Acetaminophen is a mild to moderate painkiller typically used to relieve headaches, muscle aches, menstrual symptoms, colds and sore throats, toothaches, backaches, reactions to vaccines, and to reduce fevers (1). Although acetaminophen is considered “safer” than nonsteroidal anti-inflammatory drugs (NSAIDs), there are still many risks associated with this over-the-counter medication (2).

Many people don’t realize that although acetaminophen may be FDA-approved, that doesn’t necessarily mean it’s safe (or effective). Acetaminophen was approved during a time when they’d give a large dose (in a short period) and see if it was lethal. If no death occurred following the dose, it was considered “safe.” In other words, no long-term safety studies were conducted before its approval.

When acetaminophen was first FDA-approved in 1950, it was only available with a prescription (3). It wasn’t until the 1960s that the FDA started requiring clinical reviews to establish the safety and effectiveness of drugs (4,5). Interestingly, experts still don’t understand how acetaminophen works, and although mechanism theories were established in the 1970s and 2000s, they didn’t survive scrutiny (6). Between the lack of understanding and failure to undergo modern safety tests (which are sometimes still inadequate), many experts question acetaminophen’s safety, and for good reason (7).

Potential Risks of Acetaminophen

Acetaminophen overdose is the leading cause of calls to poison control centers in the United States, responsible for more than 56,000 emergency room visits and 2,600 hospitalizations (8). Overdose aside, acetaminophen is linked to an increased risk of health problems when used long-term or in larger doses. Some possible risks associated with acetaminophen include:

Liver & Kidney Damage

Acetaminophen is responsible for about 500 deaths yearly due to acute liver failure (8). Over half of all acute liver failure cases in the United States are due to accidental acetaminophen overdoses (9).

The Tylenol website claims:

“TYLENOL® does not affect kidney function the way that non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin (Bayer®), naproxen sodium (Aleve®), and ibuprofen (Advil®, MOTRIN® IB) can (10).”

Yet, one study found that heavier use of acetaminophen was associated with an increased risk of end-stage renal disease (11). End-stage renal disease, or kidney disease, occurs when there’s a gradual loss of kidney function or chronic kidney disease (12).

Glutathione Depletion

The body’s master antioxidant, glutathione (13), is often diminished when you take acetaminophen due to toxin buildup and liver damage (14). Glutathione helps protect cells from damage caused by free radicals. The buildup of free radicals has been linked to chronic diseases, such as cancer and heart disease (15). Interestingly, immediate administration of N-acetylcysteine (NAC), the precursor to glutathione, can prevent mortality from acetaminophen toxicity (16).

Cardiovascular Events

Several studies have highlighted the influence of acetaminophen and cardiometabolic risk. Cardiometabolic risk is a person’s chance of having a cardiovascular event such as a heart attack or stroke (17). One study found that individuals taking opiates (some containing acetaminophen) were 95 percent more likely to be obese and 63 percent more likely to have hypertension (18).

Cancer

Researchers have found an association between acetaminophen and cancer. A meta-analysis of epidemiological studies found that acetaminophen was associated with a significantly increased risk of kidney cancer (19). This risk is quite shocking since, according to Tylenol’s website:

“The National Kidney Foundation recommends acetaminophen, the active ingredient in TYLENOL®, as the pain reliever of choice for occasional use in patients that have underlying kidney disease (10).”

Yet, according to Moffitt Cancer Center:

“Now acetaminophen is making headlines because California regulators are considering labeling it a carcinogen. It is part of the state’s Proposition 65 law requiring California to warn consumers of any products known to cause cancer, birth defects or reproductive harm (20).”

Emotional Processing Impairment

Ohio State University researchers wanted to determine if acetaminophen affected emotional processing. They found that participants who took acetaminophen:

“…evaluated unpleasant stimuli less negatively and pleasant stimuli less positively, compared with participants who took a placebo (21).”

