# Tylenol Dosage Question. Did I Poison My Wife? **URL:** \ **Category:** Factual Questions\ **Created:** [February 16, 2008, 9:17pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913 "2008-02-16T21:17:56Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![Frylock](https://avatars.discourse-cdn.com/v4/letter/f/ce7236/32.png) [@Frylock](https://boards.straightdope.com/u/Frylock)\ **Post date:** [February 16, 2008, 9:17pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/1 "2008-02-16T21:17:56Z")
A few years ago, our doctor told us that it’s okay to replace a single dose of OTC tylenol with a double dose twice a day. Today, however, a pharmacist griped me out for doing this, intimating that my wife (to whom I gave the pills this morning) ought to be going to the ER for possible liver damage. When I told her a doctor had advised me that it was okay, she simply said “No,” and repeated her stance. Any way I can find out for sure whether the advice from my doctor is, indeed, bad advice? He said at the time that OTC tylenol is far below acceptable dosage levels. Is this not true? -Kris ---
**Author:** ![Frylock](https://avatars.discourse-cdn.com/v4/letter/f/ce7236/32.png) [@Frylock](https://boards.straightdope.com/u/Frylock)\ **Post date:** [February 16, 2008, 9:31pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/2 "2008-02-16T21:31:38Z")
Geez, reading a few sites about this is starting to freak me out. But I’ve been doing this for years and never suffered for it. :eek: ☹ -FrL- ---
**Author:** ![Frylock](https://avatars.discourse-cdn.com/v4/letter/f/ce7236/32.png) [@Frylock](https://boards.straightdope.com/u/Frylock)\ **Post date:** [February 16, 2008, 9:35pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/3 "2008-02-16T21:35:06Z")
Well shit. My sister tells me it was _Ibuprofin_, not Tylenol, that our doctor advised us about. -FrL- ---
**Author:** ![Harmonious\_Discord](https://avatars.discourse-cdn.com/v4/letter/h/74df32/32.png) [@Harmonious\_Discord](https://boards.straightdope.com/u/Harmonious_Discord)\ **Post date:** [February 16, 2008, 9:40pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/4 "2008-02-16T21:40:19Z")
Tylenol in too high a dose will destroy the liver and you’ll find out 24 hours later. Unless your wife has some liver problem, I’m sure your doctor’s advice is still relevant. The only cases I ever see articles on are doses way beyond double. ---
**Author:** ![Frylock](https://avatars.discourse-cdn.com/v4/letter/f/ce7236/32.png) [@Frylock](https://boards.straightdope.com/u/Frylock)\ **Post date:** [February 16, 2008, 9:46pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/5 "2008-02-16T21:46:06Z")
[QUOTE=Harmonious Discord] Tylenol in too high a dose will destroy the liver and you’ll find out 24 hours later. Unless your wife has some liver problem, I’m sure your doctor’s advice is still relevant. The only cases I ever see articles on are doses way beyond double. [/QUOTE] I just called Poison Control, and they said we shouldn’t worry unless she takes more than 4 grams in a day. So that’s good. -Kris ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [February 16, 2008, 10:26pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/6 "2008-02-16T22:26:12Z")
[QUOTE=Frylock] I just called Poison Control, and they said we shouldn’t worry unless she takes more than 4 grams in a day. So that’s good. -Kris [/QUOTE] BTW 4 grams equals 8 pills.\* \*Assuming standard 500mg pills. And don’t forget to check the labels of anything else you are taking. Often times cough or cold medicine will contain it as well and you have to add that in. ---
**Author:** ![Frylock](https://avatars.discourse-cdn.com/v4/letter/f/ce7236/32.png) [@Frylock](https://boards.straightdope.com/u/Frylock)\ **Post date:** [February 16, 2008, 10:34pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/7 "2008-02-16T22:34:25Z")
[QUOTE=Joey P] BTW 4 grams equals 8 pills.\* \*Assuming standard 500mg pills. And don’t forget to check the labels of anything else you are taking. Often times cough or cold medicine will contain it as well and you have to add that in. [/QUOTE] Yes. Our Tylenol bottle contains 500mg pills, and the dose I have been referring to was a dose of 4 pills, for a total of 2 grams. -FrL- ---
**Author:** ![jasonh300](https://avatars.discourse-cdn.com/v4/letter/j/46a35a/32.png) [@jasonh300](https://boards.straightdope.com/u/jasonh300)\ **Post date:** [February 16, 2008, 10:50pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/8 "2008-02-16T22:50:47Z")
[QUOTE=Frylock] Yes. Our Tylenol bottle contains 500mg pills, and the dose I have been referring to was a dose of 4 pills, for a total of 2 grams. -FrL- [/QUOTE] I have to question the “4 grams in a day” limit. Correct me if I’m wrong…the only bottle of Tylenol I have in the house is missing most of the label because it got wet. A standard dose of Extra Strength Tylenol is 2 - 500mg caplets (1 gram) every 4 hours. If you take this dose around the clock, you’d get 6 grams a day. Do they assume you sleep 8 hours a day and won’t be taking the pills when you sleep? Is 6 grams in a day going to shut down my liver? Or would it have to be 6 grams a day over a long period of time? ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [February 16, 2008, 10:55pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/9 "2008-02-16T22:55:59Z")
