Is Tylenol Safe?

Acetaminophen is one of the most commonly used drugs. What is the danger of taking too much?

Rob Lamberts, MD,
July 8, 2009
Episode #004

I am sure a lot of you have heard about the recent warnings regarding acetaminophen, the ingredient found in Tylenol. It seems like nearly every medicine we thought was safe ends up being dangerous, doesn’t it? In this podcast I will explain the dangers of this drug and safe ways to use it.

Let me remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.

FDA Recommendations for Tylenol

For those of you who did not hear the news, here are the FDA recommendations for acetaminophen:

1.      All acetaminophen products should be clearly labeled with a warning of the risk of liver damage.

2.      The warning should also mention the danger of moderate to heavy alcohol consumption with this drug.

3.      There are many medications that contain acetaminophen in combination with other drugs; these should be clearly labeled as containing acetaminophen.

4.      Acetaminophen is an important medication and should not be taken off of the market.

What’s my bottom line? Acetaminophen is very safe if taken appropriately, but very dangerous if taken in large amounts.

When Acetaminophen is Dangerous

You probably don’t realize it, but acetaminophen is the number one cause of drug-induced liver failure in the United States. Each year thousands of people need treatment for liver damage related to this drug, and hundreds of people die due to liver failure from taking too much of it. There are three main ways people put themselves at risk:

1. Intentional Overdose

The first is intentional overdose. Two of my saddest moments as a doctor have been because of acetaminophen overdoses. I have seen two young people who took large doses of it as suicide gestures. Neither of them was really trying to kill themselves; they took it because they thought it was safe. It’s just Tylenol; it’s not that dangerous. Unfortunately, neither realized the danger until it was too late. Both of them died because they didn’t seek help in time. I really believe that proper labeling and education might have prevented these tragic deaths.

2. Combination Drugs

The second way people get too much of this medication is by taking it along with combination drugs that contain acetaminophen. Many common pain medicines contain acetaminophen along with a narcotic. Common examples include:

·        Vicodin

·        Percocet

·        Lortab and Lorcet

·        Darvocet

There are also common non-prescription drugs containing acetaminophen. Here are some examples:

·        Nyquil

·        Theraflu

·        Excedrin

·        Contac

I’ll post a link to a list of these drugs in the show notes. In general, look for “cet” at the end of the name or the letters “APAP” on the label, as they often indicate the presence of acetaminophen.

3. Alcohol and Liver Disease

Finally, people who drink more than two drinks per day, and people with liver disease should be very careful taking acetaminophen. Alcohol is also toxic to the liver, and so can increase the toxicity of this drug. Ask your doctor if you are not sure if you should take Tylenol or other acetaminophen-containing drugs.

What about the binge-drinker? An alcohol binge can certainly harm the liver, so adding drug that could harm the liver is not a good idea. If you think you might drink heavily later in the day, you should skip the Tylenol.


Acetaminophen overdoses are not necessarily fatal; we have good treatment in case of overdose . As long as the treatment is given within 8-10 hours of an overdose, the chance of liver failure is low. But if treatment is not sought in time, the destruction of the liver cells is irreversible. That is what happened to the two kids I saw.

Taking a little over the recommended dose won’t hurt you. It takes more than seven times the recommended dose to cause liver damage. But taking more doesn’t make it more effective either. Stick with what is recommended. I will put a dosage chart at the end of the show notes.

When Acetaminophen is Safe

But hear me on this point: if taken in its recommended dosage, acetaminophen is extremely safe. It has been used for years by millions of people without problems. It is good at reducing fevers and relieving pain without risk of serious side effects. It is still the safest medication for these problems.

But no drug is totally safe. Aspirin, decongestants, and even antacids can cause problems if taken in large amounts. Never take medication you don’t need and certainly never take medication outside of the recommended dosage range unless under the close supervision of your doctor.

Quick and Dirty Tips Regarding Use

So here are my tips regarding acetaminophen:

1.      It is safe to use for fever and pain. Make sure you read the dosage guides carefully, and consult your doctor if you are unsure. 

2.      Using it outside of the recommended dose doesn’t make it work better and can cause serious harm.

3.      Check the labels of any other prescription or over-the counter medications you are taking. Not doing this could make you accidentally take too much acetaminophen. Always read labels.

4.      Don’t take acetaminophen if you have liver disease or regularly drink more than two drinks per day without first consulting your doctor.

5.      If you or a loved one has possibly taken too much, seek immediate attention. Time is of the essence. Go to the emergency room immediately.

That’s it for today’s episode. Please remember that though medications can reduce suffering and treat problems, all medications should only be taken as directed and only if you really need them.
If you have questions you want answered, send them to housecalldoctor@quickanddirtytips.com.
Catch you next time! Stay Healthy!
List of drugs containing acetaminophen (not necessarily complete):
Good article on the subject:
Dosage chart for children:


Pills image courtesy of Shutterstock