by Rachel Kunze
Acetaminophen, also known as Tylenol, is a popular analgesic that can be bought over the counter. Like many drugs, acetaminophen has serious health consequences if the maximum dose is exceeded.1 Tens of thousands people each year end up in the hospital due to acetaminophen overdose and 150 of these cases are fatal due to acute liver failure.2 Factors that increase the risk for liver toxicity include long term alcohol use and use of drugs that are broken down by the cytochrome P450 2E1 enzyme system, including acetaminophen.3 A recent article entitled Tylenol’s Risks Not Fully Understood, Poll Shows explored the public’s knowledge on this drug. Shockingly, fifty-one percent of people surveyed were not aware of any warnings with acetaminophen usage. Forty-nine percent incorrectly said that an acetaminophen overdose would cause heart palpitations. Thirty-five percent of those surveyed believed it was safe to take two products containing acetaminophen simultaneously.1 In response to these polling results, the FDA has launched a safety campaign known as The FDA’s Safe Use Initiative in order to raise awareness of acetaminophen’s risk factors.1 This campaign includes a webpage, pamphlets, and a YouTube channel on the risks associated with acetaminophen. Tylenol manufacturers have also taken steps to raise awareness by making posters for doctors’ offices and making a YouTube channel of their own.1 This article only used polls to measure patient awareness, so threats to validity were possible. The article did not explain factors that may have led to a certain survey response, such as a career in health care.
I was surprised to learn that a large percentage of the public was unaware of the safety concerns with acetaminophen. I agree with the article that steps need to be taken to improve patient education on this issue. Despite the safety concerns, this would not change my self-care recommendations. I still see acetaminophen as an effective analgesic, but would take the time to warn my patients about the health risks. One study determined that out of 662 cases of acute liver failure in a hospital, 42 percent of them had to do with misuse of Tylenol.2 I believe that many hospital visits could be avoided if patients were more aware of the safety concerns with Tylenol products. While it may be true that the FDA campaign may reduce the number of hospital visits, I believe that even more should be done. The FDA’s creation of a YouTube channel, for example, will only help if a patient happens to find it on the internet. What about those who do not own a computer? A patient should not have to go out of their way to be educated on a medication, even if it can be bought over the counter. I believe something should be done in pharmacies to more directly educated patients. Pharmacists should take a direct role in educating patients in person. Flyers that warn about overdoses should be put up next to the acetaminophen products in pharmacies. This way, a pharmacist can warn the patient on the maximum dosage and what can happen if there is an overdose of the drug. It would not take up too much of a pharmacist’s time and can be a very effective way to educate the public. This is just one possible solution to the issue. Based on the statistics this article gave, are the safety concerns severe enough to take more initiative? If so, should Tylenol maybe become a behind the counter drug so the pharmacy can further monitor its usage? How else can we reduce the number of acetaminophen overdoses?
 Miller TC, Gerth J. Tylenol’s Risks Not Fully Understood, Poll Shows. ProPublica: Journal in the Public Interest. 2013. Available at: http://www.propublica.org/article/tylenols-risks-not-fully-understood-poll-shows. Accessed October 7, 2013.
 Larson A. M., Polson J., Fontana R. J., Davern T. J. et. al. Acetaminophen-induced acute liver failure: Results of a United States multicenter, prospective study. Hepatology [serial online]. 2013;42(6): 1364-1372. Available at: http://onlinelibrary.wiley.com/doi/10.1002/hep.20948/full. Accessed October 11, 2013.
 Kozer E, Koren G. Management of Paracetamol Overdose: Current Controversies. Drug Safety [serial online]. January 1, 2001;24(7):503-512. Available from: E-Journals, Ipswich, MA. Accessed October 20, 2013.