[QUOTE=jasonh300] I have to question the “4 grams in a day” limit. Correct me if I’m wrong…the only bottle of Tylenol I have in the house is missing most of the label because it got wet. A standard dose of Extra Strength Tylenol is 2 - 500mg caplets (1 gram) every 4 hours. If you take this dose around the clock, you’d get 6 grams a day. [/QUOTE] I don’t have a bottle near me, but IIRC it says to take blah blah blah not to exceed 4 doses in 24 hours. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [February 16, 2008, 11:00pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/10 "2008-02-16T23:00:12Z")
[QUOTE=jasonh300] Is 6 grams in a day going to shut down my liver? Or would it have to be 6 grams a day over a long period of time? [/QUOTE] I’ve wondered that as well. I had a friend (and another person I spoke to once) that said she tried to kill herself one night by downing a bottle of tylenol and a bunch of vodka. She said she woke up the next day feeling like a million bucks (oddly, the other person said almost exacty the same thing, woke up feeling great). The feeling like a million bucks part I assume has something to do with spending a good deal of time very seriously and deeply contemplating their life. But from everything I had been told, I was surprised they woke up at all. ---
**Author:** ![Mandarax](https://avatars.discourse-cdn.com/v4/letter/m/df705f/32.png) [@Mandarax](https://boards.straightdope.com/u/Mandarax)\ **Post date:** [February 16, 2008, 11:56pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/11 "2008-02-16T23:56:46Z")
The Master Speaks: [Does Tylenol + alcohol = liver failure?](http://www.straightdope.com/columns/000929.html) > [@](#): > > 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. > … > Of 71 patients treated at a Dallas medical center for acetaminophen overdose, 50 were attempted suicides and 21 were victims of an accidental overdose (Schiodt et al, New England Journal of Medicine, October 1997). The would-be suicides on average took twice as much of the drug as the accidental victims. Yet far more of the latter went into a coma (seven versus three) and died (four versus one). Why? Because most of the accidental victims were alcoholics. Five people–three accidental victims, two attempted suicides–overdosed on less than four grams, the claimed safe dosage for 24 hours. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [February 16, 2008, 11:58pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/12 "2008-02-16T23:58:46Z")
[QUOTE=Mandarax] The Master Speaks: [Does Tylenol + alcohol = liver failure?](http://www.straightdope.com/columns/000929.html) [/QUOTE] That doesn’t seem like alcohol + Tylenol. It seems like that stat has more to do with ODing on tylenol when your liver is already shot from drinking. ---
**Author:** ![Mandarax](https://avatars.discourse-cdn.com/v4/letter/m/df705f/32.png) [@Mandarax](https://boards.straightdope.com/u/Mandarax)\ **Post date:** [February 17, 2008, 12:08am UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/13 "2008-02-17T00:08:41Z")
[QUOTE=Joey P] That doesn’t seem like alcohol + Tylenol. It seems like that stat has more to do with ODing on tylenol when your liver is already shot from drinking. [/QUOTE] Hey, I just pasted the title. The original questioner was asking specifically about alcohol plus Tylenol. The interesting (and relevant) parts of the article were (1) the toxic dose is less than twice the maximum daily dose (the amount that **Frylock** was using to poison his wife), and (2) people with impaired liver function have overdosed on as little as 4 g. ---
**Author:** ![Nunavut\_Boy](https://avatars.discourse-cdn.com/v4/letter/n/e95f7d/32.png) [@Nunavut\_Boy](https://boards.straightdope.com/u/Nunavut_Boy)\ **Post date:** [February 17, 2008, 6:08am UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/14 "2008-02-17T06:08:28Z")
We need a pharmacist to check in, but my vague recollection of pharmacokinetics is that there is a difference between fast, normal and slow metabolizers (cytochrome p450 system). For arguments sake, let’s say 10% of people are slow metabolizers, 80% are normal and 10% are fast. I would ASSUME that the directions would be the maximum dose for slow metabolizers so the company making the drug can cover their ass. Also, I think this would depend on zero or first order pharmocokinetics. Damn. I’m really not helping at all, but I’ve typed all this so I might as well submit it. ---
**Author:** ![susan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/susan/32/17537_2.png) [@susan](https://boards.straightdope.com/u/susan)\ **Post date:** [February 17, 2008, 6:25am UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/15 "2008-02-17T06:25:43Z")
> [@](#): > > I’ve wondered that as well. I had a friend (and another person I spoke to once) that said she tried to kill herself one night by downing a bottle of tylenol and a bunch of vodka. She said she woke up the next day feeling like a million bucks (oddly, the other person said almost exacty the same thing, woke up feeling great). The feeling like a million bucks part I assume has something to do with spending a good deal of time very seriously and deeply contemplating their life. But from everything I had been told, I was surprised they woke up at all. Whereas I worked at a college where a person tried an OD on Tylenol, woke up feeling a little fluey, and disregarded it. When the hall resident got wind of this, he sent the student for an evaluation that immediately sent the student to the local hospital, from which s/he was airlifted elsewhere. Last anyone on faculty or staff heard, s/he was in liver and kidney failure and being evaluated for organ transplantation. ---
