ACETAMINOPHEN

Information That Patients Need to Know About Their Medication

Kasey Malotte, PharmD

Pain and Palliative Care Pharmacy Resident
University of Maryland, School of Pharmacy
Baltimore, Maryland

Mary Lynn McPherson, PharmD, MA, BCPS, CPE

Professor and Vice Chair
Department of Pharmacy Practice and Science
University of Maryland, School of Pharmacy
Baltimore, Maryland

What is acetaminophen? How do I take this medication?

Acetaminophen is a medication that is readily available Ask your pharmacist and follow instructions shown on the
over-the-counter (which means you can buy it without a product packaging or prescription bottle. For adults, acet-
prescription) in many different dosage forms as seen in aminophen can be taken 4 to 6 times throughout the day as
the table below. It can be used in patients of all ages and long as the total amount taken is not more than 3,000 mg
with varying underlying medical conditions. Other names for the whole day. Under the supervision of a prescriber, up
that you may recognize are Tylenol, Excedrin, and Feverall. to 4,000 mg a day of acetaminophen can be taken.
Sometimes acetaminophen is just one of the medications Acetaminophen is dosed by weight for children—ask the
in a combination medication such as Percocet, Vicodin, pharmacist or doctor for dosing assistance. For an infant or
Nyquil, Coricidin, Midol, and others! a child less than 2 years old, acetaminophen cannot be used
without instruction from a prescriber.
Table. Acetaminophen Do not take higher than recommended doses, extra doses,
Dosage Formulation Strength(s) or take it longer than recommended. Carefully check the
labels of other medications you are taking to make sure they
Tablet 325, 500 mg do not also contain acetaminophen. Your pharmacist can
Tablet, dispersible 80, 160 mg help you with this as well.
Tablet, chewable 80 mg
Acetaminophen can be taken with food or on an empty
stomach (but always with a full glass of water). Sometimes
Tablet, extended-release 650 mg taking with food can lessen any upset stomach that may occur.
Capsule 500 mg If you are taking the oral solution or suspension, or giving
a dose to a child, use a calibrated measuring spoon instead
Oral Solution 80 mg/0.8 ml, 100 mg/ml,
of a household teaspoon to measure the dose.
160 mg/5 ml, 325 mg/5 ml,
500 mg/15 ml, 1000 mg/30 ml
Is this drug safe?
Oral Suspension 80 mg/0.8 ml, 160 mg/5 ml Based on current research, doses up to 3,000 mg per day,
Oral Gel 160 mg/5 ml or 4,000 mg per day under a doctor’s supervision, are con-
Rectal Suppository sidered safe. However, taking more than 4,000 mg per day
80, 120, 325, 650 mg
may cause liver damage, either as one large dose, or exces-
Intravenous 10 mg/ml sive doses over weeks or months. If you already have liver
problems, acetaminophen may not be the right drug for you.
What is it used for? It can be taken with most medications, foods, and drinks.
It is commonly used to reduce a fever and to treat both Do not take acetaminophen if you have a history of alcohol
acute pain (such as headache, toothache, sprains or mus- abuse, or consume alcohol while using acetaminophen. You
cle strains) and chronic pain (back pain and osteoarthritis). should also avoid acetaminophen if you have a history of
Acetaminophen may be purchased over-the-counter (with- liver disease (including hepatitis), severe kidney disease, or
out a prescription). phenylketonuria. If you are taking a blood thinner such as

