People often make questionable choices, especially when it comes to self-administered pain relief. Surveys show that about a quarter of Americans routinely take more over-the-counter pain relief pills than they are supposed to. This is usually free of consequence, so we don’t learn to act otherwise. But for a surprising number of Americans every year, it results in a visit to the ER. Sometimes without a return trip home.
Pop quiz: What do the following household medications all have in common? Excedrin Extra Strength, NyQuil, Robitussin, Sudafed, Alka-Seltzer Plus, Theraflu, Tylenol, Anacin, Dimetapp and Vicodin HP.
They all contain acetaminophen.
It is “The Safe Choice” according to Tylenol maker McNeil Consumer Healthcare, a division of Johnson & Johnson. Given its effectiveness and reputation, perhaps it’s no surprise that it gets incorporated into so many multisymptom medications. This makes inadvertent overdosing a common occurrence.
When you’re laid out on the couch with the sniffles, you might reach for the NyQuil Cold & Flu Multi-Symptom Relief Liqui-Caps, which contain 325 mg of acetaminophen. An hour or two later, you still have a headache, so you take some Extra Strength Tylenol, which contains 500 mg of acetaminophen. And maybe, just maybe, you take that extra pill or two in both instances. And you do that a few times a day over the course of a multiday flu. It’s really easy to double dose, and not terribly hard to triple dose.
But here’s the thing. Acetaminophen has an excellent safety record at recommended doses, but it has a remarkably narrow margin between a safe dose and a toxic one. Federal data show acetaminophen as the cause of as many as 78,000 emergency room visits and 33,000 hospitalizations each year. It is the leading cause of acute liver failure. National poison control data link acetaminophen with more deaths than any other over-the-counter drug. Many victims are children whose bodies are particularly sensitive to big mistakes.
Taken over several days, as little as 25 percent above the maximum daily dose—or just two additional extra-strength pills a day—has been reported to cause liver damage, according to the FDA. Taken all at once, a little less than four times the maximum daily dose can kill you. About 150 Americans die each year by accidentally taking too much of “The drug that American hospitals trust the most.”
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