# So how deadly is acetaminophen really? **URL:** \ **Category:** Factual Questions\ **Created:** [March 19, 2012, 6:25am UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202 "2012-03-19T06:25:06Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![grude](https://avatars.discourse-cdn.com/v4/letter/g/e47774/32.png) [@grude](https://boards.straightdope.com/u/grude)\ **Post date:** [March 19, 2012, 6:25am UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/1 "2012-03-19T06:25:06Z")
For all purposes let us assume the patient is a average person with no hepatic problems in average health. I see warnings that say anywhere from 2-4 grams in a 24 hour period COULD be deadly and to seek medical attention, yet many people routinely exceed this to scary degrees and don’t have an issue. I remember a woman who claimed to be taking around twenty vicodin a day due to addiction without issue, that was around 10 grams daily of aceto! In fact a physician advised me to take OTC painkillers with what would total 4 grams of acetaminophen in a day, when I scoffed she said it would be fine just not to drink liquor while taking it:confused: I’m guessing this is a better safe than sorry issue and the warning uses the smallest conceiveable amount that could cause a problem, but makes it unclear where the real line for concern is. ---
**Author:** ![Senegoid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/senegoid/32/6606_2.png) [@Senegoid](https://boards.straightdope.com/u/Senegoid)\ **Post date:** [March 19, 2012, 9:44am UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/2 "2012-03-19T09:44:14Z")
Of course, it varies by individual. The dangerous thing about acetaminophen (paracetamol everywhere else in the world), and with many other drugs, is that the amount you need to have the desired effect is _very close_ to the amount that is toxic. So you have to be very careful with the dosage. ---
**Author:** ![Miss\_Violaceous](https://avatars.discourse-cdn.com/v4/letter/m/2bfe46/32.png) [@Miss\_Violaceous](https://boards.straightdope.com/u/Miss_Violaceous)\ **Post date:** [March 19, 2012, 10:49am UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/3 "2012-03-19T10:49:16Z")
You also have to consider that the warnings are directed at the population as a whole, which includes a lot of people who lie, justify or are in denial about their drinking. ---
**Author:** ![Antigen](https://avatars.discourse-cdn.com/v4/letter/a/848f3c/32.png) [@Antigen](https://boards.straightdope.com/u/Antigen)\ **Post date:** [March 19, 2012, 10:57am UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/4 "2012-03-19T10:57:07Z")
> [@Miss\_Violaceous](#): > > You also have to consider that the warnings are directed at the population as a whole, which includes a lot of people who lie, justify or are in denial about their drinking. Not to mention people who are taking other medications that affect the liver and can interact badly with the acetaminophen. It’s easy to figure it must be safe, since it’s available over the counter and really cheap, but the truth is it doesn’t take much for it to do a number on your liver, in the right circumstances. ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [March 19, 2012, 11:07am UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/5 "2012-03-19T11:07:26Z")
A guy I know who takes large amounts of a narcotic-acetaminophen combo, does a simple extraction procedure to remove the acetaminophen. I don’t know how common this is. ---
**Author:** ![benbo1](https://avatars.discourse-cdn.com/v4/letter/b/e19adc/32.png) [@benbo1](https://boards.straightdope.com/u/benbo1)\ **Post date:** [March 19, 2012, 11:16am UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/6 "2012-03-19T11:16:48Z")
this is a serious & ongoing problem, as everyday we hear about more side effects of whatever analgesic is taken. Just last year, a study came out saying there’s NO safe amount of time for anyone with heart issues to take an NSAID (like Alleve) - even 1 day could affect the heart. Of course, with Tylenol it’s the liver to be concerned about. The only alternative I’ve found is Norco, which has more codeine & less acetaminophen. Still, no more than 6 a day (assuming they call a day as 24 hours). The Holy Grail of pills would be an analgesic with no effects on any organ. None so far. ---
