Tylenol (Acetaminophen) Liver Damage

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Acetaminophen (Tylenol) liver damage facts

  • Acetaminophen is a very safe drug when taken as directed, even for people with liver disease. Nevertheless, every drug carries risks.
  • Liver damage from acetaminophen, which can be severe, can result either from an overdose or from regular doses that are taken while drinking alcohol.
  • Most cases of acetaminophen-induced liver injury are caused by an intentional or suicidal overdose.
  • Unintentional or accidental overdose of acetaminophen can usually be avoided with care and attention to the dosing.
  • Physicians can estimate a patient's probability of developing liver injury based on the timing of the overdose and the blood level of the drug.
  • In patients with acetaminophen liver damage, the usual clinical sequence is nausea and vomiting for the first 12-24 hours, then the patient seems well for the next 12-24 hours, after which abnormal liver blood tests develop.
  • An antidote, N-acetyl cysteine, is available and should be given to the patient as soon as possible, preferably within 16 hours after the acetaminophen was taken.

"Is it safe for me to take Tylenol?"

Tylenol is currently the most popular painkiller in the United States. Americans take over 8 billion pills (tablets or capsules) of Tylenol each year. Acetaminophen is the general (generic) name for Tylenol, which is a brand name. Although acetaminophen is contained in over 200 medications, most of them do not have the name "Tylenol" on their labels. Moreover, just about every patient with liver disease in my practice invariably asks:

  • "Is it safe for me to take Tylenol?" or
  • "How much Tylenol can I take?"

These questions highlight the public's awareness of the potential for acetaminophen to cause liver damage or injury.

Tylenol is a very effective pain-killing (analgesic) and fever-reducing (anti-pyretic) agent. It is also a very safe drug as long as the recommended dosage is not exceeded. In fact, the use of Tylenol instead of aspirin to treat fevers in infants has greatly reduced the occurrence of Reye's syndrome, an often fatal form of liver failure. Ironically, however, taking too much Tylenol (an overdose) can also cause liver failure, although by a different process (mechanism), as discussed below.

Medically Reviewed by a Doctor on 1/6/2014

Patient Comments

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Tylenol Liver Damage - Symptoms Question: What was the treatment of your Liver damage?
Tylenol Liver Damage - Signs and Symptoms Question: What were the signs and symptoms of Tylenol-induced liver damage in you or someone you know?
Tylenol Liver Damage - Alternatives Question: If concerned about acetaminophen liver damage, how do you manage pain? What else do you take?
Taking too much acetaminophen (Tylenol) can be easily done if a person is taking mulitple medications with acetaminophen as an ingredient.

Drug Interactions: Know the Ingredients, Consult Your Physician

Medical Author: Dennis Lee, M.D.
Medical Editor: Jay M. Marks, M.D.

John is a gentleman with a delightful sense of humor, a successful businessman, a loving husband, and a proud father of two beautiful children. I first met him more than 10 years ago in a local hospital. (Both of us were under 40 years of age.) I was asked by his internist to help manage John's serious liver disease. The way in which he developed his liver disease demonstrates how ordinarily-safe, over-the-counter (OTC) medications can be deadly when used improperly and the potentially serious nature of adverse interactions among drugs and of drugs with food.

While actual dates of the events have become fuzzy, I remember the essence of what happened. John had more than a few drinks at a New Year's Eve party at a local restaurant. The following morning, he developed nausea, vomiting, headacheand flu-like symptoms. He took several over-the-counter cold/flu medications every few hours for relief from his symptoms; as the symptoms persisted he took more medications.

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