June 3, 2020
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How to take Tylenol safely

By: George Malkemus
April 19, 2019

Tylenol is an effective, frequently used, over-the counter pain reliever.    Acetaminophen is the generic name of Tylenol and an active ingredient found in many over-the-counter products and prescription medications. 

Acetaminophen is used to relieve mild to moderate pain from headaches, muscle aches, menstrual periods, colds and sore throats, toothaches, backaches and to reduce fever. Acetaminophen may also be used to relieve the pain of osteoarthritis (arthritis caused by the breakdown of the lining of the joints). Acetaminophen is in a class of medications called analgesics (pain relievers) and antipyretics (fever reducers). It works by changing the way the body senses pain and by cooling the body.

 Tylenol is the brand name for acetaminophen produced by McNeil Consumer Healthcare, a subsidiary of Johnson & Johnson.  Like other well-known products, such as Kleenex for tissues, Clorox for bleach, or Advil for ibuprofen, Tylenol is the commonly used name for acetaminophen.  Acetaminophen is often used in combination with other active ingredients, called “combination medicines,” to treat symptoms of colds and influenza (flu), allergy and insomnia. Many prescription drugs contain acetaminophen and other active ingredients to help relieve pain.  For example, the often-prescribed pain relievers Norco and Vicodin combine acetaminophen with the narcotic hydrocodone, as well as tradition pain medication Tylenol with Codeine. 

The Safe Use of Acetaminophen

 Acetaminophen-containing products are safe and effective when used according to their label instructions. The new recommended maximum daily dose is 3,000 milligrams.  Taking more than this amount, particularly for several days, can lead to liver damage. In the United States, acetaminophen overdose is the primary cause of acute liver failure.  The recommended maximum daily dose had been 4000 mg until 2015, but has been lowered to 3000 mg due to the many liver complications in the U.S. 

It is extremely important to check the amount of acetaminophen in any medication being taken by reading the list of “active ingredients” and determining the total amount being consumed.  For example, Tylenol Regular Strength contains 325-milligram tablets, so the maximum daily dose is 9 tablets.  Tylenol Extra Strength contains 500-milligram tablets, so the maximum daily dose is 6 tablets.

Be extremely careful when taking more than one product that contains acetaminophen.  Acetaminophen overdose can happen when multiple products such as cold medications and pain relievers are taken together and exceed over 3000 milligrams of acetaminophen per day.  This often happens without the person even realizing that they are taking multiple doses of acetaminophen.  Read the labels of all the prescription and nonprescription medications you are taking to see if they contain acetaminophen. Be aware that abbreviations such as APAP, AC, Acetaminophen, Acetaminophens, Acetaminop, Acetamin, or Acetam. may be written on the label in place of the word acetaminophen. Ask your doctor or pharmacist if you don’t know if a medication that you are taking contains acetaminophen.

Treatment of Dental Pain

The combination of ibuprofen [Advil] and acetaminophen [Tylenol] is extremely effective for treating dental pain.  The two medications work differently.  Ibuprofen is a good anti-inflammatory drug when used in high doses and acetaminophen is a good pain reliever.   I recommend a Tylenol-Advil regime to patients with dental pain:Tylenol Extra Strength [500 milligrams of acetaminophen] – Take 1 tablet every 4 hours [6 times a day] not to exceed 6 tablets or 3000 milligrams per day.

Advil [200 milligrams of ibuprofen] – Take 2 tablets every 4 hours [6 times a day] not to exceed 12 tablets or 2400 milligrams per day.             

Several years ago, I began prescribing this regime to my patients. Most patients have been impressed with the effectiveness of this combination of ibuprofen and acetaminophen. This drug combination makes a significant difference in patient comfort levels. As a result of this effectiveness, I have been able to prescribe fewer narcotics in my practice and hear reports of less discomfort. When a dental infection is involved, adding an antibiotic to this regime noticeably helps reduce dental pain and swelling. 

 If pain is not controlled by these medications, then a narcotic medication such as Norco can be taken.  Norco has recently replaced Vicodin as the narcotic medication of choice after codeine.  Both Norco and Vicodin contain equal amounts of hydrocodone 7.5 mg, but Narco with 325 mg of acetaminophen is the safer drug.  Vicodin has 500 mg of acetaminophen and Vicodin ES has 750 mg of acetaminophen.   I tell patients to use the Advil-Tylenol regime, but if they need to take a narcotic, such as Norco, then do not take a Tylenol since acetaminophen is found in the narcotic already.  However, they should keep taking the ibuprofen.   

Actually, acetaminophen and ibuprofen work better for direct pain relief at the problem site, such as a toothache, then narcotic medications.  Narcotics work on the brain and replace the pain sensation with euphoria, so the patient doesn’t care that they have pain.  “I have a tooth ache, it hurts, but ha, ha, ha; I feel great!”   

Overdosing on Acetaminophen

Taking more than 3,000 milligrams of acetaminophen for several days, can lead to liver damage.  Common signs and symptoms of possible liver damage include abnormally yellow skin and eyes (jaundice), dark urine, light-colored stools, nausea, vomiting and loss of appetite. Because these signs and symptoms are similar to those of flu, they are often unnoticed for several days and believed to part of the initial illness. Serious cases of liver disease can lead to mental confusion, coma and even death.

As with most medications, children should be dosed at a lower level of acetaminophen than adults. To avoid errors, the measuring tool packaged with the medicine should be used and a record kept of the treatment times and the doses give to the child.  Make sure to share this information with caregivers so they will know how much acetaminophen your child has taken.

 Alcohol affects livers as well as acetaminophen.  Acetaminophen-containing products should not be used if three or more alcoholic drinks are consumed in a day.  The medication should also not be used in cases of alcohol abuse, active liver disease or past liver damage.  Acetaminophen should also not be taken in individuals with advanced kidney disease, or in individuals that are malnourished or are fasting.  

Acetaminophen increases the risk of bleeding in persons

 taking warfarin [a common brand name is Coumadin by Bristol-Meyers Squibb].  Acetaminophen should be avoided if you are taking warfarin. 

If you have any of these conditions, tell your dentist or physician. You can determine if an over-the-counter medicine contains acetaminophen by checking the product’s drug facts label under the heading “active ingredients.” If you don’t know the active ingredients of your prescription medicines, ask your dentist or physician. You should follow all directions on the drug facts label, and/or prescription label.  Acetaminophen is a wonderful medication for pain if used wisely.

Enjoy Life and Keep Smiling!

George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@  Visit Dr. Malkemus’ Web site at