**Author:** ![mnemosyne](https://avatars.discourse-cdn.com/v4/letter/m/c4cdca/32.png) [@mnemosyne](https://boards.straightdope.com/u/mnemosyne)\ **Post date:** [March 19, 2012, 2:42pm UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/7 "2012-03-19T14:42:44Z")
> [@benbo1](#): > > The Holy Grail of pills would be an analgesic with no effects on any organ. None so far. Which would mean it wouldn’t work at all - medicine must, by definition, affect _something_ in the body! I know, you meant no _negative_ or unwanted side effects 🆒 Drug design is an interesting field (sorta… I almost went into it) and it would be awesome to be able to design a molecule that affects only the system/organ/chemical pathway/whatever that is causing illness. The problem is that the body isn’t compartmentalized in that manner - the enzymes and proteins in our cells often have more than one role and they are often “generalists” - able to function with a whole class of molecules rather than with one specific thing. Trying to tweak things with a different molecule (one created in a lab) will pretty much always disrupt something other than the intended system, to some extent. If that happens to be a very small disruption, that’s a good thing. Think about it - you are putting stuff into your body with the intended purpose of screwing around with the way your body is currently functioning (to treat/stop/alter symptoms of illness/injury). Is it really a surprise, then, that the drug screws around with the way your body functions? 🙂 ---
**Author:** ![Thudlow\_Boink](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/thudlow_boink/32/320_2.png) [@Thudlow\_Boink](https://boards.straightdope.com/u/Thudlow_Boink)\ **Post date:** [March 19, 2012, 3:38pm UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/8 "2012-03-19T15:38:22Z")
[The Master Speaks](http://www.straightdope.com/columns/read/2354/does-tylenol-alcohol-liver-failure-plus) [QUOTE=Cecil Adams] The real problem with drugs like Tylenol is that the difference between a therapeutic (that is, medically effective) dose and a toxic one is surprisingly small. In adults the maximum safe dosage is four grams (eight 500-milligram tablets) over a 24-hour period. The toxic dose is a mere seven grams taken all at once. You can make the margin even thinner by drinking too much and eating too little. [/QUOTE] ---
**Author:** ![Senegoid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/senegoid/32/6606_2.png) [@Senegoid](https://boards.straightdope.com/u/Senegoid)\ **Post date:** [March 20, 2012, 3:48am UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/9 "2012-03-20T03:48:05Z")
> [@Thudlow\_Boink](#): > > [The Master Speaks](http://www.straightdope.com/columns/read/2354/does-tylenol-alcohol-liver-failure-plus) That’s what I wrote in post #2. Aha! I knew I learned that fact from somewhere! (From elsewhere, I’ve heard the same said about lithium (used as an antidepressant), from a user of such.) ---
**Author:** ![wheresmymind](https://avatars.discourse-cdn.com/v4/letter/w/91b2a8/32.png) [@wheresmymind](https://boards.straightdope.com/u/wheresmymind)\ **Post date:** [March 20, 2012, 5:33am UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/10 "2012-03-20T05:33:55Z")
> [@grude](#): > > In fact a physician advised me to take OTC painkillers with what would total 4 grams of acetaminophen in a day, when I scoffed she said it would be fine just not to drink liquor while taking it:confused: It should be noted that taking acetaminophen the morning AFTER a night of drinking (i.e. as a hangover remedy) can be as bad or even worse than tanking it WITH alcohol. ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [March 20, 2012, 7:57am UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/11 "2012-03-20T07:57:48Z")
> [@wheresmymind](#): > > It should be noted that taking acetaminophen the morning AFTER a night of drinking (i.e. as a hangover remedy) can be as bad or even worse than tanking it WITH alcohol. Taking acetaminophen WITH alcohol actually REDUCES the chance of toxicity. Paraphrasing what I said [here](http://boards.straightdope.com/sdmb/showthread.php?t=570464): > [@myself](#): > > 1. if the alcohol is taken at the same time as the acetaminophen, the chance of toxicity is actually reduced. > 2. however, if the person uses alcohol on a daily, or near-daily, basis, the risk of toxicity from the co-ingestion of acetaminophen is increased. > > To explain these statements, you