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Took 4 tylenol pm by accident: Tylenol Poisoning (Acetometophen Overdose)

Tylenol Poisoning (Acetometophen Overdose)

Written by WebMD Editorial Contributors

  • Acetaminophen (Tylenol) Poisoning Overview
  • Acetaminophen (Tylenol) Poisoning Causes
  • Acetaminophen (Tylenol) Poisoning Symptoms
  • When to Seek Medical Care
  • Exams and Tests
  • Acetaminophen (Tylenol) Poisoning Treatment
  • Self-Care at Home
  • Medical Treatment
  • Next Steps
  • Prevention
  • Outlook
  • More

Acetaminophen is one of the most common medications found in households. It is used for the treatment of pain and to lower fever.

Over many years, it has been used countless times by many people, and it has proven to be a safe and effective medication. However, if taken in excess amounts (overdose, whether on purpose or by accident), acetaminophen can cause life-threatening illness. Unless otherwise directed by your care provider, the usual maximum recommended dose is 3 grams in 24 hours.

Acetaminophen is the active ingredient in Tylenol. It is also found in many other over-the-counter medications and in prescription drugs. Acetaminophen is in Actifed, Alka-Seltzer Plus, Benadryl, Co-Gesic, Contac, Excedrin, Fioricet, Lortab, Midrin, Norco, Percocet, Robitussin, Sedapap, Sinutab, Sudafed, TheraFlu, Unisom PM Pain, Vick’s Nyquil and DayQuil, Vicodin, and Zydone.

Acetaminophen in overdose can seriously damage the liver. If the damage is severe, a liver transplant may be necessary in order to save someone’s life.

The antidote to acetaminophen overdose is N-acetylcysteine (NAC). It is most effective when given within eight hours of ingesting acetaminophen. Indeed, NAC can prevent liver failure if given early enough. For this reason, it is absolutely necessary that acetaminophen poisoning be recognized, diagnosed, and treated as early as possible.

Illness from acetaminophen overdose is caused primarily by liver damage.

Acetaminophen is primarily metabolized by the liver. Too much acetaminophen can overwhelm the way the liver normally functions.

If the liver is already damaged because of infection, alcohol abuse, or other illness, a person may be more susceptible to damage from acetaminophen overdose. For this reason, people with liver illnesses or people who chronically consume large amounts of alcohol should be particularly careful when taking acetaminophen and should consult their doctor prior to taking acetaminophen compounds. The FDA currently recommends that anyone taking medications that contain acetaminophen should not drink alcoholic beverages.

Long-term use of acetaminophen in recommended doses has not been shown to be harmful to the liver.

Soon after taking an overdose of acetaminophen, you may have no symptoms from taking a toxic amount. You may remain symptom-free for up to 24 hours after taking a toxic overdose of acetaminophen.

After this initial period, the following symptoms are common:

  • Nausea
  • Vomiting
  • Not feeling well
  • Not able to eat or poor appetite
  • Abdominal pain
  • Confusion

You must call a doctor, a poison control center, or emergency medical services for any suspected acetaminophen overdose.

Overall it is important that anyone suspected to have taken an overdose of acetaminophen get treatment early, before symptoms occur. Starting treatment early can greatly improve the outcome.

Seek emergency medical care at a hospital’s emergency department in the following situations:

If the person suspected to have taken an overdose of acetaminophen is unconscious, semiconscious, or not breathing, call 911 immediately.

Go to the hospital’s emergency department if the poison control center tells you to go.

Seek emergency care if you are unsure of the types and amounts of medication taken.

If a child took acetaminophen without adult supervision and may have taken an overdose, seek immediate medical attention.

