When fevers strike or you get that occasional headache, it’s common to use an over-the-counter (OTC) medication to relieve it. A popular choice for these ailments is acetaminophen. But many people simply call it Tylenol.
Tylenol is one of the most commonly used medications and is a staple for many people’s medicine cabinets. Its low risk of common side effects, like nausea or stomach pain, may appeal to lots of people. It’s even considered safe for most infants and pregnant women.
But Tylenol isn’t without risks. One serious side effect of Tylenol is possible liver damage. But if you don’t have liver problems, should you still be concerned?
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While you shouldn’t be scared to take Tylenol when needed, liver damage is still something to be aware of — especially if you take Tylenol regularly.
Does Tylenol affect the liver?
Yes, Tylenol can affect the liver. But for most people, occasional use at recommended doses isn’t an issue. Problems typically only happen when taking too much Tylenol. But since many OTC and prescription medications include acetaminophen (Tylenol’s active ingredient), it can be easy to accidentally take more than what’s recommended.
Medications are responsible for nearly half of the acute (sudden) liver failure cases in the U.S. And Tylenol is the most common medication involved. This dangerous side effect was first noted by healthcare professionals in the 1960s.
How and where is Tylenol metabolized?
Tylenol is mainly metabolized (broken down) by the liver. At regular doses, Tylenol is broken down into a few substances. The majority of these substances are harmless. But a small percentage of Tylenol is broken down into a toxic chemical called NAPQI. Your liver quickly makes NAPQI non-toxic with a molecule called glutathione. Your body then gets rid of it through your kidneys, and you urinate it out.
But if you take large amounts of Tylenol, your liver doesn’t have enough glutathione to handle all of the NAPQI in the body. This toxic substance can build up and start poisoning liver cells. If left untreated, this can lead to life-threatening liver failure.
How much Tylenol can you take?
For most adults, the recommended daily maximum of Tylenol is 4,000 mg in 24 hours. This would mean no more than 8 extra-strength Tylenol (500 mg per pill) or 12 regular-strength Tylenol (325 mg per pill) per day.
If you’re taking Tylenol for longer than 7 days in a row, some experts suggest only taking a total of 3,250 mg per day. That's no more than 6 extra-strength Tylenol or 10 regular-strength Tylenol per day.
But some people may be better off taking even less than this, including:
People with liver disease
People who drink three or more alcoholic beverages per day
People who have poor nutrition
People who are fasting
People with a low body weight
People who are sick with a fever
Taking a safe dose: Pharmacists review recommended Tylenol (acetaminophen) dosages to help prevent serious complications.
Other Tylenol risks: Liver damage is one of Tylenol’s rare but serious side effects.
Avoiding risky combinations: Learn about which Tylenol interactions can raise your risk of liver damage.
If any of the above situations apply to you, or if you’ve been told you have a history of liver problems, speak with a healthcare professional before taking Tylenol.
If you think you or someone you know has taken too much Tylenol, contact a healthcare professional or seek immediate help. You can also call Poison Control at 1-800-222-1222 for guidance.
Is taking Tylenol every day bad for your liver?
No. For most people, taking Tylenol every day isn’t bad for your liver. Just be sure to stay under the maximum daily dose. Studies have found that taking 4,000 mg of Tylenol per day for a week can affect the liver. These effects are reversible and don't cause liver damage. But to err on the side of caution, it might be a safe idea to stick to the 3,250 mg daily limit discussed above.
Good to know: There’s conflicting evidence on whether daily Tylenol use is linked to cardiovascular problems. Some studies have found that long-term use can raise blood pressure. Other studies haven’t found a link. It’s best to avoid daily use of Tylenol unless a healthcare professional has told you to do so.
Is Tylenol bad for your kidneys?
No, it’s not. In fact, Tylenol is preferred over other OTC pain relievers if you have kidney problems. As detailed earlier, Tylenol is broken down almost completely by the liver. So the kidneys aren’t really involved until the end. Their biggest job is getting rid of Tylenol after it’s been made non-toxic by the liver.
But if a person does experience liver failure, it can affect their kidneys too. They might start making less urine or have swelling in their stomach area. This isn’t the Tylenol causing kidney problems. This is a sign of the liver shutting down.
How can you protect your liver when takingTylenol?
Unfortunately, accidentally taking too much Tylenol is all too easy. Hundreds of OTC and prescription medications have acetaminophen in them. Acetaminophen works well for fevers, minor pain, headaches, and more.
When picking an OTC medication, it’s important to read the “drug facts” label on the package. Check the list of active ingredients for acetaminophen. For prescription medications, your label should have either acetaminophen or “APAP” on it. If you’re unsure whether an OTC or prescription medication contains acetaminophen, ask your pharmacist.