need to understand, firstly, that toxicity due to acetaminophen is a result of the accumulation of one of its breakdown products, and not the acetaminophen itself. This toxic breakdown product is formed as the result of a particular enzyme working on the acetaminophen. As it turns out, this enzyme is also one of the ones that’s also involved in breaking down alcohol. Since our bodies have only a limited amount of this enzyme, if follows that if the enzyme is busy working on alcohol, there is less of it available to work on acetaminophen (and thus less available to generate the toxic breakdown product). In other words, drinking alcohol at the same time as taking acetaminophen protects against acetaminophen toxicity. > > But why does _daily_ alcohol use tend to lead to increased acetaminophen toxicity? The answer is twofold: a. habitual alcohol users have a limited supply of glutathione, the natural ‘antidote’ for acetaminophen. This makes them more susceptible to acetaminophen toxicity b. daily alcohol users tend also to have increased levels (or ‘activity’) of the enzyme responsible for generating the toxic breakdown product of acetaminophen as described above (i.e. alcohol “induces” that enzyme, a not uncommon phenomenon in biology where an enzyme’s substrate is also its inducer). Again, the expected result is increased acetaminophen toxicity. ---
**Author:** ![bouv](https://avatars.discourse-cdn.com/v4/letter/b/bc8723/32.png) [@bouv](https://boards.straightdope.com/u/bouv)\ **Post date:** [March 20, 2012, 1:29pm UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/12 "2012-03-20T13:29:49Z")
I have to wonder…if acetaminophen was discovered today, would any drug company even bother to market it? I mean…here you have a drug that, on paper, is no better at pain/fever relief than NSAIDS, but with a much smaller margin between therapeutic and toxic doses, and with worse long term side effects as well. ---
**Author:** ![mnemosyne](https://avatars.discourse-cdn.com/v4/letter/m/c4cdca/32.png) [@mnemosyne](https://boards.straightdope.com/u/mnemosyne)\ **Post date:** [March 20, 2012, 3:04pm UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/13 "2012-03-20T15:04:48Z")
> [@bouv](#): > > I have to wonder…if acetaminophen was discovered today, would any drug company even bother to market it? > > I mean…here you have a drug that, on paper, is no better at pain/fever relief than NSAIDS, but with a much smaller margin between therapeutic and toxic doses, and with worse long term side effects as well. This is purely anecdotal, from one of the drug design guys at a contract pharmaceutical company I worked for - it was his \*opinion \*that were it to be wholly discovered today, acetaminophen would likely not be available OTC, but that historical reasons and public (or, perhaps, more likely corporate) pressure on the FDA keep it OTC. I have no idea if there’s any truth to that, but based on my experience, it at least sounds _plausible._ ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [March 20, 2012, 3:55pm UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/14 "2012-03-20T15:55:58Z")
Right. But the other problem is that acetaminophen hides in quite a few other OTC medicines, like most “cold & flu” concoctions. So, some dude is sick, he takes his acetaminophen as per label…. Well maybe “just a little extra”. But then he also takes Dayquil then Nyquil. Meanwhile he is drinking and not eating much. WHAM- liver failure. ---
**Author:** ![mnemosyne](https://avatars.discourse-cdn.com/v4/letter/m/c4cdca/32.png) [@mnemosyne](https://boards.straightdope.com/u/mnemosyne)\ **Post date:** [March 20, 2012, 7:39pm UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/15 "2012-03-20T19:39:46Z")
That’s a very good point, and is probably a larger contributor to patients with liver problems than people simply taking too many Tylenol straight up. It’s pretty important to read medicine labels - and especially with cough and flu medications just buy the ingredients you need: you can always take acetaminophen separately if you need it for pain relief, but there’s not much need to take it if you don’t have symptoms it can treat. Pain -\> acetaminophen Dry Cough -\> detromethorphan (often things labelled “DM” also have acetaminophen, but some don’t) Productive cough -\> guaifenesin Congestion - phenylephrine (pseudoephedrine) (Drowsiness - caffeine) All-in-one products are tempting from a cost and marketing perspective, but separate ingredients (or choosing the small package of particular ingredients instead of the big bottle for each time you get sick!) are probably smarter health-wise. 🙂 ---
