Toxicity

Mickie Cathers

As cold and flu season rolls on, so does a spike in calls to poison control centers due to acetaminophen overuse. Many patients reach for acetaminophen to combat symptoms, but unintentional overdoses can lead to serious health risks, emphasizing the need for cautious medication management.

In a January 2025 alert, Rutgers University-New Brunswick said a New Jersey poison control center assisted in the care of several patients who accidentally took too much acetaminophen while self-treating flu-like symptoms. Each patient received antidotal therapy to prevent liver failure and death.

“Most people don’t realize they’re at risk of overusing acetaminophen because they’re unaware so many medicines contain this ingredient,” said Diane Calello, executive and medical director of the New Jersey Poison Control Center at Rutgers New Jersey Medical School. “There are more than 600 products on the market that contain acetaminophen.”

Potential adverse effects of taking too much acetaminophen can include life-threatening emergencies such as severe liver damage, liver or kidney failure, or even death.

Safe use of acetaminophen

Acetaminophen, found in Tylenol and many OTC products, is safe when used correctly and within the daily limit of 4,000 mg. Knowing the correct dosage helps prevent overdose and ensures acetaminophen remains an effective pain and fever reducer. Regular Strength Tylenol contains 325 mg per tablet, while Extra Strength has 500 mg.

“Pharmacists also need to remind patients that acetaminophen is included in some prescription products,” said Nicholas W. Carris, PharmD, associate professor and director of the division of ambulatory care at the University of South Florida. “Patients need to know what the maximum safe dose of acetaminophen is for them. If patients don’t need to take the maximum dose to manage their condition, then there is no need to take the maximum dose and potentially increase the risk for accidental overdose.”

Infants and children are particularly susceptible to accidental acetaminophen overdose. It takes much less acetaminophen to cause harm in children compared with adults, highlighting the need for cautious dosing. Dosages for children should be based on their weight, not age, to ensure safety. Educating parents and caregivers on proper dosing guidelines is crucial to safeguard children’s health.

Impact of pharmacists

Pharmacists are strategically positioned to help prevent accidental acetaminophen overdoses. With their expertise and accessibility, pharmacists can educate patients about safe medication use and identify potential overdose risks.

“Community pharmacists are usually at the forefront of where they can help catch an issue with acetaminophen dosing,” said Brenda Denson, PharmD, pharmacy educator at Children’s of Alabama, Birmingham. “While medical offices may provide written educational materials, pharmacists are often the ones who ask questions about OTCs.”

A general lack of awareness about acetaminophen overdose risks is a significant concern.

Encouraging active pharmacist–patient communication can enhance public health outcomes and prevent medication-related accidents.

“Pharmacists can suggest agents that do not contain acetaminophen for the flu or colds so that acetaminophen can be given separately,” said Denson. “This makes the dosing for fever or aches/pain more intentional without the worry of calculating with the combination products when not feeling well.”

By educating the public on safe usage and dosage, pharmacists can reduce the risk of overdose and promote safer medication practices.

“Pharmacists need to make sure patients are comfortable with how many of what product(s) is safe for them to take in a clearly defined time period,” said Carris, who is also vice chair of the department of pharmacotherapeutics and clinical research. “This way the patient can then repeat back the specifics of what they’ll actually take and when they’ll actually take it.” ■

Tips on counseling patients to prevent overusing acetaminophen

• Open communication: “Every time a pharmacist is counseling on everyday aches, pains, and fevers they need to be aware of acetaminophen and discuss it with their patient,” said Nicholas W. Carris, PharmD, associate professor and director of the division of ambulatory care at the University of South Florida.

• Checking labels and consulting with your pharmacist can help avoid unintentional overdoses: “Caution patients on the importance of looking at the ingredient list of anything they take,” said Carris.

• Avoid combining medicines and products: Remind patients that acetaminophen is an ingredient in some prescription products and warn them that taking more than one OTC product containing acetaminophen at the same time or within a short period of time can be dangerous. Review all product ingredients to prevent doubling up on acetaminophen, a common cause of overdose. Be mindful of the total milligrams consumed from all sources within 24 hours. “Cutoffs for dosing in patients based on alcohol intake should also be mentioned,” said Carris.

• Follow the directions on the label: Carefully read the warnings and dosing directions on the label, insert, or product packaging before taking or giving medicine. ■