Acetaminophen Potential Risks and Complications

The risk of overuse or overdose is the most significant risk most people face with acetaminophen. The potential danger stems in part from the use of acetaminophen in combination with other drugs in hundreds of over-the-counter medications and narcotic medications. Acetaminophen is a common ingredient in over-the-counter cough and cold medication, for instance, as well as in prescription narcotic pain relievers such as Vicodin.

See Narcotic Pain Medications

These combinations make it more likely that a person taking acetaminophen might take a second medicine—such as cough syrup—without realizing the cough syrup also contains acetaminophen.

An overdose of acetaminophen is serious, causing liver damage, and can be fatal. Anyone who shows signs of an overdose needs immediate medical attention.

To minimize the potential risk of overuse or overdose, patients need to:

  • Carefully track the amount taken in any 24-hour period
  • Review the ingredient list on medication or cough syrup containers to check for any other sources of acetaminophen to avoid inadvertently taking too much
  • Check the label for alternative terms used for acetaminophen; it is sometimes called “APAP” or paracetamol on prescription pill bottles or other forms of medication
  • Anyone who has or suspects they may have liver disease, or who drinks alcohol, should consult with the prescribing doctor and/or pharmacist before taking acetaminophen in any form.

While relatively rare, there are a number of potential risks and complications associated with acetaminophen. It is advisable to consult with a doctor or pharmacist regarding any concerns or unusual side effects.

See Pain Management Specialists

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Effectiveness Questioned

While acetaminophen has been shown to be effective in other cases, recent research has questioned acetaminophen’s effectiveness in controlling pain and speeding recovery in cases of acute back pain.

See Types of Back Pain: Acute Pain, Chronic Pain, and Neuropathic Pain

One analysis of multiple clinical studies found acetaminophen ineffective in easing low back pain, and of minimal help against osteoarthritis, the most common form of arthritis and one that is often connected to back pain.4 Another study concluded that acetaminophen worked no better than a placebo in shortening patients’ recovery time for acute back pain.5

See Osteoarthritis Medications

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Doctors’ reactions to the research findings have been mixed. While some supported the findings, others found fault with the studies and suggested more research is needed before concluding that acetaminophen is not helpful.

The bottom line is that individuals respond differently to pain relievers, making it likely that acetaminophen is a good choice for a number of patients.

Each individual should discuss with a doctor the best form of pain relief for his or her situation.


  1. Machado, GC. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ 2015;350:h1225.
  2. Williams, CM, et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. The Lancet, Vol. 384, No. 9954, p1586–1596, 1 November 2014.
Further Reading: Narcotic Pain Medications
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