Acetaminophen (such as Tylenol®) is the most commonly used analgesic medication worldwide. I have never been a fan of using acetaminophen for any condition. Let me explain.
A recent study published in the British Medical Journal (March 1, 2015) highlighted some of the adverse effects of acetaminophen. The researchers looked at multiple trials that reported adverse events related to acetaminophen use including mortality as well as cardiovascular, gastrointestinal or kidney problems. In one study, the authors found a 90% increased risk in overall mortality in those taking acetaminophen. Furthermore, there was a dose-response curve in the relative rate of mortality. This means the highest exposure to acetaminophen was associated with a higher mortality rate when compared to the lowest exposure group. Of the four studies that looked at cardiovascular adverse events and acetaminophen exposure, all found a dose-response with the highest users of acetaminophen having more cardiovascular adverse events (68%) as compared to the lowest exposure group (11%). With gastrointestinal and kidney adverse events, a similar dose-response was found; increasing doses of acetaminophen were associated with more problems.
Comment: Many physicians and lay people assume that acetaminophen is perfectly safe. It is not. Of course, any substance taken in the wrong amounts could cause harm to the body. However, acetaminophen is an example of a substance that has a small therapeutic window. That means that taking amounts slightly outside the therapeutic window could prove to be toxic. The liver is most affected by acetaminophen as that is where it is detoxified. The upper limit of acetaminophen a day is 4,000mg/day. For most people this maximal limit is safe. But, once the 4,000mg/day limit is crossed, the liver can be damaged and the damage can happen quickly. This upper limit for dosing acetaminophen can quickly be breached when someone is unknowingly using acetaminophen in common cold and upper respiratory remedies as well as prescription and non-prescription pain killers. The FDA has realized the problem and taken steps to remove acetaminophen-containing pain killing drugs from the market.
Also, children can overuse acetaminophen when they are ill with a fever. I would highly advise parents against using acetaminophen for fever control in both children and adults. The reason is that during an acute illness that produces a fever, the last thing anyone should do is to take a medication that is potentially toxic to the liver. It is best to treat children with a fever symptomatically with supportive care such as tepid bathing and rest. If an anti-fever medication is needed in an adult, I suggest using a nonsteroidal, anti-inflammatory medication. I know these drugs also have problems, but I think they are safer for short-term use than acetaminophen.
One final note about acetaminophen use in children. I would strongly discourage the use acetaminophen either before or after a vaccine. A single dose of acetaminophen lowers the liver’s ability to produce the potent antioxidant glutathione. All vaccines are designed to create an inflammatory reaction in the body and the body needs adequate glutathione levels to combat this inflammation. Again, it is best to use supportive care for children who have a fever or who suffer adverse effects from a vaccine.
Finally, the elderly need to be cautious when using acetaminophen. As compared to a young person, an elderly person’s liver is more susceptible to damage from acetaminophen. If you take acetaminophen, use the lowest dose possible for the shortest time period. Also, it is best to support the liver with the proper supplements when using acetaminophen. This can include taking vitamin C (3-6,000mg/day), N-acetyl cysteine (300-600mg/day), and alpha lipoic acid (3-600mg/day). There are many herbal products helpful for maintaining optimal liver function. My partners and I have designed a nutraceutical product that supplies the liver with natural items that aid the detoxification pathways. It is known as Total Liver Care or TLC. One scoop of TLC twice per day can help the liver optimize its’ function.
DrB
– To learn more about natural ways to maintain a healthy liver, check out our ‘Detoxification Packages’.
I wanted to share that recent research is suggesting adverse neurologic effects from acetaminophen, particularly from use during pregnancy. Four human studies have found increased risk of ADHD and now autism in offspring whose mothers used acetaminophen while pregnant. Animal studies support these findings and also suggest that the critical time period of exposure may extend into early life. This is concerning because acetaminophen is often given to infants, as well. This infant exposure begins early, pain management guidelines suggest the use of acetaminophen with the circumcision procedure.
http://www.ncbi.nlm.nih.gov/pubmed/26688372
http://www.ncbi.nlm.nih.gov/pubmed/24163279
http://www.ncbi.nlm.nih.gov/pubmed/24566677
http://www.ncbi.nlm.nih.gov/pubmed/25251831
http://www.ncbi.nlm.nih.gov/pubmed/24361869
http://www.ncbi.nlm.nih.gov/pubmed/25607892
http://www.ncbi.nlm.nih.gov/pubmed/26254283
Are there any clinical trials which were done in America? I note the only one referenced was from England, why hasn’t any American doctors performed clinical trials if what you say is true about acetaminophen being so dangerous to the liver? And if is so dangerous, then how on earth can the maximum daily dosage be as high as 4,000 Mgms? I keep hearing different snippets about how dangerous it is but no one references any clinical trials verifying it?
