A perspective on the epidemiology of acetaminophen exposure and toxicity in the United States

Expert Rev Clin Pharmacol. 2014 May;7(3):341-8. doi: 10.1586/17512433.2014.904744. Epub 2014 Mar 28.


Acetaminophen is a commonly-used analgesic in the US and, at doses of more than 4 g/day, can lead to serious hepatotoxicity. Recent FDA and CMS decisions serve to limit and monitor exposure to high-dose acetaminophen. This literature review aims to describe the exposure to and consequences of high-dose acetaminophen among chronic pain patients in the US. Each year in the US, approximately 6% of adults are prescribed acetaminophen doses of more than 4 g/day and 30,000 patients are hospitalized for acetaminophen toxicity. Up to half of acetaminophen overdoses are unintentional, largely related to opioid-acetaminophen combinations and attempts to achieve better symptom relief. Liver injury occurs in 17% of adults with unintentional acetaminophen overdose.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acetaminophen / administration & dosage
  • Acetaminophen / therapeutic use
  • Acetaminophen / toxicity*
  • Analgesics, Non-Narcotic / administration & dosage
  • Analgesics, Non-Narcotic / toxicity*
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / therapeutic use
  • Analgesics, Opioid / toxicity
  • Chemical and Drug Induced Liver Injury / epidemiology*
  • Chemical and Drug Induced Liver Injury / etiology
  • Dose-Response Relationship, Drug
  • Drug Overdose
  • Drug Synergism
  • Drug Therapy, Combination
  • Humans
  • Kidney Diseases / chemically induced
  • Kidney Diseases / epidemiology*
  • Risk Factors
  • United States / epidemiology


  • Analgesics, Non-Narcotic
  • Analgesics, Opioid
  • Acetaminophen