Your doctor will diagnose acetaminophen overdose with the following methods:

  • History. The doctor will attempt to determine the time and amount of acetaminophen taken. Having access to all medication bottles that the person may have taken will help the doctor to determine the maximum amount taken.
  • Physical. The doctor will look for signs and symptoms of acetaminophen poisoning. These may include jaundice (yellow skin), abdominal pain, vomiting, and other signs and symptoms.
  • Laboratory tests. A blood level of acetaminophen will aid in determining if a toxic dose was taken. The doctor may order more than one blood level of acetaminophen and test for other drugs taken. In addition, the doctor may order other blood and urine tests as needed.

If you or a member of your household has taken or may have taken an overdose of acetaminophen, take quick action.

  • If the person is unconscious or not breathing, call 911 immediately for emergency medical services.
  • If the person is awake and breathing without symptoms, call your local poison control center or the American Association of Poison Control Centers at (800) 222-1222.

The following information is helpful for both medical personnel and a poison control center:

  • All medication that the person has taken, both prescribed and nonprescribed (have the bottles close)
  • All medications that are available in the house, prescribed and nonprescribed
  • The time that the person took the medication

Treatment in the emergency department depends on the condition of the person and any other medications taken.

If someone is suspected of having taken an overdose but has no symptoms, the doctor will begin the following treatment:

  • Emptying of the stomach. In the very few cases in which a person comes to the hospital minutes after taking the overdose, the doctor may attempt to empty the stomach by running a tube through the mouth into the stomach.
  • Activated charcoal.Activated charcoal should be given by mouth within 4 hours of the overdose to bind any drug remaining in the gastrointestinal tract.
  • N-acetylcysteine (NAC). NAC is the antidote for toxic acetaminophen overdose. It is generally given by mouth. The medication has a foul odor but may be mixed with juice or other flavorings to make it taste better. If the person cannot take NAC by mouth, a tube may be placed through the mouth and into the stomach to help administer it. If giving NAC by this method is not possible, the doctor may give it by IV. NAC should be given within 8 hours of ingestion, and is generally given for 20 hours to 72 hours.


After being discharged from the hospital or doctor’s office, you may be asked to return for an examination or blood tests to check the condition of your liver and your general health. Your doctor may instruct you to avoid alcohol and certain medications.

You can take these steps to avoid acetaminophen overdose:

  • Always securely close acetaminophen containers and use child-proof bottles. Keep all medication out of the reach of children and securely locked up.
  • Know the correct dose of acetaminophen and the amount of acetaminophen in the preparation you are using. If taken in recommended doses, there is no risk of poisoning from acetaminophen. In fact, to prevent accidental overdose, the maker of Extra-Strength Tylenol brand acetaminophen has reduced the maximum dose from 8 pills (4,000 milligrams) to 6 pills (3,000 milligrams) a day. Also, the FDA has asked drug companies to limit the amount of acetaminophen in prescription medications to 325 milligrams per dose.
  • Never mix different medications if both medications contain acetaminophen, except if instructed to do so by your doctor. For example, acetaminophen with codeine and cold medicine containing acetaminophen should not be taken together. Read product labels. They clearly indicate the contents.

If you or a family member is depressed and suicidal, remove all medications and dangerous substances from the house and seek medical attention immediately.

If you are unsure about how and when to take pain medications, ask your doctor for a plan. Write down this plan and follow it.

  • When you are given a new medication, always make sure the doctor knows all of the medication and supplements that you are taking, both prescribed and nonprescribed. The easiest way to do this is to keep a written list of medications and supplements and go over it with your doctor.
  • Do not take acetaminophen if you consume alcoholic beverages.

The outcome for someone who has an acetaminophen overdose depends largely on three factors: the amount of acetaminophen ingested, the timing of emergency treatment, and the initial general health of the person.

If a toxic dose is taken and emergency treatment is delayed, liver failure may follow. Liver failure may mean that a liver transplant is needed to prevent death. Alternatively, if treatment of a toxic overdose is begun early, the person may recover with no long-term health problems.

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Acetaminophen Overdose: Symptoms & Treatment Options

Medically reviewed by Drugs.com. Last updated on Jul 3, 2023.

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What is an acetaminophen overdose?

