help decrease the number of consumers who experience liver toxicity through acetaminophen use. A public education campaign has been started to educate consumers.

Consumers can do their part by reading all of the ingredients in combination products. On OTC medications, check the “Drug Facts” label under the “Active Ingredients” section. On prescription combination products, it can be listed as acetaminophen or APAP, a well known abbreviation for acetaminophen.

Common prescription medications that contain acetaminophen:

Acetaminophen and Hydrocodone (Vicodin®, Lortab®, Norco®)
Acetaminophen and Oxycodone (Percocet®, Roxicet®, Endocet®)
Acetaminophen and Propoxyphene (Darvocet-N®)
Acetaminophen and Tramadol (Ultracet®)
Acetaminophen and Isometheptene and Dichloralphenazone (Midrin®)
Acetaminophen and Butalbital and Caffeine (Fioricet®)
Acetaminophen and Codeine (Tylenol #3®, Tylenol #4®, Tylenol Elixir with Codeine)

Common OTC medications that contain acetaminophen:

Acetaminophen and Diphenhydramine (Tylenol PM®, Excedrin PM®, Tylenol Severe Allergy®)
Acetaminophen and Aspirin and Caffeine (Excedrin® Extra Strength, Excedrin® Migraine)
Acetaminophen and Pamabrom (Midol®)
Acetaminophen and Phenylephrine (Alka-Seltzer Plus® Sinus Formula, Sudafed PE® Sinus Headache, Vicks® DayQuil® Sinus, Excedrin® Sinus Headache)
Acetaminophen and Dextromethorphan and Doxyalamine (Vicks® NyQuil® Cold and Flu Multi-Symptom)
Acetaminophen with Chlorpheniramine (Coricidin HBP® Cold and Flu)

Make sure you are checking your medication lists twice so that you aren't doubling up on your medications. And as always, speak to your family doctor regarding any medication changes.


Alisia Baker, Pharm.D.