Can taking too much tylenol make your stomach hurt

Tylenol (acetaminophen) is a common OTC medication that can help with pain and fever, and it’s safe for children and adults at recommended doses.

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“How much Tylenol can I take” is a common question if you’ve ever taken Tylenol (acetaminophen) for more than a one-time dose. Tylenol is one of the most common over-the-counter (OTC) pain relievers available today. It’s also known as APAP or paracetamol. In addition to using it as a pain reliever, Tylenol can be used as an antipyretic, or fever reducer. 

It’s typically safe when used within recommended doses, but it is possible to take too much Tylenol. You especially need to be careful if you have liver damage, consume lots of alcohol, have certain health conditions, or take other medications containing acetaminophen because the amount you can safely take may be different.

Read on to learn what you need to know about how much Tylenol you can safely take. You should always check with your healthcare provider for guidance about what dose of Tylenol is right for you.

How much Tylenol can you take in a day?

For adults, the maximum dose of Tylenol you can take is 4,000 mg in a day, which has been validated in several studies. However, since Tylenol can cause liver damage (also called hepatotoxicity) at doses higher than 4,000 mg per day, some experts recommend a lower maximum dose of 3,250 mg per day, especially if used daily for more than a week at a time. Additionally, manufacturers of acetaminophen products may suggest a particular daily dose based on the tablet strength for that specific product; for example, the manufacturer lowered their max recommended dose to 3,000 mg per day.

If you have more than 3 drinks of alcohol in a day, poor nutrition, low body weight, illness with fever, or liver disease, you might have a higher risk of getting liver damage from taking acetaminophen. If you have one or more of these characteristics, you may need to drop your maximum daily dose to as low as 2,000 mg per day or avoid acetaminophen. Always ask your healthcare provider if you aren’t sure how much acetaminophen you should take.

For kids, the oral Tylenol dose is often based on how much they weigh, and the labeled maximum daily dose is 75 mg/kg per day, not to exceed 4,000 mg in a day. Since the standard dose for children is 10-15 mg/kg per dose, this usually means that children should not have more than five doses of acetaminophen in a day.

Is it harmful to take Tylenol every day?

In short, no — most people can safely take Tylenol within recommended doses every day. But, it matters how much Tylenol you take because it can become unsafe if you take too much. 

As mentioned above, if you have normal liver function and plan to take Tylenol for longer than seven days, it’s safest to use a lower maximum daily dose of 3,000 mg per day to avoid liver injury. 

If you have liver disease or another condition listed above that makes you more prone to liver damage from acetaminophen, you should check with your healthcare provider before taking any acetaminophen.

Tylenol dosage information for children and adults

As discussed, the dose of Tylenol is different for kids and adults. While adult dosing is usually based on the strength of the pill (325 mg, 500 mg, or 650 mg for OTC products), children’s oral dosing is weight-based. The American Academy of Pediatrics recommends 10-15 mg/kg per dose for children, but most OTC Tylenol product information lists a set dose for a given weight range and age range. The Table below lists dose information for some common OTC Tylenol medications.

In this study of over 1500 pregnant women, about 60% reported using Tylenol during their pregnancy. While generally considered safe at standard adult doses, researchers have recently suggested that Tylenol may not be as safe as we thought in pregnant women and could affect development of the fetus. The researchers pointed out the need for more studies to evaluate this, since alternative options for pain or fever control during pregnancy are very limited. You should always talk to your healthcare professional before taking any medication when you’re pregnant. 

