# Tylenol really seems to pound the liver- How safe is it really? **URL:** \ **Category:** Factual Questions\ **Created:** [September 2, 2006, 10:54pm UTC](https://boards.straightdope.com/t/tylenol-really-seems-to-pound-the-liver-how-safe-is-it-really/371249 "2006-09-02T22:54:37Z")\ **Posts on this page:** 14\ **Page:** 1
**Author:** ![astro](https://avatars.discourse-cdn.com/v4/letter/a/9dc877/32.png) [@astro](https://boards.straightdope.com/u/astro)\ **Post date:** [September 2, 2006, 10:54pm UTC](https://boards.straightdope.com/t/tylenol-really-seems-to-pound-the-liver-how-safe-is-it-really/371249/1 "2006-09-02T22:54:37Z")
I keep reading about how dangerous taking too much [Tylenol](http://en.wikipedia.org/wiki/Tylenol) is, especially if you drink alcohol after taking it. It seems almost like a nuke targeted at your liver. Is this stuff really safe enough to be OTC? > [@](#): > > [Tylenol Liver Damage](http://www.medicinenet.com/tylenol_liver_damage/page2.htm) > > 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. What is more, 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** ---
**Author:** ![diggleblop](https://avatars.discourse-cdn.com/v4/letter/d/ac91a4/32.png) [@diggleblop](https://boards.straightdope.com/u/diggleblop)\ **Post date:** [September 2, 2006, 11:17pm UTC](https://boards.straightdope.com/t/tylenol-really-seems-to-pound-the-liver-how-safe-is-it-really/371249/2 "2006-09-02T23:17:56Z")
IANAD, but it’s a very safe drug if taken in moderate doses. There are also very few side effects. 7grams is the technical lethal dose. But some people have survived after taking up to 25 grams at once. Everybody is different. ---
**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:** [September 2, 2006, 11:57pm UTC](https://boards.straightdope.com/t/tylenol-really-seems-to-pound-the-liver-how-safe-is-it-really/371249/3 "2006-09-02T23:57:09Z")
Just to point out that despite the label having words to the effect of “not to exceed 4 grams per day” (implying that up to that amount is safe), [this article from JAMA](http://jama.ama-assn.org/cgi/content/abstract/296/1/87)\* in July 2006 showed that there is evidence of significant liver inflammation at the 4 grams per day dose. - In the article, the term alanine aminotransferase (ALT) is used. That a liver enzyme, the blood levels of which rise with liver damage ---
**Author:** ![astro](https://avatars.discourse-cdn.com/v4/letter/a/9dc877/32.png) [@astro](https://boards.straightdope.com/u/astro)\ **Post date:** [September 3, 2006, 2:47am UTC](https://boards.straightdope.com/t/tylenol-really-seems-to-pound-the-liver-how-safe-is-it-really/371249/4 "2006-09-03T02:47:17Z")
[QUOTE=KarlGauss] Just to point out that despite the label having words to the effect of “not to exceed 4 grams per day” (implying that up to that amount is safe), [this article from JAMA](http://jama.ama-assn.org/cgi/content/abstract/296/1/87)\* in July 2006 showed that there is evidence of significant liver inflammation at the 4 grams per day dose. - In the article, the term alanine aminotransferase (ALT) is used. That a liver enzyme, the blood levels of which rise with liver damage [/QUOTE] No kidding! This drug is more dangerous than people realize. > [@](#): > > 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. ---
**Author:** ![Bryan\_Ekers](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bryan_ekers/32/183_2.png) [@Bryan\_Ekers](https://boards.straightdope.com/u/Bryan_Ekers)\ **Post date:** [September 3, 2006, 2:59am UTC](https://boards.straightdope.com/t/tylenol-really-seems-to-pound-the-liver-how-safe-is-it-really/371249/5 "2006-09-03T02:59:07Z")
Yikes, it’s starting to sound like you’re better off taking something relatively safe like cyanide. What? ---