A poorly researched article. Misleading at best and most likely, a prime example of “cherry-picking” to support your bias.
Your summary was quite inaccurate such as the 90% “mortality”. You either deliberately failed to provide the relevant clinical trial results or you are simply lying. And you are a Doctor? Of what? Certainly not medicine. Bullshit perhaps?
Publish the trial data or retract this b.s. altogether. A 90% mortality drug would have NEVER made it to the supermarket shelves. Anything this dangerous would have long ago been pulled.
The implications of this article are astounding – you have no idea what you’re doing.
JR….Why are you even on here? For an example, others including myself are signed up to recieve newsletters from Dr. Brownstein cause we value his knowledge and research and enjoy that heshares it with us. If you don’t believe the data and think tylenol is not toxic to your liver, then you are completely misinformed cause tylenol is 100% toxic to your liver if you take too much and that’s coming from an ER nurse. I personally have witnessed it more than once. Just curious, what is your occupation concidering you think you know more that a MD?
Dr. B.,
This article is timely. My neighbor’s young, adult daughter had an ear infection, she
took too much Tylenol which caused liver failure. She sees a doctor twice a week
and is taking an experimental drug.
You know I appreciate you and CHM for your dedication to the world’s health!
I hope people will listen and learn prevention. V/R Pam
Thank you so much for this article! I have always liked Motrin better than Tylenol & thank God I have that when my kids got vaccines, I also prayed knowing in my gut they were not good. Good to know about Tumeric, bromelain & natural inflammatories!! I have RA & fibromyalgia. I used to take methotrexate but it scared me so I stopped taking it. A new dr has put me on Avera. Am also on Duragesic & morphine as I have horrible pain. I do worry about all side effects as I am on generic Effexor XR as well & Trazadone to sleep. I take herbal supplements for adrenal health, Greens everyday which has 8+ fruits & vegetables, 38 Superfoods including wheat grass & probiotics & a product that helps regenerate HGH in our body. After being on those I started sleeping much better & felt generally better but with constant stress my pain flares up. Also on Victoza for hyperinsulinemia. If I miss Trazadone or Venlaxafine for 2 days I have withdrawal & start vomiting. Hate that!!! Any suggestions?? Also on Armour Thyroid for hypothyroid. I know, I am a mess, but better somewhat better after supplements. Have to supplement with Vit D3 off & on for low Vit D levels. I love reading your blogs & have told many people to look you up! Thank you for your honesty & research regarding conventional medicine. Was an RN for 20 yrs & saw so many things that I knew were wrong!!!
Who takes 4000mgs of acetemetophin per day? What about 200mgs per day? Is that healthy? Would truly like to konw.
Karen,
Some of the pills come in 500mg doses. A lot of people take those doses.
DrB
Magnesium “oil” spray would be something to try for tension (muscle) headache relief. Apply it to unbroken skin, away from the eyes. Try a small amount first, as it can cause stinging or redness on those who are deficient in magnesium. Most people could use supplementation of this vital mineral. Our soils are depleted making it hard to get enough through food alone. As vitamin D goes up, magnesium goes down, so be careful supplementing with the D.
I’ve read that ibuprofen can damage gut bacteria.
What do you recommend for a headache?
Dear M,
Sometimes just hydrating with salt and water helps a headache. Sometimes, one needs more than a natural therapy for a headache. I would say a NSAID like ibuprofen would be a better choice than acetaminophen.
DrB
What about ibuprofen? Does it have the same effect on the liver? A lot of women will take tyenol or ibuprofen to deal with menstrual cramps.
Ana,
Ibuprofen has its share of adverse effects. But, it is not toxic to the liver at low doses like acetaminophen. If you use ibuprofen, I suggest using it for the shortest time period possible as long-term use is associated with kidney problems. Taking it for a few days per month should not cause any problems.
DrB
Total Liver Care contains rice protein. I have several cans of Total Liver Care, but am reluctant to use it since I saw the test results of rice grown in different parts of the world.
What is the source of the rice protein and has Total Liver Care been tested for heavy metals or other contamination?
Most rice contains high levels of arsenic, brown rice having the highest levels and white rice having lower levels of arsenic.
It does not matter if the rice is organic or conventional. Both have high levels of contamination.
