Can You Take Tylenol If You Have Fatty Liver Disease?

More than 60 million adults take acetaminophen (Tylenol) on a weekly basis. While Tylenol is generally safe to use, it may harm your liver. This is especially true if you already have some form of liver disease.

As many as 30% of adults in the U.S. have a liver condition called MALSD (metabolic dysfunction-associated steatotic liver disease). This condition used to be called non-alcoholic fatty liver disease (NAFLD), or fatty liver disease, for short.

As MASLD gets worse, the fat builds up in the liver and can lead to scarring. This can affect both your liver function and how it processes medications like Tylenol. So, is Tylenol safe if you have this condition? We’ll explain the necessary precautions you need to take.

Just a note before we dive in, we use the terms “fatty liver disease” and “MALSD” to mean the same thing throughout the article.

Is it safe to take Tylenol if you have fatty liver disease​?

Yes, experts agree that Tylenol is safe for most people with liver disease to use. But it’s really important that you stick to the recommended doses:

• The maximum daily dose for most adults is 4,000 mg per day. 

• The maximum dose for children is 75 mg per kilogram of weight.

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If you take too much Tylenol — either all at once or over a period of several days — it can cause serious harm to your liver. This is true for people with and without liver disease. But if you have existing liver disease, the consequences of liver damage may be more severe. 

One of the main jobs of your liver is to break down medications and detoxify your blood. Many people with fatty liver still have normal liver function. This means their liver will still process Tylenol. But it’s always a good idea to talk to a healthcare professional first to make sure Tylenol is safe for you. They can help you understand your current liver health and liver function.

How does MASLD affect liver function?

People with MALSD have a buildup of fat in their liver. In the earlier stages, this doesn’t affect the liver’s ability to do its job. But as more fat builds up, it can start to cause swelling and liver damage. Over time, this can lead to scar tissue forming in your liver. This is called fibrosis, and it can make it harder for the liver to do its job.

In some cases, fibrosis may be reversed. But if it progresses, fibrosis may lead to cirrhosis, which can’t be reversed.

How does Tylenol affect your liver?

When taken in normal doses, Tylenol doesn’t cause liver damage. The liver processes Tylenol just like it does with many other medications. But high doses of Tylenol can be toxic to your liver. Large doses can overwhelm the liver and make it hard for it to process it. 

The degree of liver damage depends on things like:

• How much Tylenol you take and how often

• If your liver is already weak or damaged

• How quickly you get professional treatment with the antidote

It’s important to note that some people may not have any obvious symptoms from Tylenol toxicity. When symptoms do appear, it can take up to 24 hours after the last dose. Symptoms of Tylenol toxicity may include:

• Nausea, vomiting, diarrhea

• Right upper abdominal pain

• Loss of appetite

• Yellowing of skin or eyes (jaundice)

• Feeling easily irritable

• New-onset seizures

• Coma

An overdose of Tylenol can lead to liver failure and even death within several days if not treated quickly. That’s why it’s important to get emergency medical treatment right away for any suspected overdose.

What is the safest pain reliever for liver disease?

There’s no single recommended pain medication for people with liver disease. 

Some people with liver problems may prefer nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief. Even though these medications aren’t processed through the liver like Tylenol, they still come with some risks. NSAIDs — like ibuprofen (Advil) or aspirin — can: 

• Damage your stomach lining and cause ulcers in the area

• Increase bleeding risk in people with liver problems 

• Cause kidney damage

The risk of kidney damage is important for people with more severe liver problems, like cirrhosis. That’s because cirrhosis can already affect kidney function. So, people with this condition may be at higher risk of kidney damage from NSAID use. 

The safest pain reliever for someone with liver disease depends on how serious their liver disease is and whether they have other medical problems. It’s also a good reminder that just because a medication is sold over the counter (OTC) doesn’t mean it’s safe. 

If you have liver disease and often need pain relief, this is something you should discuss with your healthcare team.

How can you protect your liver while taking Tylenol?

It’s important to still take precautions to protect your liver while taking Tylenol. Here are some other tips for safe use:

• Always take Tylenol as directed. If you’re not sure how much to take, call your primary care provider or pharmacist.

• Tell your healthcare team about all the medications you’re taking — even OTC ones. Some medications and supplements — like seizure medications and St. John’s wort — can cause toxic levels of Tylenol in your body. This is true even if you take a normal dose of Tylenol.

• Don’t take more than one medication with acetaminophen at a time. And be aware that many medications already contain Tylenol — especially cold and flu medicines.

• If you drink alcohol, it’s best to avoid it when you take Tylenol. The combination can overwhelm your liver’s detoxifying process, even in safe amounts of Tylenol and alcohol. 

If you think you or someone else has taken too much Tylenol, or if you have any symptoms of a Tylenol overdose, take immediate action:

• Call 911 or go to the nearest emergency room.

• If you don’t have any symptoms and aren’t sure if you need treatment, call Poison Control (1-800-222-1222) at any time of day for advice on the next steps.

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Written by:

Alexandria Nyembwe, PhD, MBA, RN

Alexandria Nyembwe has been a registered nurse since 2017. She has a background in cardiac care and has clinic experience as a nurse, serving people experiencing housing instability.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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