A common medication mistake that can harm your liver

Acetaminophen (Tylenol) is such a common over-the-counter medication that most people don’t think twice about using it. Taken in recommended doses, it’s a great way to relieve pain and fevers. But when people take too much, either intentionally or unintentionally, it can cause serious damage to the liver that can lead to hospitalization, the need for a transplant or even death.

People may assume that over-the-counter medications are always safe. Plus, people who are in pain can be tempted to take additional doses when the first dose either wears off or doesn’t work.

We talked to Lola Alade, manager of pharmacy clinical services at Cape Cod Healthcare, about how to safely take acetaminophen.

“For most healthy adults, the maximum daily dose from all medicines containing acetaminophen is 4,000 milligrams,” she said. “Some experts may suggest a lower daily limit, between 2,000 milligrams and 3,000 milligrams, especially for people with certain health conditions.”

Those health conditions include liver damage, low body weight, heavy alcohol use and people who are using acetaminophen chronically.

“There are hundreds of medications, both over-the-counter and prescription, that contain acetaminophen, either alone or in combination with other ingredients,” said Alade. “Because it’s in so many products, people can easily take more than intended without realizing it.”

Common over-the counter medications that contain acetaminophen include cold and flu medications like DayQuil, NyQuil and Theraflu, as well as other pain relievers, like Excedrin or Midol. Some prescription medications like Vicodin and Percocet also contain acetaminophen.

The Dangers

Alade summed up the dangers of taking too much acetaminophen. The main points include:

• Be aware of the potential for liver damage.
• When taken at the correct dose for a short period of time, your liver can safely break down and remove acetaminophen from your body. However, taking more than the recommended dose can overwhelm your body’s ability to break it down. “This can lead to a buildup of a toxic byproduct that can harm your healthy liver cells and may even cause liver failure,” Alade said.
• People should not take acetaminophen for more than 10 consecutive days for pain or three consecutive days for fever without speaking to a healthcare provider, said Alade.
• When asked about mixing acetaminophen with alcohol, Alade advises it’s best to avoid mixing acetaminophen and alcohol, as the combination can cause serious stress to your liver, and in some cases, severe or life-threatening liver damage.

“The package label warns that liver damage can occur with three or more alcoholic drinks daily,” she said. “But even moderate drinking can increase risk, so the best approach is to talk with your healthcare provider about your personal risk before combining acetaminophen or any medication with alcohol.”

For people in chronic pain, like those with rheumatoid arthritis, acetaminophen is a common and effective choice for managing long-term pain. But Alade stressed that it is important for people to talk to their healthcare providers to find the right dose. Some providers may recommend a lower daily dose if acetaminophen is taken daily.

Tips for Daily Use

Some key tips for daily use of acetaminophen products include:

• Let your doctor or pharmacist know about all your medications, including over-the counter meds.
• Read your medication labels and stay within your limit. Take the lowest dose that works for pain relief and never go over the daily amount recommended by your doctor. Reach out to your local pharmacy if you need help with this.
• Avoid taking multiple medications containing acetaminophen.
• Limit or avoid alcohol
• If you suspect an overdose, contact poison control or seek emergency treatment right away. Early treatment can prevent liver damage. There are medications they can give you at the hospital that can help.

Other Medications That Can Help With Pain

If you are in pain, there are other medications, both over-the-counter and prescription, that may help. Over-the-counter medications, like ibuprofen (Advil), naproxen (Aleve) and aspirin, may be a better choice than acetaminophen if your pain is accompanied by inflammation. Those medications have anti-inflammatory properties that acetaminophen doesn’t have, so they are better choices for injuries like a sprain.

While these medications are generally safe when taken as directed, they carry different risks than acetaminophen, Alade said. Aspirin and ibuprofen can cause stomach irritation, bleeding or damage to your heart and kidneys. The risk of side effects may be higher if they are combined with certain other medications, so check with your doctor or pharmacist before taking them.