In other words, both negative and positive stimuli were less emotionally arousing to people who had taken acetaminophen. In other words. acetaminophen could affect an individual’s evaluative (judgment) and emotional processing, regardless of negative or positive valence (emotional value). Another study found that acetaminophen influences behavioral and neural (nerve) measures of cognitive control and emotional processes (22). A final study found acetaminophen reduced empathy for pleasurable experiences in people (23).

Neurodevelopmental Consequences During Pregnancy

Acetaminophen is currently marketed as safe during pregnancy. However, acetaminophen use may have neurodevelopmental consequences for the fetus. A study followed more than 2,000 mother-child pairs from the first trimester of pregnancy and performed several behavior tests when the children were about five years old. The study concluded:

“Prenatal acetaminophen exposure was associated with a greater number of autism spectrum symptoms in males and showed adverse effects on attention-related outcomes for both genders. These associations seem to be dependent on the frequency of exposure (24).”

According to mainstream source, WebMD:

“New research shows that women who took acetaminophen, best known as Tylenol, at the end of their pregnancies were much more likely to have child with attention-deficit/hyperactivity disorder (ADHD) or autism (25).”

Stevens-Johnson Syndrome

Acetaminophen is also linked to rare but severe skin reactions such as Stevens-Johnson Syndrome and toxic epidermal necrolysis. These reactions can be fatal. Between 1969 and 2012, there were 107 such cases, of which 67 required hospitalization, and 12 people died. In 2013, the FDA issued a warning and mandated that skin reactions be listed on acetaminophen-containing drug labels as a potential adverse effect (26). Exactly how acetaminophen causes these potentially fatal skin reactions is supposedly unknown. What’s particularly alarming is that skin reactions can occur even if you’ve taken acetaminophen in the past without any problems.

Endocrine Disruption

Acetaminophen is an endocrine (hormone) disruptor. An animal study found that rats who received acetaminophen had female offspring with fewer eggs, smaller ovaries, and smaller litters when they reached reproductive age. Male offspring had fewer sperm progenitor cells early in life, but these returned to normal by adulthood. Particularly concerning was the effect it had on the next generation. Granddaughters of the rats given acetaminophen were also found to have smaller ovaries and stunted reproductive functionality (27).

Asthma

Researchers have established an affiliation between acetaminophen and asthma. A systematic review and meta-analysis discovered that asthma probability increased with previous acetaminophen use in both adults and children (28). Moreover, prenatal exposure to acetaminophen also heightened the risk of asthma in the child, possibly due to increased oxidative stress during prepregnancy (29).

Natural Alternatives for Acetaminophen

There are many reasons why people take acetaminophen. It’s recommended so often that our culture almost sees it as a cure-all drug. Personally, I’m uncomfortable taking or recommending acetaminophen, but I respect your right to medical freedom. With that said, if you use it for whatever reason, I’d suggest opting for a brand that’s free from artificial additives, fillers, and food coloring such as Genexa, and even some generic store brands.

My go-to alternatives for acetaminophen are typically herb-based. Of course, when using herbal remedies, one must ensure the correct remedy has been chosen. What works for a headache may not not work for fever reduction. With that said, I’ve compiled a list of medicinal herb per symptom. You could add these to food, or use them to make capsules, infusions, and tinctures.

• Arthritis → Turmeric
• Fever → Catnip
• Headache → Ginger
• Illness → Elderberry or echinacea
• Inflammation → Cinnamon
• Menstrual symptoms → Red raspberry
• Muscle aches → Arnica
• Pain → Peppermint
• Sore throat → Mullein or raw honey
• Toothache → Clove
• Vaccine reaction → Activated charcoal

Of course, sometimes we want a convenient catch-all remedy. If you’ve read my blog, Benefits of Cannabinoids, you know how beneficial CBD can be for almost anything. I use The Brother’s Apothecary CBD Oil for that purpose.

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