**Author:** ![thelabdude](https://avatars.discourse-cdn.com/v4/letter/t/dc4da7/32.png) [@thelabdude](https://boards.straightdope.com/u/thelabdude)\ **Post date:** [March 20, 2012, 8:24pm UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/16 "2012-03-20T20:24:11Z")
At my urologist today over blood in my urine, longterm complex problem. He asked about taking aspirin. I said no, but I am taking I Ibruprofen. He said to switch to Tylenol. ---
**Author:** ![VOW](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/vow/32/3043_2.png) [@VOW](https://boards.straightdope.com/u/VOW)\ **Post date:** [March 20, 2012, 8:42pm UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/17 "2012-03-20T20:42:46Z")
Aspirin and NSAIDs affect the kidneys. I’m Diabetic, with High Blood Pressure and High Cholesterol. My doctor has been monitoring my kidney function for quite some time now, and she finally spelled it out: I’ve got Chronic Kidney Disease, Stage 3. I’m not supposed to take NSAIDs, any more. It’s one of those damned if you do, damned if you don’t. Because for a HELLUVA lot longer than I’ve had the Diabetes-Cholesterol-Blood Pressure business, I’ve had chronic migraines. With chronic pain, you do whatever you can to survive. The doctors don’t like giving pain relief medication, so while you may get a prescription, you’ll also be told, “Try not to use this.” Recalling Darvocet from the market was a horrible kick to the head! Try not to use pain meds. Don’t use NSAIDs. Okay, here’s Tylenol, but if you take “too much,” you’ll blow up your liver. ~VOW ---
**Author:** ![obbn](https://avatars.discourse-cdn.com/v4/letter/o/d6d6ee/32.png) [@obbn](https://boards.straightdope.com/u/obbn)\ **Post date:** [March 21, 2012, 12:05am UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/18 "2012-03-21T00:05:41Z")
> [@VOW](#): > > Aspirin and NSAIDs affect the kidneys. > > I’m Diabetic, with High Blood Pressure and High Cholesterol. My doctor has been monitoring my kidney function for quite some time now, and she finally spelled it out: I’ve got Chronic Kidney Disease, Stage 3. I’m not supposed to take NSAIDs, any more. > > It’s one of those damned if you do, damned if you don’t. Because for a HELLUVA lot longer than I’ve had the Diabetes-Cholesterol-Blood Pressure business, I’ve had chronic migraines. > > With chronic pain, you do whatever you can to survive. The doctors don’t like giving pain relief medication, so while you may get a prescription, you’ll also be told, “Try not to use this.” > > Recalling Darvocet from the market was a horrible kick to the head! > > Try not to use pain meds. Don’t use NSAIDs. Okay, here’s Tylenol, but if you take “too much,” you’ll blow up your liver. > ~VOW As a fellow chronic pain sufferer I feel for you. Especially the fact that you have migraines. I never had them and then I had post surgical migraines due to a dura tear. I have never felt such pain in my life, my God they were horrible. I would take my excruciating back pain over a migraine any day. The sad part also is that drugs like Tylenol work so much better on migraines than drugs like morphine. At least that what I found out, the morphine didn’t do squat for the migraine, but a dose of Tylenol knocked it right down. I hope that you get the headaches under control. I wish you the best of luck. ---
**Author:** ![Parenchyma](https://avatars.discourse-cdn.com/v4/letter/p/5f9b8f/32.png) [@Parenchyma](https://boards.straightdope.com/u/Parenchyma)\ **Post date:** [March 21, 2012, 3:53am UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/19 "2012-03-21T03:53:40Z")
If you’re a cat, one extra-strength Tylenol is enough to kill you. ---
**Author:** ![MLS](https://avatars.discourse-cdn.com/v4/letter/m/919ad9/32.png) [@MLS](https://boards.straightdope.com/u/MLS)\ **Post date:** [March 21, 2012, 5:21pm UTC](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202/20 "2012-03-21T17:21:24Z")
Fortunately for me, acetaminophen does exactly zero for any pain I may have; I never take it. I’ve heard that liver failure is a nasty way to go. [Next page](https://boards.straightdope.com/t/so-how-deadly-is-acetaminophen-really/616202.md?page=2)