Tylenol Liver Damage (cont.)
Why should we know that the generic name of
Tylenol is acetaminophen?
For the remainder of this discussion, we will refer to the generic name
acetaminophen, rather than to the brand name Tylenol. We have decided to do this to
emphasize the need for people to read the labels of medicine bottles carefully.
As mentioned above, the labels usually will say acetaminophen rather than
Tylenol. For example, each tablespoon of the common nighttime cold remedy,
NyQuil, contains 500 milligrams (mg) of acetaminophen. Similarly, each tablet of
hydrocodone/acetaminophen (Vicodin), a popular, potent painkiller that contains a narcotic, has also either
500, 650, or 750 mg of acetaminophen, depending on the formulation.
As already mentioned, an overdose of acetaminophen can cause liver damage.
This damage occurs in a dose-related manner. (Some other medications can cause
liver injury in an unpredictable fashion that is unrelated to the dose.) In
other words, liver injury from acetaminophen occurs only when someone takes more
than a certain amount of the drug. Likewise, the higher the dose, the greater is
the likelihood of the damage. Moreover, this liver injury from an overdose
of acetaminophen is a serious matter because the damage can be severe and result
in liver failure and death. In fact, acetaminophen overdose is the leading cause
of acute (rapid onset) liver failure in the U.S. and the United Kingdom.
Just how much acetaminophen is safe to take?
For the average healthy adult, the recommended maximum dose of acetaminophen
over a 24 hour period is four grams (4000 mg) or eight extra-strength pills.
(Each extra-strength pill contains 500 mg and each regular strength pill
contains 325 mg.) A person who drinks more than two alcoholic beverages per day,
however, should not take more than two grams of acetaminophen over 24 hours, as
discussed below. For children, the dose is based on their weight and age, and
explicit instructions are given in the package insert. If these guidelines for
adults and children are followed, acetaminophen is safe and carries essentially
no risk of liver injury.
On the other hand, a single dose of 7 to 10 grams of
acetaminophen (14 to 20 extra-strength tablets) can cause liver injury in the
average healthy adult. Note that this amount is about twice the recommended
maximum dose for a 24 hour period. In children, a single dose of 140 mg/kg (body
weight) of acetaminophen can result in liver injury. Amounts of acetaminophen,
however, as low as 3 to 4 grams in a single dose or 4 to 6 grams over 24 hours
have been reported to cause severe liver injury in some people, sometimes even
resulting in death. It seems that certain individuals, for example, those who
regularly drink alcohol, are more prone than others to developing acetaminophen-induced liver damage. To
understand this increased susceptibility in some people, it is useful to know
how acetaminophen is processed (metabolized) in the liver and how the drug
causes liver injury.
Next: How is acetaminophen processed (metabolized) in the body? »
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