Acetaminophen overdose means you took more than is safe to take. It may also be called acetaminophen poisoning. Acetaminophen is called paracetamol in countries outside the United States. When used correctly, acetaminophen is a safe drug that decreases pain and fever. Many medicines contain acetaminophen, including some that you can buy without a prescription.

What causes an acetaminophen overdose?

  • You took more than the recommended dose. Acetaminophen comes in many forms, such as pills, capsules, and liquids. Strengths include regular strength, extra strength, and extended release. The most acetaminophen that is safe for most people to take is 4,000 milligrams (4 grams) in a 24-hour period. Some forms of acetaminophen need to be limited to lower doses, such as 3,000 mg (3 grams). Only a healthcare provider can recommend a larger maximum dose. You might accidentally take too much if your pain or fever did not go away after the recommended dose. You may also get too much if you take acetaminophen for too many days in a row.
  • You accidentally took more than one medicine that contains acetaminophen at a time. Many medicines contain acetaminophen along with other drugs. These include medicines for colds, the flu, allergies, or trouble sleeping. You may have taken more than one medicine that contains acetaminophen, and the total was too much.
  • You took an extended-release form. When you take extended-release pills, the medicine stays in your body longer. You are supposed to take these medicines less often than you would take regular acetaminophen. If you take this medicine too often, you will have too much in your body at one time.

What are the signs and symptoms of an acetaminophen overdose?

You might not have any signs or symptoms at first. Early signs and symptoms may make you feel like you have the flu. Common signs and symptoms happen during each stage of an acetaminophen overdose. If the overdose is treated right away, you might have fewer or easier symptoms in the later stages.

  • First 24 hours:
    • Nausea, vomiting, stomach pain, and loss of appetite
    • Paleness
    • Tiredness
    • Sweating
  • 24 to 72 hours after the overdose:
    • Pain in your upper right side
    • Dark urine
    • Urinating less often than usual
    • Skin and the whites of your eyes turn yellow
  • 72 to 96 hours after the overdose:
    • Blood in your urine
    • Fever, lightheadedness, or fainting
    • Fast breathing or trouble breathing
    • Extreme weakness or tiredness
    • Feeling very hungry, or shaking
    • Blurred vision, a fast heartbeat, or headache that will not go away
    • Trouble staying awake
    • Confusion
    • Coma

How is an acetaminophen overdose diagnosed?

Tell your healthcare provider when you took the acetaminophen and how much you took. He or she may ask how long you have been taking acetaminophen. He or she may ask about other medicines you take and when you take them. Your provider may ask if you have any medical problems, such as liver disease. He or she may ask if you drink alcohol and how much you drink. Your blood pressure and temperature will be checked. Your provider may check your skin for color changes and your stomach for pain. You may also need any of the following:

  • Blood tests are used to check the amount of acetaminophen in your blood.
  • Liver function tests may show if your liver is working properly.
  • Prothrombin time (PT) and INR rates measure how long it takes for your blood to clot. If your liver is damaged, your blood may not clot properly. You could have serious bleeding problems.

How is an acetaminophen overdose treated?

Acetaminophen overdose is a serious problem. Treatment should be started as soon as possible. Treatment depends on how much time has passed since the overdose and if the overdose happened all at one time:

  • Activated charcoal medicine may be given to soak up the acetaminophen that is still in your stomach. Activated charcoal will make you vomit.
  • Gastric lavage may be needed to clean out your stomach to get rid of the acetaminophen. Gastric lavage is also called having your stomach pumped.
  • Antidote medicine may be given to stop the effect of the overdose. You may also be given medicine to slow the effects of acetaminophen.

Treatment options

The following list of medications are in some way related to or used in the treatment of this condition.

  • acetylcysteine
  • Acetadote

How can an acetaminophen overdose be prevented?

