What you should know about acetaminophen

Acetaminophen is a medication that is commonly recommended for people with pain, and is available over-the-counter (OTC). It is sometimes combined with other medications, such as opioids, and a prescription is needed. Acetaminophen is generally regarded as safe and effective with relatively few side effects. In fact, depending on your symptoms and medical history, your health care provider may consider it the first choice for decreasing your pain.

It is important to remember that just because acetaminophen is widely recommended, regarded as safe, and readily available does not mean that it is harmless. On the contrary, it is an active yet often undetected ingredient in more than 100 medical products: cough syrups, pain relief creams, and headache medications, to name a few. As a result, it can be very easy to take too much of the drug—and that is when it can put your health at serious risk.

How acetaminophen works

The American College of Rheumatology recommends acetaminophen for the treatment of mild to moderate pain caused by osteoarthritis. An “analgesic” is a type of medication whose job is to relieve pain. Acetaminophen is a good example of a well-known analgesic. While it relieves pain, it does not reduce swelling or inflammation like nonsteroidal anti-inflammatory drugs (NSAIDs). Although researchers do not fully understand how it works, it’s thought to dull pain by affecting the parts of the brain that receive pain messages.

The American College of Rheumatology recommends acetaminophen for the treatment of mild to moderate pain caused by osteoarthritis. An “analgesic” is a type of medication whose job is to relieve pain. Acetaminophen is a good example of a well-known analgesic. While it relieves pain, it does not reduce swelling or inflammation like nonsteroidal anti-inflammatory drugs (NSAIDs). Although researchers do not fully understand how it works, it’s thought to dull pain by affecting the parts of the brain that receive pain messages.

Many health care providers initially recommend acetaminophen over NSAIDs because it has fewer gastrointestinal side effects and less potential for heart problems, bleeding, and other NSAID-related complications.

Realizing the risks

People who take excessively high doses of any acetaminophen-containing medication, OTC or prescription, run the risk of developing liver problems and these problems are not reversible. In fact, studies show that acetaminophen overdose is the leading cause of liver failure in the U.S. More than half of these cases are linked to prescription and OTC products containing acetaminophen. This can result in the need for a liver transplant to avoid death due to liver failure. In order to reduce this problem, in 2011 the FDA limited the amount of acetaminophen that can be put in prescription medications to 325 milligrams, and also recommended a lower maximum daily dosage.

The risk for acetaminophen-related liver damage is highest for people who:

    • Exceed the recommended daily dosage limit
    • Unknowingly consume several products containing acetaminophen at one time, exceeding the daily limits
  • Drink large amounts of alcohol regularly

5 steps for safe use

1. Stick to the daily dosage. If your health care provider recommends acetaminophen, be sure that you understand exactly how many pills you are supposed to take each day. This applies to both OTC and prescription products. If you don’t feel better, do not increase the dosage on your own. This could result in acetaminophen overdose. Instead, tell your health care provider that your pain hasn’t improved and review your current treatment plan together.

2. Share information. Tell your health care provider about any medications you are taking, including those that are not for your arthritis. As many other medications contain acetaminophen, you may be taking more than you realize. Examples of products with acetaminophen include:

  • Other OTC pain medications
  • Prescription pain medications that combine acetaminophen and other drugs
  • Cough syrups
  • Cold and flu products
  • Headache medications
  • Allergy relief products
    • Sinus products/decongestants

Even if you use these medications occasionally, let your health care provider know. if you are about to start taking one, be sure to check in with your health care provider or pharmacist beforehand.

3. Know what you take. It might not be immediately clear from the front of a box or the bottle if a product contains acetaminophen. Therefore, it’s important to read the list of ingredients on the side or back to see if acetaminophen is included (look for the heading “Active Ingredients”). Note that acetaminophen may be listed under the name “APAP”; this is often the case with prescription drug labels. If you find either “acetaminophen” or “APAP” as an ingredient, do not take the product without first consulting your health care provider or pharmacist.

Other ingredients found in OTC and prescription drugs may not mix well with acetaminophen. This “interaction” may cause or increase side effects and/or decrease the effectiveness of the drugs. Ask your health care provider or pharmacist what you should avoid.

4. Watch your alcohol intake. People who take acetaminophen and drink more than an average of three or more alcoholic beverages per day (two for women) may be at higher risk for liver problems. Even if you drink less than this, there may be special considerations regarding your consumption of alcohol and acetaminophen. Ask your health care provider what’s best for you.

5. Know your risk. As each person is unique, you may have factors in your medical history that make you more prone to acetaminophen risks. Talk to your health care provider to become aware of any symptoms or side effects that should concern you. Above all, always let your health care team know how you’re feeling and what you’re taking to ensure safe and effective acetaminophen use.