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 Acetaminophen
warfarin you should talk with your prescriber before start-
ing this medication.
How do I know if it is working?
If taking this medication for pain or to lower a fever, then
you should feel better! It usually takes about 45 minutes for
oral, liquid, or tablet acetaminophen to start working. The
oral disintegrating tablets start to work in about 20 minutes.
Rectal suppositories can take a little longer to start working—
up to 2 hours. Acetaminophen usually lasts about 4 hours for
pain relief and fever reduction, so you shouldn’t take it more
often. If your pain does not get better or your fever does not
start to come down after 1 to 2 hours, you may want to call
your pharmacist or prescriber to see if you need a larger dose
or if a different medication may be right for you.
How do I know if something is wrong?
You should contact your prescriber if you have any swell-
ing, rash, or trouble breathing. If you become nauseated,
try taking acetaminophen with food or milk.
How do I store my medication?
Store in a cool, dry place, such as your nightstand. Don’t
store acetaminophen or any medications in a humid place
such as the kitchen or bathroom. All medications should be
stored in a location in your house that is out of reach from
pets, children, or adults who could accidently take or mis-
use this medication.
Prescriber Quick Fact Card
Name:
Acetaminophen (Tylenol, Excedrin, etc)
Class:
Anti-pyretic, analgesic
Dosage Forms:
• Tablet (325 mg, 500 mg)
• Dispersible tablet (80 mg, 160 mg)
• Chewable tablet (80 mg)
• Extended-release tablet (650 mg)
• Capsule/Gelcap/Geltab (500 mg)
• Injection (10 mg/ml - 100 ml vial)
• Oral Solution (80 mg/0.8 ml, 100 mg/ml, 160 mg/5 ml,
325 mg/5 ml, 500 mg/15 ml, 1000 mg/30 ml)
• Oral Gel (160 mg/5 ml)
• Rectal Suppository (80 mg, 120 mg, 325 mg, 650 mg)
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What do I do if I miss a dose?
If you are taking acetaminophen on a regular schedule take it as
soon as you remember. However do not take another dose until
the appropriate time has passed (such as 4 hours for a regular
tablet or capsule). If you are unsure what to do, contact your
pharmacist. Importantly, you should never take double the rec-
ommended dose. If you are taking acetaminophen occasionally
for pain or fever, then you can just take the medication when
you need it, but no sooner than directed on the box.
References
1. Tylenol [package label] 325mg acetaminophen tablet. Fort Washington, PA:
McNeil-PPC, Inc; 2013. NDC 55154-1918-0.
2. Acetaminophen Preparations. Pediatric & Neonatal Lexi-Drugs. Hudson, Oh:
Lexicomp, Inc; 2014.
3. Guggenheimer J, Moore PA. The therapeutic applications of and risks associat-
ed with acetaminophen use: a review and update. JADA. 2011;142:38-44.
4. The Acetaminophen Hepatotoxicity Working Group. Recommendations for FDA
Interventions to Decrease the Occurrence of Acetaminophen Hepatotoxicity.
http://www.fda.gov/downloads/UCM164898.pdf. Accessed January 30, 2015.
5. Food and Drug Administration, HHS. Organ-specific warnings; internal analge-
sic, antipyretic, and antirheumatic drug products for over-the-counter human
use; final monograph. Final rule. Fed Regist. 2009;74(81):19385-19409.
6. Sharma CV, Mehta V. Paracetamol: mechanisms and updates. Contin Educ
Anaesth Crit Care Pain. 2014;14(4):153-158.
7. Whaba H. The antipyretic effect of ibuprofen and acetaminophen in children.
Pharmacotherapy. 2004;24(2):280-284.
8. Moller PL, Norholt SE, Ganry HE, et al. Time to onset of analgesia and
analgesic efficacy of effervescent aceta-minophen 1000 mg compared to
tablet acetaminophen 1000 mg in postoperative dental pain: a single-dose,
dou-ble-blind, randomized, placebo-controlled study. J Clin Pharmacol.
2000;40(4):370-378.
Indications:
Pain or fever
Directions for Use:
Every 4-6 hrs either scheduled or as needed
MAX 3-4 g/d for adults
Cautions:
Do not use with alcohol, may diminish effectiveness of
vaccines, caution in liver impairment
Side Effects:
Well-tolerated, increased LFTs,* hepatotoxicity*, rash*
Monitoring:
Relief of symptoms, assess alcohol use and signs/symptoms
of liver disease
* rare but serious side effects
LFTs, liver function test
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