Tylenol side effects , caution, danger, adverse events, safety by Ray Sahelian, M.D.
Feb 12 2014

Tylenol is a common over the counter pain medicine. Tylenol is present in hundreds of products and may sometimes be unsafe even when used at the maximum daily doses recommended on package labeling. Tylenol (APAP) is the most common drug overdose in pregnancy. Tylenol isn't a NSAID, but it sometimes does reduce pain and fever. Unlike the NSAIDs, however, Tylenol does not reduce inflammation.

Safety of Tylenol side effects
Taken occasionally and in dosages less than 600 mg, Tylenol is generally safe. However, if you frequently take this pain medication than is recommended, Tylenol side effects can occur. Taking a large dose of Tylenol with alcohol increases that risk and can lead to sudden and severe problems, such as liver failure. Tylenol is included in many different medications for pain, headaches, colds and sleep aids. Be sure to read the ingredients listed for all your medications to make sure you are not consuming more Tylenol than you realize. For natural options on how to deal with insomnia.
     More than a third of healthy adults starting Tylenol at the maximum recommended daily dosage of 4 grams will exhibit ALT elevations. Liver enzyme elevation is a common Tylenol side effect. The lead researcher is Dr. Paul B. Watkins, from the University of North Carolina in Chapel Hill. Dr. Watkins's study involved 145 healthy adults who were randomized to receive Tylenol alone, Tylenol plus opioid in one of three combinations, or placebo for 14 days. In all of the Tylenol groups, the Tylenol dosage was 4 g/day. No ALT elevations greater than three times the upper limit of normal were seen in the placebo group. By contrast, the incidence of such elevations ranged from 31% to 44% in the four groups receiving Tylenol. As noted, treatment with opioids did not further increase the ALT elevation seen with Tylenol. Serum Tylenol levels were usually not measurable at the time of the elevation. JAMA 2006;296:87-93.

Liver Failure and Tylenol, natural treatment
In patients with acute liver failure, a test can determine whether Tylenol toxicity is involved. More than 56,000 emergency room visits and nearly 500 deaths in the US each year are attributed to Tylenol toxicity, owing to either intentional or unintentional overdoses. Tylenol toxicity is currently the most common cause of acute liver failure in the US and Europe. Although intentional Tylenol overdose is fairly easy to diagnose, in unintentional overdoses, the diagnosis can be elusive, leading to a delay in the administration of potentially life-saving treatment. In animal and human studies, "serum Tylenol-protein adducts" or mutations, are specific biomarkers for drug-related toxicity. Gastroenterology March 2006.
   Acetylcysteine is used in hospitals to reverse Tylenol overdose symptoms and signs. For more acetylcysteine information.

J Diet Suppl. Jan 10 2014. Hepatoprotective Action of Echinophora platyloba DC Leaves Against Acute Toxicity of Tylenol in Rats. The results suggest that E. platyloba extract has impressive hepatoprotective effects on acute Tylenol induced liver injuries.

Skin problems
Tylenol and other painkillers containing the ingredient acetaminophen can cause a potentially deadly skin rash known as Stevens-Johnson Syndrome.

Tylenol and osteoarthritis treatment, are there better alternatives?
The evidence to date suggests that NSAIDs are superior to Tylenol for improving knee and hip pain in people with osteoarthritis. In fact, it is possible that chronic use of Tylenol could harm or cause damage to articular tissue, or, at the least, harm liver tissue. For osteoarthritis pain and joint health, glucosamine and chondroitin are preferred.
   For natural options on how to reduce pain and discomfort from osteoarthritis.

Questions
Q. I would like to use n-acetylcysteine to protect my liver from the amount of Tylenol I am required to take on a daily basis due to my injuries. How much would I need to take of acetylcysteine?
   A. We have not seen any studies regarding the long term use of Tylenol and Acetyl-L-Cysteine, however a dose of 100 to 200 mg a day would seem reasonable. You can purchase N-acetylcysteine at the link provided above.

Q. People who are addicted to pain medications, such as hydrocodone, often take way too much Tylenol in the process. For over a year, I was one of them. I averaged over 30 10/325 tablets a day, often taking much more (several times 80 or more). Knowing what I was doing to my liver, I researched the procedure used in the ER for Tylenol overdose and proceeded to treat myself accordingly, using OTC NAC (n-acetylcysteine). I am thankfully free of this addiction now (over 9 months), but still communicate with others in the throws of it. I have suggested to them that they should stock up on N-acetyl Cysteine and use it if necessary (obviously the right solution is to go straight to the ER if you've taken over 10 grams of Tylenol, but we both know that may not happen with these folks). When I pointed this out, I was overwhelmingly ridiculed and dismissed by those who said the NAC available over the counter is nothing like that used in the ER. I know there is probably a difference, but given that one is not going to seek proper medical treatment, isn't the NAC we have access to a great alternative? What exactly is the difference between the two formulations?
   A. Based on my limited knowledge, since I have not seen head to head research comparisons, I tend to think that the benefits of oral and intravenous NAC would not be too different, but I have no proof of this.