Ask your healthcare provider or a pharmacist if you are not sure about any of the following:

  • Read labels carefully. Read the labels of all the medicines you take. If your medicine contains acetaminophen, it will be listed in the active ingredients section. Acetaminophen may be listed on the label as APAP, Acetaminoph, Acetaminop, Acetamin, or Acetam. Check carefully to see if the acetaminophen is a regular or extended-release form.
  • Do not take more than 1 type of acetaminophen at a time. Many combination medicines contain acetaminophen. Make sure the total dose of acetaminophen you take is not more than 4,000 milligrams (4 grams) in 1 day. Check other medicines to see if they contain acetaminophen. Do not take these medicines together with acetaminophen. The combined amount of acetaminophen may be too much.
  • Take the correct dose. Make sure you take the right amount and wait the right number of hours between doses. Never take more than the label says to take. If the medicine came with a device such as a spoon or dropper, use it to measure your medicine. If you need to give acetaminophen to your child, check the label to find out how much to give. The amount and timing will be based on your child’s age and weight.
  • Do not take acetaminophen for too many days in a row. Do not take acetaminophen for more than 10 days to treat pain, unless your healthcare provider tells you to. Do not take acetaminophen for more than 3 days to treat a fever, unless your healthcare provider tells you to. Your pain or fever may need to be treated another way if it lasts longer than a few days.

What should I do if I think I took too much acetaminophen?

Immediately call the Poison Control Center at 1-800-222-1222 .

Where can I find more information?

  • 24-Hour Nationwide Poison Control Hotline
    National Capital Poison Center
    3201 New Mexico Avenue, Suite 310
    Washington , DC 20016
    Phone: 1- 800 – 222-1222
    Web Address: http://www.poison.org
  • US Food and Drug Administration
    10903 New Hampshire Avenue
    Silver Spring , MD 20993
    Phone: 1- 888 – 463-6332
    Web Address: http://www.fda.gov

When should I seek immediate care?

  • You or another person took too much acetaminophen.
  • You feel confused or more tired than usual, or you are sweating more than usual.
  • You have severe nausea and are vomiting.
  • You cannot have a bowel movement or urinate.
  • Your skin and the whites of your eyes turn yellow.

When should I call my doctor?

  • You have a fever.
  • You have taken too much acetaminophen by mistake, even if you do not have any signs or symptoms.
  • You have pain in the upper right side of your abdomen.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© Copyright Merative 2023 Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes.

Learn more about Acetaminophen Overdose

Treatment options
  • Medications for Acetaminophen Overdose
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  • Prescription Opioid Overdose
  • Safe Use of Acetaminophen
  • Safe Use of Nsaids

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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In the footsteps of a drugstore poisoner, the FBI undertook to investigate the 1982 murders with renewed vigor: Mir: Lenta.ru

On Wednesday, February 4, FBI agents searched one of the apartments at 170 Gore Street in Cambridge, a suburb of Boston. The owner of the premises – James Lewis – was once a key figure in the case of the Chicago poisonings, committed 26-odd years ago. The motives and perpetrators of the crime that claimed the lives of seven people have not yet been established, but now there is hope again.

The Chicago poisonings are dated September 1982. An unknown perpetrator – or perpetrators – “worked” in stores selling Tylenol, a paracetamol-based pain reliever and antipyretic popular in the US manufactured by Johnson & Johnson. It was about one of the drugs of this brand, namely Extra-Strength Tylenol, the capsules of which were poisoned with potassium cyanide.

All seven deaths occurred in Chicago and its suburbs. The first victim was 12-year-old Chicago schoolgirl Mary Kellerman. Morning 29September, she took two Tylenol capsules and died soon after. On the same morning, 27-year-old Adam Janus, a postal worker, died, and then – his age, young mother Mary Reiner (Mary Reiner). Then died 31-year-old Mary Makfarlend (Mary McFarland) – an employee of the telephone company Illinois Bell.

On the evening of September 29, 25-year-old brother of Adam Janus Stanley (Stanley Janus) and his wife Theresa (Theresa Janus) who came to the house of a relative after his death were poisoned and died. Unaware of the cause of Adam’s death, they used the medicine from the same jar. The latest victim was flight attendant Paula Jean Prince, 35, who was found dead in her Chicago apartment on October 1.

