Acetaminophen Overdose

Oct 22, 2013

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

A few years ago I was listening to an interview on Valentines Day. It wasnt about flowers and candy, though. It was an interview with the head of The Alibi Network. The gentleman was explaining how, for a fee, his company would provide alibis for cheating spouses. For example if a husband wanted to go away with his mistress for a weekend, The Alibi Network would provide him with a fake phone number to a fake remote fishing lodge with no cell phone service. So if his wife called the faked number she would be told her husband was out on the water and they would leave a message for him. The Alibi Network would then contact the husband and tell him to call back his wife with a fish story. I was fascinated that someone had made a business out of helping people lie to do things they know they arent supposed to do.


I know some of you out there do things you arent supposed to as well. No, Im not talking about cheating on your spouses. Im talking to the if one pill is good, three must be better crowd. For example how many acetaminophen or Tylenol do you take for your migraines? Whereas acetaminophen is a safe medication when used properly, there are maximum doses on the box for a reason. But first, here is my confession. When Im not listening to CKDM, I occasionally step out with other radio programs. It is so easy to do now that other radio programs have all gone on the internet. Last week I listened to This American Life because they had an intriguing show on acetaminophen overdose.


What is acetaminophen? Acetaminophen is a pain killer and fever medication. Its most common brand name is Tylenol. Acetaminophen is very safe if used properly. One of the first bits of the This American Life show that caught my attention was an angry liver specialist. He was railing against the makers of Tylenol using the phrase that Tylenol is the safest over the counter pain killer. That caught my attention, because Ive told patients that. Despite the rantings of this very smart liver specialist, I think I still stick by my words. Acetaminophen is the safest over the counter pain killer. But now I should add the caveat that acetaminophen is the safest over the counter pain medication, if you dont exceed the maximum recommended dose of acetaminophen.


Acetaminophen has what is called a narrow therapeutic index. That means the difference between a safe and effective dose of acetaminophen and an overdose which will harm you is relatively small. How much acetaminophen can you take during a day? In 2010 that was reduced to 3000 mg per day. That is 6 acetaminophen 500 mg tabs per day. The maximum used to be 4000 mg per day or 8 acetaminophen 500 mg tabs per day. One of the reasons the maximum dose was decreased was that 8 tabs of 500mg acetaminophen per day can actually harm people with liver conditions and people who regularly consume more than 3 alcoholic drinks per day. One reason acetaminophen overdose is so common is because acetaminophen is in so many different over the counter medications. It isnt just in the pain control aisle. Medicines for allergies, colds and flus can all have acetaminophen in them. Some prescription pain medications have acetaminophen in them as well. You should not take more than one medication with acetaminophen in them at one time.



The people from This American Life and ProPublica really hit on this risk of acetaminophen overdose. The numbers they used were that acetaminophen causes about 150 deaths per year in the USA due to accidental overdose. T. Christian Miller and Jeff Gerth from ProPublica came up with this number after looking at databases from the US Centers for Disease Control. Now any death from a medication is terrible, but you have to remember it is estimated that millions of doses of acetaminophen are taken every week in the US. So by any measure, that still makes acetaminophen a safe medication. However This American Life and ProPublica focused on how the deaths due to accidental overdose of acetaminophen greatly outnumber the number of deaths from accidental overdose of ibuprofen or ASA or naproxen combined. These are the other over the counter pain killers. While that is true, it is not really an apples to oranges comparison. The missing bit is that ibuprofen, ASA and naproxen can harm the stomach and the kidneys even when taken exactly as prescribed. Acetaminophen is very unlikely to cause any harm if it is taken as prescribed.


I think the take home message is to be careful not to take too much acetaminophen. Have your pharmacist help you determine if the different OTC products you buy have acetaminophen in them. Dont take two different products with acetaminophen in them together. And read the maximum dose warnings on the box. 3000 mg per day of acetaminophen means 6 or fewer 500 mg acetaminophen tablets per day. There is evidence of liver injury and death with as little as 6000 mg per day if taken for a few days. That is only 12 500mg tab of acetaminophen per day for 2-3 days. I know some of you in the if one pill is good, three pills are better crowd have taken that many. Acetaminophen overdose warnings are serious and you should listen to them.


Cheating on drug overdose warnings is a bad thing. Just like cheating on your spouse, cheating on overdose warnings will get you in trouble too. At the end of The Alibi Network interview, the interviewer asked what the latest trends in cheating were. The head of the Alibi Network said it was coming up with alibis to give to mens mistresses so the men could spend more time with their wife and kids. I cant believe how complicated some peoples lives have gotten when they have to lie to their mistress and their wife at the same time. I guess marriage vows are like drug overdose warnings ignore at your own peril.


The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


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This American Life Tylenol overdose story -

ProPublic Tylenol overdose story -

The alibi network -


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