Acetaminophen: What You Should Know
By Adam W. Cooper, Pharm D, Preston Road Pharmacy, North Dallas LIVING WELL Magazine
“Tylenol” and Its Aliases
Most everyone has, at some point, stocked a medicine cabinet with Tylenol. The name is as ubiquitous as Coke and used almost as generically. We might ask someone if they have any Tylenol, when ibuprofen or any other pain reliever may suffice. However, even a cursory review of the Tylenol product line shows that this product is anything but generic. There is Tylenol, Tylenol Extra Strength (XS), Tylenol Arthritis, Tylenol Cold and Sinus, Tylenol PM, etc. All of these over-the-counter medications are different in their own right.
The active ingredient in each of the above Tylenol products is known chemically as acetaminophen (or n-Acetyl-Para-AminoPhenol). This chemical is found in many over-the-counter products that do not bear the trade name Tylenol. In fact, nearly all major retailers that sell pharmaceutical products sell store-branded products that contain acetaminophen. The trouble here is that a consumer’s ability to know that the product contains acetaminophen, though there is a labeling requirement, is not implicit. CVS’s product reads “Extra Strength Pain Reliever” for its equivalent to Tylenol XS, while The Medicine Shoppe’s product reads “Pain Reliever Extra Strength.” The designation of the drug as acetaminophen is located on the box, but in much smaller lettering.
To muddy the waters even further, there are many cough and cold products (i.e. Nyquil) that also contain acetaminophen. Consumers must search the list of active ingredients on the back of the box to determine if the drug is contained in the product.
Then, there are the prescription drugs. Lortab, Lorcet, Vicodin, Percocet, Ultracet, Norco, Fiorcet, Tylenol with Codeine, hydrocodone/APAP, oxycodone/APAP, tramadol/APAP, butalbital/APAP/Caffeine, etc., all contain acetaminophen. Which brings up the third alias of acetaminophen, APAP. This abbreviation is a shortened version of the chemical name above, n-Acetyl-Para-AminoPhenol (capitals emphasized).
The ability to confuse and combine these products becomes easily apparent when the breadth of use of acetaminophen is known. A sufferer of migraines, for example, may take his/her Fiorcet for a migraine, Extra Strength Tylenol for chronic knee pain, and Nyquil for an on-going cold, never realizing that each product contains acetaminophen. The potential for overdose is high among the general population, many of whom are unfamiliar with drugs.
What’s The Danger?
A common misconception of over-the-counter (OTC) products is that these products are not dangerous. “So, who cares if ‘Tylenol’ (acetaminophen) is taken from multiple sources? It is over-the-counter and harmless,” one may say. Well, acetaminophen is not harmless. In fact, there are a number of deaths associated with acetaminophen overdose each year. It is also the number one cause for acute liver failure (approximately half of the cases) each year. Half of the cases of liver failure attributed to acetaminophen are unintentional overdoses from OTC, prescription, or combinations of OTC and prescription products containing the drug. At very high doses, acute kidney injury can also occur.
The Up Side
Acetaminophen is very useful for a number of ailments including joint pain, general pain, mild headaches, and fever. The intent of this article is not to demonize the drug, but rather to advocate for its safe use. The body is able to process acetaminophen very effectively when used appropriately. There are guidelines to the maximum allowable daily quantities of acetaminophen. For a single dose, 1000 mg is the maximum quantity that should be taken. As for the maximum in a day, 4000 mg is the upper limit. McNeil, the company that markets Tylenol has placed voluntary labeling on its packages stating that 3000 mg is the maximum daily allowance. This number is a conservative value and more of a guideline, where 4000 mg is the current Food and Drug Administration (FDA) daily maximum. However, these numbers do carry a caveat. Those persons with concurrent liver injury or who drink three or more alcoholic drinks a day, have a higher chance for liver toxicity due to acetaminophen use. These persons should seek medical advice from a physician when using this medication.
The FDA is taking steps to protect the consumer. By January 2014, all prescription products must comply with a limit of 325 mg acetaminophen per tablet. There are also OTC labeling requirements, as alluded previously, which attempt to bring attention to products containing the drug. The FDA also maintains that acetaminophen is safe to use when the maximum daily doses are observed.
Things to Consider
Acetaminophen certainly has a place in the household medicine cabinet. However, discretion should be used. There are ways to limit the potential for acetaminophen toxicity. First, avoid combination cold and cough products and buy the components individually to avert unintentional acetaminophen consumption. This is also to say, keep a container of acetaminophen as a single product for treatment of the common ailments listed above if the product is preferred over alternatives such as ibuprofen. Second, review prescription medications to determine acetaminophen presence and determine the daily dose used. Third, do not take acetaminophen for more days than necessary or take only as directed by a physician. Additionally, do not take OTC products in excess of the package instructions. Fourth, remember that APAP is synonymous with acetaminophen. Lastly, consult a healthcare provider if there is prior liver damage or if three or more alcoholic drinks are consumed daily.
As a final note, pharmacists are always available to sort through the plethora of products on the market to help you determine the presence of acetaminophen and its safe use. Do not forget about this valuable resource. Call or visit them when in doubt.
Adam W. Cooper, Pharm D, is employed by Preston Road Pharmacy. Call 214-521-9991 or visit the pharmacy at 6901 Preston Road, Dallas, TX. You may also visit their website at prestonroadpharmacy.com to see ways that Preston Road Pharmacy can serve your healthcare needs.