**Author:** ![Lobelia\_Overhill](https://avatars.discourse-cdn.com/v4/letter/l/54ee81/32.png) [@Lobelia\_Overhill](https://boards.straightdope.com/u/Lobelia_Overhill)\ **Post date:** [September 3, 2006, 11:39am UTC](https://boards.straightdope.com/t/tylenol-really-seems-to-pound-the-liver-how-safe-is-it-really/371249/6 "2006-09-03T11:39:17Z")
Over here you can only buy paracetemol (our name for tylenol) in packs of 12 to prevent people accidently overdosing on the stuff. Happens quite a lot if someone has a cold - they take a half a dozen rememdies that all contain levels of paracetemol and a few years later die from liver damage ---
**Author:** ![Kevbo](https://avatars.discourse-cdn.com/v4/letter/k/e47774/32.png) [@Kevbo](https://boards.straightdope.com/u/Kevbo)\ **Post date:** [September 3, 2006, 8:26pm UTC](https://boards.straightdope.com/t/tylenol-really-seems-to-pound-the-liver-how-safe-is-it-really/371249/7 "2006-09-03T20:26:43Z")
I just checked snopes, and found nothing about this: Is it true that “tylenol is the pain killer hospitals use most” because the company gives it away free to hospitals? ---
**Author:** ![Bill\_Door](https://avatars.discourse-cdn.com/v4/letter/b/50afbb/32.png) [@Bill\_Door](https://boards.straightdope.com/u/Bill_Door)\ **Post date:** [September 3, 2006, 8:36pm UTC](https://boards.straightdope.com/t/tylenol-really-seems-to-pound-the-liver-how-safe-is-it-really/371249/8 "2006-09-03T20:36:40Z")
[QUOTE=diggleblop] IANAD, but it’s a very safe drug if taken in moderate doses. There are also very few side effects. 7grams is the technical lethal dose. But some people have survived after taking up to 25 grams at once. Everybody is different. [/QUOTE] Technically, 7 grams is the LD50, meaning that half of the people who take that dosage will live. Half will die from that dose or lower. Considering that the theraputic dose for Tylenol is [1 gram](http://www.tylenol.com/product_detail.jhtml;jsessionid=EEDKGZR1ARZNACQPCCFSUYYKB2IIQNSC?id=tylenol/hdache/prod_ex.inc&prod=subpex&_requestid=85456#Top), Is there an over the counter medication with a more narrow range between the theraputic dosage and the lethal dosage? ---
**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:** [September 3, 2006, 8:39pm UTC](https://boards.straightdope.com/t/tylenol-really-seems-to-pound-the-liver-how-safe-is-it-really/371249/9 "2006-09-03T20:39:23Z")
[QUOTE=Kevbo] I just checked snopes, and found nothing about this: Is it true that “tylenol is the pain killer hospitals use most” because the company gives it away free to hospitals? [/QUOTE] I doubt it. Acetaminophen (tylenol, non-aspirin, paracetamol, etc) is sort of the default pain killer choice for most hospitals and nursing homes because when given in low doses, it is unlikely to cause problems like sedation (narcotic pain killers), bronchospasm (aspirin), kidney trouble (NSAIDS) or GI bleeding (aspirin, other NSAIDS like ibuprofen). Having said that, excess acetaminophen intake is now associated with liver trouble, as **KarlGauss** ’s link points out. I advise my patients to take 2 grams or less a day. If they need more than that regularly, an occasional ALT (liver enzyme) check is smart. It’s always something. ---
**Author:** ![groman](https://avatars.discourse-cdn.com/v4/letter/g/73ab20/32.png) [@groman](https://boards.straightdope.com/u/groman)\ **Post date:** [September 3, 2006, 9:44pm UTC](https://boards.straightdope.com/t/tylenol-really-seems-to-pound-the-liver-how-safe-is-it-really/371249/10 "2006-09-03T21:44:41Z")
My mom recently reminisced how pure 5mg codeine was over the counter in the soviet union in the late 1960s and was cheaper than aspirin per pill. That society did not crumble because of codeine, and codeine is sure as hell much safer to the average person than acetaminophen. The LD50 for codeine is 800mg - with 5mg dosage being enough for even moderate-to-severe pain it is unlikely somebody would consume 800mg accidentally. Any time I bring this up people always mention the great potential for abuse and I just