New dosing recommendations for Tylenol (acetaminophen), the most commonly prescribed drug in the United States, could change how we deal with issues from headaches to chronic pain. An FDA advisory panel of 37 physicians and pharmacists made recommendations to lower the maximum daily dose of acetaminophen in over-the-counter drugs to 2600mg from the current level of 4000mg, and urged the FDA to make extra-strength doses (two 500-milligram pills) of the drug available only by prescription. They also urged the FDA to reduce the maximum single dose to 650 milligrams from 1000 milligrams.

If you suffer from chronic pain, the FDA may consider reformulating prescription medications such as Vicodin and Percocet, both of which contain varying amounts of acetaminophen in combination with an opioid. Americans filled nearly 125 million prescriptions for these medications last year alone.

So what’s all the fuss about Tylenol anyway?

It is important to realize that acetaminophen, when taken properly, is a very safe and effective medication. In excess, however, it is harmful. Acetaminophen toxicity kills about 100 people a year, sends over 56,000 to the emergency room annually, and is the number one cause of liver transplants. Most all of these cases are the result of accidental overdoses, because in most products, acetaminophen is not the primary ingredient. As a result, we ingest more acetaminophen than intended.

What do we do in the meantime?

While we wait for the FDA to make final decisions about these new recommendations, let’s use this as an opportunity to take a closer look at the acetaminophen content in any medications that we take. Add it up. Am I taking a total amount of more than 4000mg of acetaminophen in a 24 hour period? Be sure to include both prescription and over-the-counter medications. If you need some help or have questions about the content of your medications, talk with your pharmacist. Remember- your pharmacist is your medication expert.

John M. Williamson, PharmD