What is an acetaminophen overdose?

Acetaminophen overdose means you took more than is safe to take. It may also be called acetaminophen poisoning. Acetaminophen is called paracetamol in countries outside the United States. When used correctly, acetaminophen is a safe drug that decreases pain and fever. Many medicines contain acetaminophen, including some that you can buy without a prescription.

What causes an acetaminophen overdose?

• You took more than the recommended dose. Acetaminophen comes in many forms, such as pills, capsules, and liquids. Strengths include regular strength, extra strength, and extended release. The most acetaminophen that is safe for most people to take is 4,000 milligrams (4 grams) in a 24-hour period. Some forms of acetaminophen need to be limited to lower doses, such as 3,000 mg (3 grams). Only a healthcare provider can recommend a larger maximum dose. You might accidentally take too much if your pain or fever did not go away after the recommended dose. You may also get too much if you take acetaminophen for too many days in a row.
• You accidentally took more than one medicine that contains acetaminophen at a time. Many medicines contain acetaminophen along with other drugs. These include medicines for colds, the flu, allergies, or trouble sleeping. You may have taken more than one medicine that contains acetaminophen, and the total was too much.
• You took an extended-release form. When you take extended-release pills, the medicine stays in your body longer. You are supposed to take these medicines less often than you would take regular acetaminophen. If you take this medicine too often, you will have too much in your body at one time.

What are the signs and symptoms of an acetaminophen overdose?

You might not have any signs or symptoms at first. Early signs and symptoms may make you feel like you have the flu. Common signs and symptoms happen during each stage of an acetaminophen overdose. If the overdose is treated right away, you might have fewer or easier symptoms in the later stages.

• First 24 hours:
  • Nausea, vomiting, stomach pain, and loss of appetite
  • Paleness
  • Tiredness
  • Sweating
• 24 to 72 hours after the overdose:
  • Pain in your upper right side
  • Dark urine
  • Urinating less often than usual
  • Skin and the whites of your eyes turn yellow
• 72 to 96 hours after the overdose:
  • Blood in your urine
  • Fever, lightheadedness, or fainting
  • Fast breathing or trouble breathing
  • Extreme weakness or tiredness
  • Feeling very hungry, or shaking
  • Blurred vision, a fast heartbeat, or headache that will not go away
  • Trouble staying awake
  • Confusion
  • Coma

How is an acetaminophen overdose diagnosed?

Tell your healthcare provider when you took the acetaminophen and how much you took. He or she may ask how long you have been taking acetaminophen. He or she may ask about other medicines you take and when you take them. Your provider may ask if you have any medical problems, such as liver disease. He or she may ask if you drink alcohol and how much you drink. Your blood pressure and temperature will be checked. Your provider may check your skin for color changes and your stomach for pain. You may also need any of the following:

• Blood tests are used to check the amount of acetaminophen in your blood.
• Liver function tests may show if your liver is working properly.
• Prothrombin time (PT) and INR rates measure how long it takes for your blood to clot. If your liver is damaged, your blood may not clot properly. You could have serious bleeding problems.

How is an acetaminophen overdose treated?

Acetaminophen overdose is a serious problem. Treatment should be started as soon as possible. Treatment depends on how much time has passed since the overdose and if the overdose happened all at one time:

• Activated charcoal medicine may be given to soak up the acetaminophen that is still in your stomach. Activated charcoal will make you vomit.
• Gastric lavage may be needed to clean out your stomach to get rid of the acetaminophen. Gastric lavage is also called having your stomach pumped.
• Antidote medicine may be given to stop the effect of the overdose. You may also be given medicine to slow the effects of acetaminophen.

Treatment options

The following list of medications are in some way related to or used in the treatment of this condition.

• acetylcysteine
• Acetadote

How can an acetaminophen overdose be prevented?

Ask your healthcare provider or a pharmacist if you are not sure about any of the following:

• Read labels carefully. Read the labels of all the medicines you take. If your medicine contains acetaminophen, it will be listed in the active ingredients section. Acetaminophen may be listed on the label as APAP, Acetaminoph, Acetaminop, Acetamin, or Acetam. Check carefully to see if the acetaminophen is a regular or extended-release form.
• Do not take more than 1 type of acetaminophen at a time. Many combination medicines contain acetaminophen. Make sure the total dose of acetaminophen you take is not more than 4,000 milligrams (4 grams) in 1 day. Check other medicines to see if they contain acetaminophen. Do not take these medicines together with acetaminophen. The combined amount of acetaminophen may be too much.
• Take the correct dose. Make sure you take the right amount and wait the right number of hours between doses. Never take more than the label says to take. If the medicine came with a device such as a spoon or dropper, use it to measure your medicine. If you need to give acetaminophen to your child, check the label to find out how much to give. The amount and timing will be based on your child's age and weight.
• Do not take acetaminophen for too many days in a row. Do not take acetaminophen for more than 10 days to treat pain, unless your healthcare provider tells you to. Do not take acetaminophen for more than 3 days to treat a fever, unless your healthcare provider tells you to. Your pain or fever may need to be treated another way if it lasts longer than a few days.

What should I do if I think I took too much acetaminophen?

Immediately call the Poison Control Center at 1-800-222-1222 .

Where can I find more information?

• 24-Hour Nationwide Poison Control Hotline
  National Capital Poison Center
  3201 New Mexico Avenue, Suite 310
  Washington , DC 20016
  Phone: 1- 800 - 222-1222
  Web Address: http://www.poison.org
  

• US Food and Drug Administration
  10903 New Hampshire Avenue
  Silver Spring , MD 20993
  Phone: 1- 888 - 463-6332
  Web Address: http://www.fda.gov
  

When should I seek immediate care?

• You or another person took too much acetaminophen.
• You feel confused or more tired than usual, or you are sweating more than usual.
• You have severe nausea and are vomiting.
• You cannot have a bowel movement or urinate.
• Your skin and the whites of your eyes turn yellow.

When should I call my doctor?

• You have a fever.
• You have taken too much acetaminophen by mistake, even if you do not have any signs or symptoms.
• You have pain in the upper right side of your abdomen.
• You have questions or concerns about your condition or care.

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