Overdose of acetaminophen, AKA Tylenol, the leading cause of acute liver failure in the U.S

Overdose of the over-the-counter painkiller acetaminophen (Tylenol) is the leading cause of acute liver failure, a catastrophic illness that can rapidly lead to coma and death. A new study found that unintentional overdose accounted for nearly half the cases, with attempted suicides making up most of the rest.

A. M. Larson, MD, University of Washington Medical Center, Seattle, studied 662 consecutive patients with acute liver failure who had been admitted to one of 22 critical care centers in the U.S. between 1998 and 2003. The findings, which appeared in the December 2005 issue of Hepatology, showed that the yearly percentage of acetaminophen-related acute liver failure had climbed from 28% in 1998 to 51% in 2003. Besides the 74 patients who died as a result of the acetaminophen-related acute liver failure, 23 others needed a liver transplant in order to survive.

In most of the unintentional overdose cases, the people had been taking acetaminophen regularly for acute or chronic pain, and 38% took two or more acetaminophen products simultaneously. (Many people are unaware that certain prescription painkillers like Vicodin or Percocet and over-the-counter products like TheraFlu contain acetaminophen.) The written instructions that come with each package of acetaminophen tell consumers not to exceed four grams a day, but the median dose ingested by people in this study was 24 grams, or the equivalent of 48 extra-strength tablets.

Over the years, the FDA has identified the circumstances most likely to result in harm due to exceeding the safe-dose limit. They include age (over 65), alcoholism, concomitant use of alcohol, anticoagulants, and corticosteroids, and illnesses such as kidney disease, congestive heart failure, and diabetes.

The Philadelphia-based Institute for Safe Medication Practices reported in 2002 that 27,000 cases of accidental acetaminophen overdose occur in children annually, though fatalities are rare. A leading cause is misreading of the label instructions. Parents often do not realize that acetaminophen infant drops are a far more concentrated than the liquid acetaminophen product intended for older children.

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