don’t seem to understand what is the problem - if you don’t personally feel the government needs to keep YOU away from dangerous substances like codeine and drano, how is it at all relevant to deciding whether something should be OTC or not? I think the chief determinator of OTC status (if any at all, honestly) should be if a medical setting or control is necessary to ensure safe use - i.e. subtle but possibly dangerous side effects, low dangerous dosage, complex instructions or potential for numerous severe drug interactions. Acetaminophen surely fits the bill, and opiates do not. Acetaminophen also seemed to be the suicide pill of choice among four of my friends when they were teens (independantly), all four of them made it but they’re not even all that aware that they can be carrying a time bomb in their liver. According to [this](http://headaches.about.com/cs/medicationsusage/a/acet_death.htm) > [@](#): > > The American Association of Poison Control Centers shows the following statistics for reported acetaminophen poisonings in 2001: > > ``` > * Total reported exposures: 57,516 > * Reported exposures, under the age of 19: 40,774 > * Unintentional overdoses: 35,705 > * Intentional overdoses: 20,002 > * Total treated for the exposure: 24,934 > * Impact on health from the incident: none, 15,029; minor, 6,223; moderate, 3,138; major, 829; fatal: 120 > > ``` I personally don’t like those chances. ---
**Author:** ![diggleblop](https://avatars.discourse-cdn.com/v4/letter/d/ac91a4/32.png) [@diggleblop](https://boards.straightdope.com/u/diggleblop)\ **Post date:** [September 3, 2006, 10:01pm UTC](https://boards.straightdope.com/t/tylenol-really-seems-to-pound-the-liver-how-safe-is-it-really/371249/11 "2006-09-03T22:01:51Z")
groman, I couldn’t agree with you more. I always say that, at the very least, Vicodin (Hydrocodone, which is a schedule III drug) should be over the counter. I know when I’m in pain, I don’t need the Government telling me I’m not, nor do I need a Doctor telling me I’m not, either. I think I know when I’m in pain. Thank God for online pharmacies. ---
**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:** [September 3, 2006, 10:32pm UTC](https://boards.straightdope.com/t/tylenol-really-seems-to-pound-the-liver-how-safe-is-it-really/371249/12 "2006-09-03T22:32:17Z")
[QUOTE=groman] . . . for codeine . . . 5mg dosage being enough for even moderate-to-severe pain . . . [/QUOTE] I think you’re wrong. If that dose were correct, then using commonly available equivalent analgesic doses (e.g. from the [US Pharmacopeia](http://www.usp.org/patientSafety/newsletters/qualityReview/qr461995-02-01b.html?emailLink&USP_Print)), we’d have: codeine 5 mg oral morphine 1.5 mg oral oxycodone 0.75 mg oral (equivalent to less than 1/6 of a Percocet!) etc. Those are tiny doses. For “moderate-to-severe pain”? Don’t think so. :dubious: ---
**Author:** ![groman](https://avatars.discourse-cdn.com/v4/letter/g/73ab20/32.png) [@groman](https://boards.straightdope.com/u/groman)\ **Post date:** [September 4, 2006, 5:37am UTC](https://boards.straightdope.com/t/tylenol-really-seems-to-pound-the-liver-how-safe-is-it-really/371249/13 "2006-09-04T05:37:25Z")
[QUOTE=KarlGauss] Those are tiny doses. For “moderate-to-severe pain”? [/QUOTE] I’m sorry I mis-spoke, I meant moderate-to-severe pain in the OTC sense not in the proper medical sense. Stuff you take tylenol for type of severe pain - not kidney stones type of severe pain. ---
**Author:** ![charizard](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/charizard/32/4166_2.png) [@charizard](https://boards.straightdope.com/u/charizard)\ **Post date:** [September 4, 2006, 12:50pm UTC](https://boards.straightdope.com/t/tylenol-really-seems-to-pound-the-liver-how-safe-is-it-really/371249/14 "2006-09-04T12:50:44Z")
Figured I’d reference [Cecil’s previous contribution](http://www.straightdope.com/columns/000929.html).