Dear John,
Thank you very much for your inquiries about TLC from PureZen Health. It is always great to know that our patients are educating themselves and taking the time to read product labels! The rice protein in our product is a non-GMO sprouted rice. It comes from the USA. Our lab is GMP certified. We are continually testing all of our PureZen Health products for heavy metals to ensure that they fall below the NSF Guidelines.
DrB
Dr. B., you said the BMJ researchers looked at multiple “trials” of acetaminophen, but I believe they actually reviewed only observational studies and no clinical trials. I don’t doubt the toxicity of acetaminophen, and I never take it, but as we know it’s not so simple to interpret observational findings such as these. Some of the increased mortality and morbidity they found could be reverse causation, for example, with sicker people taking more acetaminophen rather than the drug making people sicker.
I do not see where you warn people that glucosamine comes from shellfish. There are a huge number of people allergic to shellfish. Also I wish you would issue a warning to people who have allergies about these “natural herbs”, as they can cause a severe allergic reaction in people with multiple allergies. Lets show all sides of the picture please and thank you. I will stick with my Tylenol.
Margie,
You are right. Anything can cause an allergic reaction, Tylenol included. However, other items are not so toxic to the liver.
DrB
I would personally be very careful about taking ALA. It is a powerful supplement with possible side effects.
It can chelate heavy metals.
I read a while ago that a Philadelphia, PA, hospital was removing ALL supplements from its formulary.
I wondered what they would do with acetaminophen overdose since NAC is used for that. NAC is a highly effective OTC supplement.
I used NAC to clear lung congestion that a prescription drug was failing to clear. It has not been a cure, though.
I do stop taking it for a few days here and there.
I hear what your saying, and by no means want to put my children at risk, however my question is what would you suggest when a child has the flu and their temp is 105.4? This is how high my daughters got this winter more then once and the only way I could keep it from spiking that high was alternating between ibuprofen and tylenol. What is your suggestion to control fevers this high. Side note I did place her in a bath which brought it down to 103.9 only to spike back up to 105 within 5 mins of being out of the bath. The next time her temp spiked that high she had ibuprofen in her system. Thanks for all that you do. I enjoy reading your arrivals.
Emily,
It is not easy. I remember when my kids were sick.
Having said that, I did not give my kids acetaminophen. Ever.
DrB
Turmeric or/and Apple Cider Vigegar caps work very well for inflamation response. Mom’s cancer was burning her up. I brought down the inflamation in 2 days. That night she didn’t even take a pain pill. I got chewed out for waking her up and telling her it was time to take her pain pill. lol She slept all night without it. Unfortunately mom didn’t start listening to the herbal taker until after it was too late. I surely miss her.
A while ago I was told by an MD to take 800mg of Motrin and 2grams of acetaminophen alternating every 6 hours for a high fever (turned out to be caused by Lyme disease). I did this for two days and it did lower the fever quite effectively. I did follow up blood work and my doctor said I had life threatening liver enzyme levels. She didn’t suspect the acetaminophen because the dosage was considered the higher level of normal. After about a week of non-usage the liver enzymes returned to normal. Wish I had known about the Vit C and NAC before hand as I had bottles available but didn’t know to use them.
I suddenly began itching horribly then became jaundiced many years ago after taking large doses of Tylenol for migraines. After that I tried to stay within the recommended dosage and never had a problem. Then when I had my gallbladder removed two years ago, on the third day taking (the least amount possible) Vicodin suddenly began itching and looked jaundiced and went to the ER where my liver enzymes were sky high. Surgeon said he doesn’t know what happened but it’s my understanding Vicodin is essentially high-strength Tylenol? I’m so sensitive to ALL medications, I have to be very careful about taking anything, even vitamins. I can’t take any of the other pain relievers due to bleeding issues. I’m a mess
Jo,
Vicodin contains acetaminophen. You highlighted a problem–too many drugs and over-the-counter meds contain acetaminophen.