Examples of common OTC medications that may contain acetaminophen include:
Excedrin Migraine (aspirin / caffeine / acetaminophen)
Advil Dual Action (ibuprofen / acetaminophen)
Mucinex Sinus-Max Pressure and Pain (acetaminophen / guaifenesin / phenylephrine)
What about Tylenol and alcohol?
You’ll want to avoid mixing Tylenol and alcohol regularly, especially if you’ve had a lot to drink in a single sitting. You also don’t want to take more than the recommended doses of Tylenol after drinking any alcohol. But occasionally taking recommended doses of Tylenol after having one or two drinks likely won’t cause problems.
Alcohol enhances the toxic quality of Tylenol to the liver. So people who drink more than three alcoholic drinks per day may have a higher risk of liver damage from Tylenol.
What are some signs of liver damage from Tylenol?
Liver failure from Tylenol can start with symptoms that aren’t very specific, like vomiting. But over a period of a few days, other symptoms can start to appear, such as:
Pain in the upper right side of the stomach
Low blood pressure
Kidney failure (less urine, swelling, dark-colored urine)
Bleeding problems
Confusion
Liver failure due to Tylenol can be fatal and needs emergency care. Call 911 if you believe you’ve taken too much Tylenol and are having liver failure symptoms.
Can you reverse liver damage from Tylenol?
Liver damage from Tylenol can’t always be reversed. If Tylenol poisoning is caught soon enough, the likelihood of recovery is higher. Medications given in these cases aim at preventing further complications while the liver heals. But if the liver becomes too damaged, it might not recover. In these severe cases, a liver transplant may be the only option to prevent a person from dying.
Thankfully, liver damage from Tylenol can be prevented. But time is of the essence. A medication called N-acetyl cysteine (NAC) is the only available antidote for Tylenol poisoning. It works by helping the liver to detoxify NAPQI (the toxic substance Tylenol breaks down into). If NAC is started within about 10 hours of taking Tylenol, it can prevent liver damage. But the sooner NAC is started, the better.
Frequently asked questions
If you have both liver and kidney disease, ask a healthcare professional to help you select a pain medication. All oral OTC pain relievers are broken down by either the liver or kidneys. One option to consider would be OTC pain relief creams, gel, and patches. Your body doesn’t absorb as much of these medications compared to oral pills. So they may be a safer choice.
No pain reliever is recommended for long-term use if you’re taking it without a healthcare professional’s guidance. For instance, Tylenol’s OTC label recommends taking it for no more than 10 days in a row for pain. Other popular OTC pain relievers, such as ibuprofen (Advil, Motrin), have similar warnings. If you need to take these medications for any longer, you should speak with your primary care provider. They can help select the safest pain reliever for you to take longer term.
For the average person taking Tylenol as directed, the half-life of the medication is about 1 to 3 hours. A “half-life” represents how long it takes your body to remove half of the medication. It takes about 5 half-lives for your body to fully clear most medications. So that means small amounts of acetaminophen could be in your system for up to 15 hours after you take a dose.
If you have both liver and kidney disease, ask a healthcare professional to help you select a pain medication. All oral OTC pain relievers are broken down by either the liver or kidneys. One option to consider would be OTC pain relief creams, gel, and patches. Your body doesn’t absorb as much of these medications compared to oral pills. So they may be a safer choice.
No pain reliever is recommended for long-term use if you’re taking it without a healthcare professional’s guidance. For instance, Tylenol’s OTC label recommends taking it for no more than 10 days in a row for pain. Other popular OTC pain relievers, such as ibuprofen (Advil, Motrin), have similar warnings. If you need to take these medications for any longer, you should speak with your primary care provider. They can help select the safest pain reliever for you to take longer term.
For the average person taking Tylenol as directed, the half-life of the medication is about 1 to 3 hours. A “half-life” represents how long it takes your body to remove half of the medication. It takes about 5 half-lives for your body to fully clear most medications. So that means small amounts of acetaminophen could be in your system for up to 15 hours after you take a dose.
The bottom line
Tylenol (acetaminophen) is a common over-the-counter (OTC) pain reliever and fever reducer. But it does carry a risk of liver damage. Tylenol-related liver damage happens most often when a person takes too much. When liver damage or failure happens, it’s not always reversible and can be fatal.
Acetaminophen (Tylenol’s active ingredient) is found in many OTC and prescription medications. Be sure to read the labels on your medication packages, and look for the words “acetaminophen” or “APAP.” If you believe you or someone you know took too much Tylenol, call Poison Control at 1-800-222-1222. If you’re experiencing symptoms such as stomach pain, vomiting, or confusion, call 911.
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