**Author:** ![Harmonious\_Discord](https://avatars.discourse-cdn.com/v4/letter/h/74df32/32.png) [@Harmonious\_Discord](https://boards.straightdope.com/u/Harmonious_Discord)\ **Post date:** [February 17, 2008, 1:42pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/16 "2008-02-17T13:42:23Z")
The cases in the paper are often when a person tries to commit suicide. The parents or spouse catch them and they don’t seem to be dying. They make the mistake of not getting immediate medical help at that point, and a day later the person is dying, because the liver is destroyed. ---
**Author:** ![coffeecat](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/coffeecat/32/3405_2.png) [@coffeecat](https://boards.straightdope.com/u/coffeecat)\ **Post date:** [February 17, 2008, 2:46pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/17 "2008-02-17T14:46:13Z")
[QUOTE=Joey P] That doesn’t seem like alcohol + Tylenol. It seems like that stat has more to do with ODing on tylenol when your liver is already shot from drinking. [/QUOTE] Not shot, just a little winded. The liver needs glutathione to cope with tylenol or alcohol. If it uses it up on booze, and you don’t give it a chance to make more, it may not have enough left to detoxify the tylenol properly. [One non-lush who had problems:](http://www.postgradmed.com/issues/2000/01_00/draganov.htm) > [@](#): > > . . . incidents of alcohol-acetaminophen syndrome have been reported in moderate “social drinkers.” In a well-publicized case, Antonio Benedi, an appointments secretary for President George Bush, sued Johnson & Johnson and was awarded $8.8 million in damages. Although Benedi regularly had three glasses of wine with dinner, he stopped drinking alcohol because of the dose. Several days later, he had “complete liver failure,” which eventually necessitated a liver transplant. ---
**Author:** ![diggleblop](https://avatars.discourse-cdn.com/v4/letter/d/ac91a4/32.png) [@diggleblop](https://boards.straightdope.com/u/diggleblop)\ **Post date:** [February 17, 2008, 7:10pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/18 "2008-02-17T19:10:49Z")
When my cousin was addicted to Percocet. He was taking upward of 30-40 a day for at least 3 years. Now, each Percocet has 325mg of Tylenol in each pill. 325 x 35 = 11,375. He should’ve been dead numerous times. DO NOT DO THIS EVER ! Obviously. But that goes to show the amount of acetaminophen that certain people’s bodies can handle. He was tested years later and his liver was fine. But you should never exceed more than 8 pills of 500mg of Tylenol in a 24 hour period. I think the pharmacist was overreacting a bit, unless your wife has liver damage. Also, it never hurts to get a liver workup if you’ve taken Tylenol a lot in the past. With Tylenol overdose, you get better before you get worse. In other words, if you took a lot, you would get sick with flu symptoms and then feel better for about a day. Then for the next two days, all of a sudden your liver would start to shut down and _THEN_ you get _REALLY_ bad off. Just google “liver failure” and read about it. I am not a doctor and this is not medical advice, just my personal experience. ---
**Author:** ![pulykamell](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pulykamell/32/3166_2.png) [@pulykamell](https://boards.straightdope.com/u/pulykamell)\ **Post date:** [February 17, 2008, 7:22pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/19 "2008-02-17T19:22:19Z")
[QUOTE=coffeecat] Not shot, just a little winded. The liver needs glutathione to cope with tylenol or alcohol. If it uses it up on booze, and you don’t give it a chance to make more, it may not have enough left to detoxify the tylenol properly. [One non-lush who had problems:](http://www.postgradmed.com/issues/2000/01_00/draganov.htm) [/QUOTE] FWIW, perhaps he’s being overly cautious, but one of my physician friends absolutely refused to give me any acetaminophen after a night of moderate-to-heavy drinking. Luckily, he had ibuprofen on hand, but he was pretty explicit about forbidding me to ever take Tylenol for headaches caused by drinking. So question: With the liver problems Tylenol can cause, why aren’t ibuprofen or aspirin more common pain relieving drugs of choice? All three seem to work equally well for me, is there any reason I would want to choose Tylenol over the others in some cases, while aspirin or ibuprofen in others? I know aspirin can cause stomach problems, but what about ibuprofen? What set of risks does it come with? ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [February 17, 2008, 7:56pm UTC](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913/20 "2008-02-17T19:56:18Z")
[QUOTE=pulykamell] is there any reason I would want to choose Tylenol over the others in some cases, while aspirin or ibuprofen in others? I know aspirin can cause stomach problems, but what about ibuprofen? What set of risks does it come with? [/QUOTE] GI hemorrhage, basically. All NSAIDS increase the risk of this, including the cox-2 inhibitors, which are _supposed_ to be less risky for the GI tract. Basically they’re not. An estimated 16,500 deaths occur annually in the US related to NSAID use. This number has been dropping, probably due to the increased use of meds like Prilosec (omeprazole) [Next page](https://boards.straightdope.com/t/tylenol-dosage-question-did-i-poison-my-wife/437913.md?page=2)