Further deaths were avoided with the active participation of Johnson & Johnson, which, in particular, warned consumers through television advertising and switched from Extra-Strength Tylenol capsules to the same product in tablets, was avoided. The poisoning story received a great response in the United States and led to the introduction of new standards for packaging and controlling the sale of drugs.

James Lewis, 1995 Photo (c)AP


James William Lewis, a man of undetermined profession, was convicted in connection with the Chicago murders, not for the poisoning itself, but for blackmail. December 19He was arrested for 82 years in New York, and in 1983 he confessed that he sent a letter to Johnson & Johnson demanding that he pay him a million dollars “to stop the murders. ” As for the murders, the unfortunate extortionist was listed as a suspect, but the grounds for bringing charges against him were never found.

After his arrest, Lewis told investigators in detail how “someone” could have carried out the Chicago murders – to acquire Tylenol, add poison to capsules, and return the deadly drug to store shelves. At the same time, the arrested man insisted that he himself was innocent of the murders and even extorted money from Johnson & Johnson not for selfish purposes: Lewis allegedly intended to transfer a million dollars to the account of his wife’s former employer in order to embarrass him. For extortion, the court sentenced Lewis to 20 years in prison, but at 19In 1995, he was released on parole and settled in Boston.

Strange Mr. Lewis

It is reported that after his conviction, Lewis actively cooperated with the investigation, tried to help solve the murders and speculated about how the same “someone” could have done his dirty deed. U.S. Attorney Jeremy Margolis, who handled the Lewis case, says: “He’s a prolific writer and artist, and he provided me with a huge amount of documents and diagrams, all about his theories about what happened.” Apparently, all these materials had no special value, because the killer was never found.

I have been slandered all over the world as a “Tylenol man”. They accused me of being the mass murderer who poisoned Tylenol with cyanide in Chicago and killed seven people. These grotesque accusations are obviously false, otherwise I could not have written these words. 25 years later, the “Tylenol murders” remain unsolved. I have lived a long and unusual life and seen a lot, but I am sufficiently educated and bright enough to see and describe, compare and contrast completely different worlds, cultures and topics without a single moment of boredom, while my gaze is directed at professionalism, demographics and competitiveness, and my ear and heart are susceptible to the good taste and feelings of the victims.

Lewis might well have been suspected of being a relatively harmless psychopath if it weren’t for his criminal record – and it’s not limited to the Tylenol case. It is known that once Lewis was accused of murdering his former client (Lewis provided accounting services). The dismembered corpse of 72-year-old Raymond West was found in an attic in Kansas City. As far as the press knows, the charges were then dropped, as during the investigation, the police conducted an unauthorized search, and the cause of West’s death could not be confirmed. It is also reported that Lewis once served in prison two of the ten years to which he was sentenced for tax evasion.

Charges were brought later, when Lewis had already served time for blackmail. The Middlesex County Attorney’s Office (Massachusetts) confirmed that in 2004 the “writer and artist” was arrested on suspicion of rape, kidnapping and other crimes. Lewis remained in prison until 2007, after which the charges were dropped because the alleged victim, Lewis’ neighbor, refused to testify.

In suburban Boston, Lewis is known to have been involved in the creation of several Internet companies with his wife, LeAnn Lewis. One of those companies purporting to be a web design company is called Cyberlewis and is registered at the same address that was raided on Wednesday. The site www.cyberlewis.com has a section called Tylenol, which contains Lewis’s high-flown address in text and voice recording:

“So you want to hear me lament. You’ve landed on the right page. After a quarter of a century, I somehow believe that only a select few, endowed with a critical mind, will believe what I say. Many are looking for hidden plots, ambiguities and I do not pay attention to the literal meaning of my words. Many people like to twist and twist my words into something sinister and frightening that I did not even think about. Such, my friends, is the curse of the “Tylenol man.” Anyway, I can’t change human tendencies. I won’t even try. Listen if you want. Send me your comments by e-mail.

