Published February 5, 2013 (revised December 23, 2024)
Acetaminophen (brand name Tylenol) is well known as an over-the-counter (OTC) pain reliever and fever reducer. Acetaminophen is an ingredient that is also found in many OTC and prescription medicines, such as flu and cold medicines, for both adults and children.
Acetaminophen has received public attention as a cause of liver damage when more than the recommended amount is taken. In 2011, the Acetaminophen Awareness Coalition (AAC) was formed to educate people about the safe and effective use of acetaminophen. The Coalition is made up of leading healthcare organizations, healthcare providers, and consumer organizations. The US Food and Drug Administration (FDA), a member of the Coalition, issued a statement reminding consumers about the dangers of taking too much acetaminophen.
Some of the key points you should know about using acetaminophen safely include the following:
There is a large selection of both prescription and non-prescription medicines that contain acetaminophen in combination with other active ingredients. For example, many cold medicines contain acetaminophen to help reduce fever and pain, a decongestant to treat nasal stuffiness, and a cough suppressant. Combining two or more products containing acetaminophen can be harmful.
It is important to read the active ingredients on the Drug Facts label before taking the medicine.
OTC medicines: The FDA makes sure that labels on OTC medicines list all the active ingredients in the Drug Facts section of the label. Go to KnowYourDose to learn how to read an OTC label.
Prescription medicines: Because of limited space on prescription labels, sometime an abbreviation for acetaminophen, APAP, is used instead. APAP stands for N-acetyl-p-aminophenol, a chemical name for acetaminophen. So, if a prescription medicine contains acetaminophen, you may not see the word acetaminophen written out on the prescription label. For example, the pain reliever Percocet contains oxycodone (a powerful pain medicine) and acetaminophen. The prescription label for a generic brand of Percocet may list "oxycodone and APAP" on the label.
Familiarize yourself with the recommended daily dosage of acetaminophen. Taking too much can lead to severe liver damage.
Adults: The current maximum recommended adult dose is 4,000 milligrams per day. Depending on the medicine you are taking, each tablet or liquid dose of acetaminophen may vary. Carefully read the label to determine how much acetaminophen you are taking in each dose. Follow the dosing schedule as directed on the label. For example, do not take a dose sooner than recommended.
Children ages two years and up: The recommended dosage of acetaminophen for children two years and older depends on the child’s weight. OTC package labels will provide recommendations by both the age and weight of your child. However, to get the most accurate dose, it’s best to know your child’s current weight is. The maximum dosing should not exceed five doses in 24 hours.
Children ages two and younger: Currently, OTC products containing acetaminophen do not include dosing instructions for children less than two. Parents are instructed to call their physician for dosing instruction.
Be aware that the maximum amount of acetaminophen that can be safely ingested may not be the same for every person. If you have a history of liver disease, drink more than three alcoholic beverages per day, or take other medications that can affect the liver, ask your doctor what the safest dose of acetaminophen is for you.
Don’t Mix Up Concentrated “Ibuprofen Infant Drops” with “Children’s Ibuprofen”
Ibuprofen is s an over-the-counter (OTC) medicine that parents might give their child to relieve minor aches and pains or reduce a fever. For children, it is available in chewable tablets (100 mg each) and an oral suspension (liquid). But parents may not be aware that there are two different concentrations of the oral suspension. Ibuprofen for infants contains 50 mg per 1.25 mL (40 mg per mL) and is often called “infant drops.” This medicine is for 6- to 23-month-old babies who weigh 12 to 23 pounds (5.5 to 10.5 kilograms [kg]). Babies may not be able to swallow a large amount of medicine. So, ibuprofen for infants is more concentrated than ibuprofen for children.
A woman went to pick up her son's prescription for Metadate CD (methylphenidate, extended release), which is used to treat attention-deficit/hyperactivity disorder (ADHD). The pharmacist had a hard time reading the prescription. He thought the doctor had prescribed methadone. This medicine is used for drug withdrawal, and also to lessen cancer pain.
A doctor prescribed doxepin (Sinequan) 50 mg daily for a young man with depression. This medicine is available in a 50 mg capsule. But the pharmacy where the man had the prescription filled carried only 10 mg and 100 mg capsules. The lower dose (10 mg) is normally used to treat patients with chronic itching. A higher dose (50 mg or more) is the usual dose to treat depression.
Medications for children are frequently ordered by the "dropperful". There are several problems with these orders. First there is too much room for misinterpretation of what might constitute a dropperful. One individual might consider it to be a dropper filled to the upper calibration mark.
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