Study: Over Time, Even a Little Too Much Tylenol Can Kill

By Douglas Main | November 24, 2011 8:47 am

When it comes to acetaminophen (aka Tylenol or paracetamol), taking slightly too much for a few days may be more deadly than taking way too much all at once. A study in the British Journal of Clinical Pharmacology found that a quarter of the 663 patients admitted to the Scottish Liver Transplant Unit since 1992 suffered liver failure after a “staggered overdose,” in which people took a couple extra doses of acetaminophen for several days. 37 percent of patients with staggered overdoses died or required a liver transplant, compared to 28 percent of those with single overdoses.

The average single overdose was 27 grams, or 54 Extra Strength Tylenols (500 mg each). A staggered overdose was defined as an average of 4 grams per day (8 extra strength pills). Although such an overdose can even occur after one day, the average staggered overdose patient consumed a total of 24 grams.

The chemical used to treated acetaminophen poisoning, N-acetyl cysteine, is meant to protect the liver from the damage of a single overdose, and is unlikely to help patients with staggered overdoses, the researchers write. By the time these patients reach the hospital, much of the damage may already be done.

Reference: Darren G N Craig et al. Staggered overdose pattern and delay to hospital presentation are associated with adverse outcomes following paracetamol-induced hepatotoxicity. Accepted article, British Journal of Clinical Pharmacology, online November 2011. DOI: 10.1111/1365-2125.2011.04067.x

Image: tonystl / Flickr

CATEGORIZED UNDER: Health & Medicine
  • Gary B

    I wonder about the long term effect of just two of the 8-hour extended release arthritis Tylenols (650 mg each), taken regularly.

  • Sandy

    I sure am glad I’ve almost never taken Tylenol. First it gets contaminated and kills people immediately–now it’s too easy to overdose on it. Have to admit, though, that the real reason I don’t take it is because for me it is practically worthless, almost totally ineffective. Seems I’ve got some weird body chemistry in that OTC pain killers other than plain old aspirin just don’t work for me.

  • Emily

    I mistakenly took for a few days, a double dose of paracetamol. As a result, came to the clinic with a strong allergen. Very insidious drug.

  • dave chamberlin

    I don’t smoke pot and used to believe medical marijuana was just a bulls*** excuse for folks to get high. But now that I am 59 I have a number of friends of my age group tell me that very moderate use of marijuana allows them to cut their intake of liver harming pain killers in half. I have moderate arthritis and now use a number of strategies to control the need for pain killers. I keep slim, I buy really high quality shock absorbing gym shoes, I limit my excersize to those that don’t give my arthritic joints a pounding, and I avoid pills whenever possible. I recently badly broke my leg and went through rehab to regain my strength. The whole rehab center seemed to be full of seventy year olds all seemingly seventy pounds over weight. All I could think of was what in the hell were these people thinking to let themselves go like that. Good God we live in a fat country where the old adage an ounce of prevention is worth a pound of cure seems to have been forgotten, unless that ounce is in pill form.

  • Cathy

    We’re a cat household, so we don’t keep any Tylenol in the house anyway because the risk of dropping a pill and one of the cats playing with it is just too great. (That, and we’re drinkers.) I stick to plain ibuprofin, or in the cases of headaches, a generic aspirin ibuprofin caffeine combo (offbrand Excedrin.) Works better for me than Tylenol ever did anyway.

    So, is the FDA going to require smaller dosage sizes or pull this stuff off the market entirely? Every day I hear more bad things about it.

  • Silvio

    That’s why there is ongoing research to find other medication that changes TRPA1’s reaction to pain.

  • Michael

    A few important take-aways from the study:

    1. the patients in this study took much higher-than-recommended doses (24 000mg for the staggered dose group v. 27 000mg for the single point group)
    ***@Gary B: there’s no evidence to suggest that 675mg of Tylenol/day will do harm to an otherwise healthy individual

    2. About 30% of the patients in the study were suicidal; they overdosed intentionally

    3. The study was designed to describe the characteristics of hospitalized overdose patients, not to assess the safety of responsibly-used Tylenol.

  • Michael Berry

    Michael (#4): Care to site your source? At no time in the article (or the full article as linked to in the cited source..ahem) is there mention of suicide or attempted suicide. Also based on your reply to Gary, you may have slightly misread his post. He asked about the long-term effect of two (2) tablets of the extended release arthritis Tylenol taken daily, which is 650mg per tablet for a total of 1300mg daily as opposed to the 675mg you mention.

    Finally, one last question for you: Do you by chance work for a drug company which produces Tylenol or another brand of acetaminophen? I only ask because the link on your profile makes this seem awfully likely.

  • JP

    @5: The full text of the paper says, “46/134 (34.3%) of staggered overdoses were taken deliberately as a suicide attempt.”

  • J.M.

    Re: #1/#5 – 1300mg = 1.3g. “A staggered overdose was defined as an average of 4 grams per day.”

  • S. Minor

    Cathy, off-brand Excedrin would have acetominophen – the active ingredient in Tylenol – in it, not ibuprofen.

  • Jay Fox

    Personally, I never take the stuff. Plain aspirin for me.

    I find it curious that we used to test stuff on animals before taking it ourselves. That practice was discontinued, for the most part. But it did alert us to some very dangerous substances. As for acetaminophen, we know that it will kill a cat pretty quickly and effectively; whether this information comes from formal testing or anecdotes is irrelevant. So the question really is, who actually thinks that this stuff is any kind of safe for us? Is a cat really that different internally from a human that we cannot see a problem there?

    When they put melamine in dog food, it killed dogs. When they put it in baby food, it killed babies. If Tylenol can kill a cat, it can kill you. Find an alternative, and quit supporting the product. Anyone telling you that it is safe is not being truthful and probably connected in some way to big pharma.

  • pbird

    The weird thing is, that it doesn’t work anyhow. When a medical professional advises using it I know they are not serious. Its like a verbal placebo.

  • Marie

    Acetaminophen is a poison that happens to have pain killing properties, if you don’t take enough to poison yourself. Why would anyone choose to use this?

  • Ug

    Funny thing is that if Tylonol was a neww drug the FDA would not approve it due to the risk of liver damage but because it is such a household name they don’t take it off the market either.

  • alien

    i prefer tylenol than the others but at emergency rooms they keep telling people in pain to take anything because they dont have time to properly treat.

  • BJ

    I have arthritis. My doctor took me off ibuprofen because my stomach was upset all the time. Told me to take acetaminophen. Within 2 months my liver numbers, usually normal, had shot up. And even though I’ve stopped taking Tylenol, my liver numbers still jump around.

    Thanks, Tylenol!!

  • Michael

    @ Berry

    I am not affiliated with drug companies.

    “A total of 46/134 (34.3%) of staggered overdoses were taken deliberately as a suicide
    attempt” (source: the article)

    there’s no evidence that 1300mg of Tylenol Arthritis/day will cause liver damage in an otherwise healthy patient

  • Jamie

    Well Tylenol might not be the best thing in the world to take. However my father passed away at 51 due to Nash and he never took Tylenol or drank he took Motrin for 14 years straight though and it did contribute to his health issues I believe. I was in a car accident and was told to take tylen daily by my orthopedic doc and my fam doc and two pharmacists. So that being said I do take them daily and if you really do some research the fact is that Motrin has killed more people in a year than tylenol and most of those deaths were from people using it at appropriate doses. I have read alot of what dr William lee says and he is a luver specialist and seems to believe that it is an appropriate drug from many people and safe.


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