Is Tylenol dangerous?

Question: I always take Tylenol® for fever or headaches because it doesn’t seem to upset my stomach like ibuprofen does. I’ve thought that Tylenol® was safe because my doctor always recommended it for my children. However, my sister-in-law insists that Tylenol® is dangerous. Who’s right, my doctor, or my sister-in-law? 
You are both right. Tylenol®, also called acetaminophen, is quite safe to take as long as you pay close attention to HOW MUCH you take and are careful to avoid taking too much of it at a time. But if you have liver disease or drink alcohol frequently, it may NOT be a safe choice for you.                                                                                                                                            
Tylenol® was first used as a pain reliever in 1893. Due to concerns about its ability to cause liver damage, it was used cautiously until 1949, when it became a widely accepted alternative to aspirin. Today, acetaminophen is the most popular non-prescription painkiller sold in the United States. It is considered safer than ibuprofen or naproxen for mild to moderate pain, just as long as you don’t take too much. 
The best way to take Tylenol® or acetaminophen safely is to watch the TOTAL amount you take over the day and always stay below the maximum recommended dose. For healthy adults, the Food and Drug Administration (FDA) recommends no more than 4000mg per day of acetaminophen. That’s equivalent to twelve regular strength acetaminophen pills at 325mg each, eight extra-strength pills at 500mg each, or six extended-release tablets at 650mg. 
If you are over 60 years old, the FDA recommends a lower daily limit: 3100mg. You should take up to 3100mg per day if you have liver problems or drink more than 2 ounces of alcohol regularly. Two ounces of alcohol is equivalent to one 12-ounce beer, one glass of wine, or one shot glass of distilled spirits. 3100mg of acetaminophen is equal to nine regular strength 325mg tablets, six extra-strength 500mg pills, or four extended-release 650mg pills. 
Most people taking too much acetaminophen are unaware of the danger until they experience permanent liver damage. A big part of the problem is the popularity of acetaminophen with drug makers. Acetaminophen is an ingredient of over 200 over-the-counter products and the popular prescription analgesics Vicodin® and Norco®. 
You’ll find acetaminophen in non-prescription remedies for allergy, sinus problems, cough, cold and flu symptoms, and even sleeplessness. In 2005 alone, consumers in the United States purchased more than 17 billion doses of non-prescription products containing acetaminophen.
Over-the-counter remedies are not the only spots in your medicine cabinet that acetaminophen can lurk. The prescription pain medicines Vicodin® and Percocet® contain a potent narcotic pain reliever along with acetaminophen. The combination of hydrocodone and acetaminophen in narcotic pain relievers like Vicodin® and Lortab® is among the most frequently dispensed prescription medicines in the United States. In 2005, pharmacies filled 11 billion doses of this potent combination analgesic. Unfortunately, acetaminophen in your prescription medication is easy to overlook. Instead of squeezing the word acetaminophen onto the prescription label, the abbreviation APAP or ACET is used instead.
Here are 5 ways to keep yourself safe when taking Tylenol® or acetaminophen for pain relief: 
1. Know your max.
Be aware of the maximum daily amount of acetaminophen that’s safe for you to take. For healthy adults, this is 4000mg over 24 hours (8 tablets of Extra-Strength); for others, it is less. Ask your doctor or pharmacist if you aren’t sure.
 2. Keep track.
Pay attention to how much acetaminophen you are taking. Acetaminophen is called paracetamol in Europe and some other countries. Look for it on the list of active ingredients of all your medicines, food supplements, and herbal remedies. If you take prescription pain medicine, watch for the abbreviation APAP or ACET, or ask your pharmacist if there is any acetaminophen in your prescription medications.
3. Take one at a time.
Don’t take more than one medicine containing acetaminophen at a time. Taking both a non-prescription and prescription product containing acetaminophen puts you at high risk of getting too much. Watch out when taking pain medicines from more than one medical provider such as a dentist, surgeon, ER doctor, or urgent care center. 
4. Watch out if you have liver disease.
If you have liver disease, you may need to avoid taking acetaminophen or Tylenol® altogether. Ask your doctor how much acetaminophen per day is safe for you to take for fever, aches, or pain.
5. Avoid acetaminophen when drinking alcohol. 
Protect your liver by avoiding acetaminophen altogether whenever you drink alcohol.
Dr. Louise Achey, Doctor of Pharmacy, is a 40-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Check out her NEW website for daily tips on how to take your medicine safely ®2020 Louise Achey

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