New Technologies

More than a hundred investigators were involved in the Chicago investigation. They studied more than 6.5 thousand versions, more than four hundred people were on the list of suspects, and 20 thousand pages of investigative reports were collected. However, there has been no result so far, and the investigation team was almost disbanded. “Given the many recent advances in forensic technology, re-examination of available material seems quite natural,” the FBI’s Chicago office said in a statement issued in connection with the search.

FBI agents carrying boxes out of Lewis’s house. Photo (c)AP


The operatives took several boxes, a large roll of brown paper and a Macintosh computer out of Lewis’s house. In addition to the “Tylenol man’s” dwelling, a storage facility also located in Cambridge was searched. The FBI said in a statement that there was no talk of any arrests or charges yet, but some evidence of Lewis’s likely guilt was probably presented to the court in order to issue a search warrant. “For the sake of the families of the victims, we must use modern technology and new methods to investigate unsolved murders, and we hope to solve this case once and for all,” said FBI spokesman Tom Simon.

The FBI explained that the reopening of the investigation was due to heightened public interest in the 25th anniversary of the poisoning case. Then, in September 2007, Michelle Rosen, daughter of the late Mary Rainer, confessed: “I can never leave what happened because this man (the killer) is at large and lives his life, no matter how she’s worthless.” Now that the FBI’s new efforts have been made public, Alojza Janus, the 80-year-old mother of two of the poisoner’s victims, said through tears in her native Polish: “Two of my innocent children have left this world and I hope the culprit is found.” .

In 2007, Lewis – apparently recently released from prison – was invited to one of the local television shows called The Cambridge Rag. On the air, Lewis once again spoke about his innocence in the poisoning case, as well as the murder of West. However, from the idea of ​​a lie detector test, which was proposed by TV presenter Roger Nicholson (Roger Nicholson), “prolific writer” refused, calling it unscientific. It remains to be hoped that, using their new methods, the FBI will finally find out if Mr. Lewis is not the poisoner, whom he himself once called “a cold-blooded killer and a cruel monster.”

Tylenol™ – instructions for use, doses, side effects, reviews of the drug:

0.048 ‰


All forms of release, dosages, registration certificates, drug manufacturers, drug characteristics

Description of the drug Tylenol™ (caplets (caplets), 500 mg) based on the official label, approved by the manufacturer in 2000

Approval date: 07/31/2000


  • Active substance
  • ATX
  • Pharmacological group
  • Nosological classification (ICD-10)
  • Composition and form of release
  • pharmachologic effect
  • pharmachologic effect
  • Indications
  • Contraindications
  • Use during pregnancy and lactation
  • Dosage and administration
  • Side effects
  • Precautionary measures
  • Storage conditions
  • Best before date

Active ingredient

Paracetamol* (Paracetamol*)


N02BE01 Paracetamol

Pharmacological group


Nosological classification (ICD-10)

ICD-10 code list

Composition and formulation

1 caplet contains paracetamol 500 mg; in a blister of 10 pcs. , in a box 1 blister or in strips of 2 pcs., in a box of 50 strips.

Pharmacological action

Pharmacological action

analgesic , antipyretic .

Inhibits cyclooxygenase, inhibits the synthesis of PG in the central nervous system and their stimulating effect on the thermoregulatory center of the hypothalamus; increases heat transfer.

Inhibits cyclooxygenase, inhibits the synthesis of PG in the central nervous system and their stimulating effect on the thermoregulatory center of the hypothalamus; increases heat transfer.


Pain of mild to moderate intensity (including headache, toothache, sore throat and general malaise), fever.


Hypersensitivity, severe impairment of liver and kidney function, deficiency of glucose-6-phosphate dehydrogenase, children’s age (up to 12 years).

Use in pregnancy and lactation

Acceptable, but only on prescription.