Acetaminophen causes few adverse reactions when used as directed on the label or recommended by the primary health care provider. Adverse reactions associated with the use of acetaminophen usually occur with chronic use or when the recommended dosage is exceeded. Adverse reactions to acetaminophen include skin eruptions, urticaria (hives), hemolytic anemia, pancytopenia (a reduction in all cellular components of the blood), hypoglycemia, jaundice (yellow discoloration of the skin), hepatotoxicity (damage to the liver), and hepatic failure (seen in chronic alcoholics taking the drug).
Acute acetaminophen poisoning or toxicity can occur after a single 10- to 15-g dose of acetaminophen. Dosages of 20 to 25 g may be fatal. With excessive dosages the liver cells necrose or die. Death can occur due to liver failure. The risk of liver failure increases in patients who are chronic alcoholics.
Signs of acute acetaminophen toxicity include the following:
• Liver tenderness
• Acute hepatic and renal failure
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