Liver disease and acetaminophen: can you take it safely?

June 6, 2016 Swedish Blogger

close up of two hands - one holding a glass of water, the other holding two pils


In this article:

  • Doctors often recommend that liver disease patients shouldn’t use acetaminophen.

  • However, with the right dosage, acetaminophen is the best option for pain relief.

  • Contact your Swedish physician to learn if acetaminophen is right for you.

Patients with liver disease are often told that they shouldn't use acetaminophen, a common over-the-counter pain reliever found in Tylenol and many other cold and flu medications. When acetaminophen is broken down, it can form byproducts that are toxic to the liver, so this warning is not completely without merit. Still, experts say that acetaminophen is the best option for pain relief for people with liver disease.

The dose is the key

Acetaminophen is a dose-dependent hepatotoxin, which means that its toxic effects on the liver are related to the amount taken. If anyone takes too much, even those with healthy livers, it will reliably cause an acute injury to the liver. In fact, acetaminophen is the most common cause of acute liver failure in the United States, accounting for almost half of all cases.

The good news is that liver injury can be avoided by limiting the amount of acetaminophen taken each day to 3,000 mg for most people and 2,000 mg for those with chronic liver disease. Staying within these limits will generally prevent liver injury. But the toxic byproducts can accumulate, so it’s best not to take acetaminophen every day.

When acetaminophen injures the liver

It’s unlikely that taking acetaminophen over time causes chronic liver disease or cirrhosis. And when acetaminophen does cause liver injury, there is an effective antidote that can reverse the damage if started early. This drug is called N-acetylcysteine, or NAC. 

Most patients who receive NAC within 24 to 48 hours of an overdose of acetaminophen get better, and even those who progress to liver failure usually recover without the need for a liver transplant. Because of this, liver injury from acetaminophen is considered an “all-or-none” phenomenon; that is, either the patient doesn’t recover and needs a liver transplant to survive, or there is complete recovery without long-term liver damage.

What about opiates and NSAIDs?

For those with chronic liver disease, options for a safe and effective pain reliever are limited.

Patients are told to avoid opiates like oxycodone because they can be addictive or have undesirable side effects such as constipation and sedation. Opiates are also broken down by the liver and this process can cause even worse side effects, such as serious mental confusion in patients with liver dysfunction.

Another class of pain relievers is non-steroidal anti-inflammatory drugs, or NSAIDs. These over-the-counter drugs include ibuprofen (Advil, Motrin) and naproxen (Naproxyn, Aleve). However, NSAIDs can cause kidney damage, and patients with chronic liver disease are particularly susceptible to this. 

While patients with chronic liver disease should minimize their use of acetaminophen and opiates, they should avoid NSAIDs altogether to help protect their kidneys.

Using acetaminophen safely

Considering the relative risks and alternatives, acetaminophen is the best option for pain relief in patients with chronic liver disease. The advice from well-intentioned doctors that it should be avoided is often misguided because acetaminophen is effective and safe when the appropriate precautions are taken. Again, that means that patients with chronic liver disease should limit their use of acetaminophen to less than 2,000 mg a day and avoid using it every day.

Watch for hidden acetaminophen

Acetaminophen is found in many medications, particularly over-the-counter cold and flu preparations such as some types of NyQuil, DayQuil, Sudafed, Robitussin and Alka-Seltzer, to name only a few. It’s also found in prescription pain relievers, in combination with opiates. These include Percocet, Norco and Vicodin. 

It’s important to be aware of the ingredients in all of your medications so you don’t inadvertently take too much acetaminophen.

Find a doctor

If you have questions about managing liver disease, contact the Swedish Liver Center. We can accommodate both in-person and virtual visits.

Whether you require an in-person visit or want to consult a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow up as needed. If you need to find a doctor, you can use our provider directory.

Join our Patient and Family Advisory Council.

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

Follow us on FacebookInstagram and Twitter.

Previous Article
New guidelines for pediatric celiac disease

New guidelines have been published for celiac disease and introducing gluten to an infant’s diet. They incl...

Next Article
Blood thinners and how they can affect the GI tract
Blood thinners and how they can affect the GI tract

Anticoagulants and antithrombotics, commonly known as blood thinners, are used for a variety of medical con...