Table. Dosage Information for Common OTC Tylenol Products 

ProductAcetaminophen StrengthDosage FrequencyDirectionsRegular Tylenol325 mg2 tablets every 4-6 hours as needed for symptomsMaximum of 10 tablets in 24 hours.
Total labeled daily dose: 3,250 mg per day.Extra Strength Tylenol500 mg2 tablets every 4-6 hours as needed for symptomsMaximum of 6 tablets in 24 hours.
Total labeled daily dose: 3,000 mg per day.Tylenol Arthritis (extended-release)650 mg2 tablets every 8 hours as needed for symptomsMaximum of 6 tablets in 24 hours.
Total labeled daily dose: 3,900 mg per day.Tylenol with Ibuprofen250 mg acetaminophen and 125 mg ibuprofen per caplet2 caplets every 8 hours as needed for symptomsMaximum of 6 caplets in 24 hours.
Ask your child’s pediatrician to confirm dose for children under 12 years old.Children’s Tylenol chewable tablets160 mgWeight/age-based dose every 4 hours as neededMaximum of 5 doses in 24 hours.
Ask your child’s pediatrician to confirm dose for children under 2 years old.Children’s Tylenol Suspension160 mg per 5 mLWeight/age-based dose every 4 hours as needed for symptomsMaximum of 5 doses in 24 hours.
Ask your child’s pediatrician to confirm dose for children under 2 years old.Liquid Tylenol for Babies (Infant’s Tylenol)160 mg per 5 mLWeight/age-based dose every 4 hours as needed for symptomsMaximum of 5 doses in 24 hours.
Ask your child’s pediatrician to confirm dose for children under 2 years old.Children’s Tylenol Suppositories80 mg
120 mg
325 mgAge-based dose every 4-6 hours as needed for symptomsMaximum of 4-6 doses in 24 hours, depending on the product.
Age ranges differ by product.

What are the side effects of taking too much acetaminophen?

Acetaminophen is usually well-tolerated and does not commonly cause side effects. The most serious side effects that can happen from taking acetaminophen are liver damage from taking too much acetaminophen and a rare, severe skin rash. Mild side effects may include nausea, vomiting, or constipation.

Symptoms of liver damage from acetaminophen overdose include vomiting, abdominal pain, and low blood pressure. In severe cases of acetaminophen overdose, kidney damage, confusion, and death can occur.

Tylenol (Acetaminophen) overdose: How it can happen

While intentional overdoses can occur with acetaminophen since it’s so widely available, unintentional overdoses cause about half of the cases of liver damage in the U.S. It can be easy to take too much Tylenol because so many combination medications contain acetaminophen.

It’s estimated that acetaminophen overdose causes 56,000 visits to the emergency room, 2,600 hospitalizations, and 500 deaths yearly in the U.S.

There are hundreds of medications and medication combinations that contain acetaminophen. So, if you’re taking a combination medication that contains acetaminophen — whether you’re aware of it or not — and you take Tylenol on top of that, it can be easy to exceed the maximum dose and have a risk of liver damage.

How Acetaminophen Affects the Liver

Acetaminophen is mainly broken down in the liver by two different “pathways” — glucuronidation and sulfation. But, when your body has too much acetaminophen, these pathways can no longer break down most of the medication, and more acetaminophen is broken down by a different pathway — through an enzyme called cytochrome P450.

In this pathway, a toxic substance called NAPQI builds up in your body. Under normal circumstances, a molecule called glutathione helps neutralize NAPQI. However, when you have too much acetaminophen making too much NAPQI, the toxic substance, there’s not enough glutathione to neutralize it. The excess NAPQI then directly damages cells in the liver, causing liver damage.

How to avoid taking too much Tylenol

You can avoid taking too much Tylenol by carefully reviewing all of the prescription and OTC medications you take and looking for any that contain acetaminophen. Remember, acetaminophen also shows up as Tylenol, APAP, or paracetamol — they’re all the same thing. 

Once you know all of the medications you take that have acetaminophen in them, add up the total dose of acetaminophen you take in a day. If it’s more than 4,000 mg in one day, you are taking too much acetaminophen and you should contact your healthcare provider to discuss an appropriate dose. If it’s less than 4,000 mg in one day, it still is a good idea to check your dose with your healthcare provider. In most people with normal liver function, it’s usually ok to take doses of less than 4,000 mg per day for a short amount of time. 

In any case, it’s always a good idea to check with your healthcare provider to confirm how much acetaminophen you can take in a day based on your health conditions.

The bottom line

Tylenol is a common OTC medication that can help treat pain and fever, and it’s safe at recommended doses. For most adults, the maximum daily dose of Tylenol is 4,000 mg, and for kids, it’s 75 mg/kg (but not more than 4,000 mg). Your daily dose of Tylenol includes acetaminophen from all sources – including any prescription and OTC combination medications that contain acetaminophen. Some people should take less Tylenol per day if they have certain health conditions, including liver damage or heavy alcohol use.

Taking too much Tylenol — whether on accident or on purpose — can cause severe liver damage that requires medical attention. You can avoid this by carefully reviewing all of your prescription and OTC medications to determine how much acetaminophen you take in a day. Always talk to your healthcare provider to confirm how much acetaminophen is okay for you to take.

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