The most common question I am asked by hepatitis C patients, “Is Tylenol (acetaminophen or paracetamol as it is called in other countries) safe for the liver? The answer is, “Yes, if taken as directed.”
The most common scolding I get from readers is, “Are you nuts? Tylenol is bad for the liver. My doctor told me not to take it, there are warnings all over the box, and you are giving bad information.”
Which is true? My first answer is correct with one caveat – I do not give medical advice and if your doctor told you not to take it, then discuss this with him or her. So how is it that Tylenol got this reputation? If it is safe, then why are there all these warnings about acetaminophen’s potential to be hepatotoxic? The short answer is that the vast majority of acetaminophen/paracetamol-induced injury is from taking excessive amounts.
Here are some facts:
- In a study published in the British Journal of Clinical Pharmacology (Feb 2011), a team of Scottish researchers gathered data from 1992 through 2008. They noted that 75% of liver injuries from paracetamol were suicide attempts; 17% were unintentional overdose; 8% the cause could not be accurately determined.
- Similar results were reported in a Canadian study published in August 2008 issue of Clinical Gastroenterology and Hepatology. Over a ten-year period, the majority of acetaminophen-induced liver injuries were for intentional overdose. Of the remaining cases, unintentional overdose and alcoholic liver disease were found to be present.
- Research performed in the U.S. shows that about 2/3 of acetaminophen-induced liver injuries were for intentional overdose; nearly all the remaining cases were for unintentional overdose. There were a handful of cases of people who have had liver injuries despite taking less than 4000 mg a day. There appears to be no explanation for this.
So how do you take acetaminophen safely?
- Talk to your doctor or nurse about the right dose for you. Most agree that 3000 mg a day is safe, but if you have liver disase, the maximum dose is 2000 mg. However, that dose is divided over 24 hours and not taken at once. A single dose is usually 500 mg or 650 mg, but some people can take less with good results.
- Be sure that your total acetaminophen dose includes ALL sources of this drug. Acetaminophen is added to over 600 other medications, including pain meds, sleep meds, cold meds, cough meds, sinus meds, etc. Sometimes acetaminophen is listed as APAP.
- Don’t drink alcohol when taking any medication (no alcohol is advised for those with hepatitis C).
- Aim for the lowest dose. If one pill reduces your fever, then why take more?
- Don’t jump from the frying pan into the fire by switching to ibuprofen or others known as non-steroidal anti-inflammatory drugs (NSAIDs). Acetaminophen accounts for 500 deaths a year in the U.S.; the annual deaths for NSAIDs is 16,500.
For more information:
HCV Advocate’s Acetaminophen and Your Liver