But too much acetaminophen (Tylenol, others) can cause serious liver damage or even liver failure. The maximum dose for adults in 24 hours is generally 4,000 milligrams (mg), but some manufacturers are voluntarily setting the maximum dose even lower.
Excess acetaminophen interferes with the liver’s ability to neutralize toxic substances. It changes the usual breakdown process in the liver, and a small amount of toxic compound is produced. Working normally, the liver detoxifies this toxin with glutathione, a compound stored in the liver. A healthy liver stores an adequate amount of glutathione to do the job — if acetaminophen levels don’t exceed the recommended maximum dose on a regular basis.
Managing daily doses requires vigilance and label checking. Acetaminophen is found in more than 600 medications, both prescription and nonprescription. In addition to pain relievers and fever reducers, acetaminophen is used in nonprescription combination products to treat coughs, colds, flu and allergies and in sleep aids. Among combination prescription drugs, acetaminophen often is paired with opioids, such as codeine (Tylenol with Codeine, others), oxycodone (Percocet, Roxicet, others) and hydrocodone (Vicodin, Norco, others).
Many nonprescription products are nonsteroidal anti-inflammatory drugs (NSAIDs). Examples include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). They provide pain relief and reduce inflammation. But when used at higher doses and for longer periods, NSAIDs pose the risk of stomach ulcers and bleeding or kidney problems. Proper use of acetaminophen isn’t associated with these side effects.
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