You may not realize that you’re taking too much of a popular pain reliever. The most widely used medication in the United States, acetaminophen (Tylenol), is effective in relieving mild to moderate pain and reducing fever—when used at the recommended dosage. When more than 4,000 milligrams of acetaminophen are used a day, however, it can harm the liver. Acetaminophen overdosage causes an estimated 56,000 visits to emergency facilities each year and is the most frequent cause of liver failure.

Although the problems have been recognized for years, they recently gained more scrutiny. The Federal Drug Administration has taken a closer look at the safety of over-the-counter and prescription medication containing acetaminophen. Last week, an FDA joint advisory committee gathered to discuss safety questions surrounding acetaminophen. They made several recommendations, such as lowering the maximum daily dosage and strengthening the labeling.

And, manufacturers may be asked to play a bigger role in helping prevent overdoses. One issue: many remedies contain acetaminophen along with other medications. Consumers may not be aware they are swallowing acetaminophen along with both prescription and over-the-counter remedies. A majority of acetaminophen-related deaths have involved opioid/acetaminophen combination products, such as acetaminophen/oxycodone (Percocet) and acetaminophen/hydrocodone (Vicodin). Typically, the package warning labels concentrate on the more potent opioid drug.

Although the FDA is not required to accept the recommendations of its advisory committees, it usually does so.

To help protect yourself from overdosing on acetaminophen, Daniel A. Hussar, PhD, Remington Professor of Pharmacy at the Philadelphia College of Pharmacy at the University of the Sciences in Philadelphia, offers these tips:

• Know that APAP is the abbreviation for the chemical name of acetaminophen and, if found on the list of ingredients, means the product contains acetaminophen.
• For occasional, modest pain, consider starting with a dose of 500 mg (rather than 1000 mg).
• Be aware there are two concentrations of nonprescription acetaminophen for children. The infant formulation is more concentrated than the formulation for older children. Make sure you understand the concentration level before giving medication to a child.
• Check the dose of acetaminophen that is included in any combination medication. Ask your pharmacist if you are uncertain.
• For over-the-counter cold and flu remedies, seek products that treat just the symptoms you have. For sneezing and a runny nose, for example, a product containing an antihistamine and a decongestant would be sufficient.

For more information on acetaminophen, see the Pharmacist Activist Newsletter. For information and support on relieving back pain, a very common pain complaint, see the Healia Back Pain Guide. And talk to others about treatment and relief at the back pain online health community and support group.