DrB
Thank you for publishing this excellent article, Dr Brownstein. My daughter now 50 was 14 at home with her brothers 12 and 10 one evening when I was at work…I got a call from the 12 year old saying his sister had just taken 24 Tylenol. I was very busy with customers and called a close friend who was a co-worker and asked her to call poison control for me…she called me back and told me my daughter needed to be in an er within 24 hours….said she was willing to call the boss and come in and cover my shift….within the hour she was there…I went home and took my daughter to the er that evening….they admitted her and started detoxing her….3 days of it. Her brothers had been teasing her mercilessly as children sometimes do and she decided she’d had all she could take. Needless to say after what the doctors told me I have not purchased another Tylenol since. It was a harrowing experience for a single mom but I do believe today that it was the day the light bulb came on for me that over the counter medicine is not safe for anyone which was the beginning of my path to a far healthier lifestyle . I have shared this story often over the years with others one on one to raise awareness of the dangers of medicines that are considered safe by most people and I thank you for the work you do trying to raise public consciousness of these issues,
I have a lot of pain from arthritis..my right knee causes the most. I am a female in my early 70’s. My doctor does not want me to use Motrin etc. Because it is hard on the stomach as is ASA. So I take Tylenol arthritis when having a lot of discomfort Qid with Motrin before bed 400mg. My doctor has given me no other advise regarding pain I less you consider he wants me to see a surgeon regarding knee replacement. I’m not ready to consider that. I do go to physio and do exercise.. I need pain support. I have tried holistic support in the past but it has become very expensive for someone on a pension and does not give me the relief from pain I need. I take 2 Tylenol ES Qid with Motrin 400mg at HS right now. Any advise you might give would be helpfu.
Merle,
There are natural anti-inflammatory items that are not associated with the adverse effects that acetaminophen and NSAIDs have. This includes systemic enzymes, turmeric, and bromelain. I have formulated a product called Limbex which has many of these ingredients in it. You can find it here: http://www.medixselect.com/product/LX_Bundle/products?src=Y1016&utm_source=bing&utm_medium=cpc&utm_campaign=search
Finally, it is best to work with a holistic health care provider who is knowledgeable about natural approaches to help relieve pain.
DrB
In a nutshell, Aspirin caused internal bleeding in my mom. She had many health issues, but that one was the last strawthat pretty much put her in the grave at the age of 60. Afterwards the doctor told us she should never have been on aspirin… took me quite aback, as it was that same hospital that had insisted she go on aspirin!
Crystal,
All drugs have risks and benefits. Acetaminophen and aspirin included. Everybody needs to be careful when taking any medication for prolonged periods of time. I just reviewed the problems with acetaminophen. Aspirin and other NSAIDs are all associated with bleeding and kidney failure. There are natural anti-inflammatory agents that don’t have the serious side effects that acetaminophen and NSAIDs have.
I am sorry to hear about your mother.
DrB
When I graduated in the late 70’s from pharmacy school, there was an article headlined in the Star Tribune in Minnesota that stated if the FDA knew what it discovered in the 70’s for negative effects of acetaminophen, the FDA would never have approved the drug. Isn’t it interesting after all of these decades that they have done nothing to withdraw this drug.
Pjj,
So true. The FDA should never have allowed so many products to contain acetaminophen.
DrB
I was fortunate to learn of the benefit of taking NAC (N-Acetyl Cysteine) along with acetaminophen many, many years ago. I also learned that it is standard practice in Europe to only sell acetaminophen which already contains this ingredient! It saddens me so much that our medical “industry” does not open its eyes and ears to the knowledge available that can be so simple and so beneficial. Fortunately, I do not use acetaminophen often…but I keep a bottle of NAC around for those times when it is required. I will now add a bottle of ALA to the cupboard as well!
Thank you for this post. The subject is very interesting. Is it possible to provide a permalink (non-subscription) to the article you cite? When you say that the authors found a 90% mortality rate—this seems quite high! Would this be at any dosage, overdosage, and/or for extended periods of time? The Daily News says that the mortality rate in what appears to be the same BMJ-published analysis maxed out at 63% (http://nydn.us/1vZyMfY) for long-term users only. And finally, do any of the studies provide similar data—or do you have a medical opinion—regarding ibuprofen and/or naproxen sodium? Thanks once again.
Jeanine,
It is a 90% increased mortality rate in those that took acetaminophen when compared to those not taking it.
NSAIDs such as ibuprofen have their own side effects-increased bleeding risk, decreased blood flow to the kidneys, etc. However, if an adult is going to take something for pain, fever, etc., I feel a NSAID is a better choice then acetaminophen.
DrB
I have a friend, had a friend who was prescribed acetaminophen for many years for pain. She passed away from cirrhosis of the liver. You think when you go to a DOCTOR you are safe with what he prescribes. Not true. This woman was an active vital human being. She is gone. AND by the way her son was also a DOCTER. Be careful folks they act under the falsehood that they know everything but they know very little when it comes to real medicine. Read the book MEDISINES.
why can’t I print or copy this article? I want to sent to my son-in-law. Thank you.
Celia,
The article can be found here: http://www.bmj.com/content/350/bmj.h1186