ATrain Education


Continuing Education for Health Professionals

Acetaminophen: When It Becomes Dangerous

Module 7

Resources and References


Acetaminophen Safe Use Toolkit

American Association of Poison Control Centers

Consumer Med Safety

IV Acetadote Dosage Calculator

NCPIE Be Medwise (free printable resources)

Patient Education Institute. Website XPlain

Tylenol for Healthcare Professionals: Safety and Patient Education


American Geriatric Society.(2009).Pharmacological Management of Persistent Pain in Older Persons. Retrieved July 2, 2018 from

Brass E, Reynolds K, Burnham R, Green J. (2018). Medication errors with pediatric liquid acetaminophen after standardization of concentration and packaging improvements. Academic Pediatrics. Retrieved May 8, 2018 from

Buck ML. (2011). Intravenous acetaminophen use in infants and children. Pediatric Pharm 17(4). Retrieved June 18, 2013 from

Budnitz DS, Lovegrove MC, Crosby AE. (2011). Emergency department visits for overdoses of acetaminophen-containing products. Am J Prev Med 40(6):585–92. Doi:10.1016/j.amepre.2011.02.026.

Consumer Reports. (2014). Is acetaminophen a deadly pain pill? Sept 19, 2014. Retrieved May 8, 2018 from

Drahl C. (2014). How does acetaminophen work? Researchers still aren’t sure. Chemical Engineering 92(29):32. Retrieved May 8, 2018 from (2018). Acetaminophen. Retrieved May 8, 2018 from

Farrell S, Defendi G, Miller M, et al. (2018). Acetaminophen Toxicity. eMedicine, Medscape. Retrieved May 8, 2018 from

Food and Drug Administration (FDA). (2017). Acetaminophen Information. Retrieved May 8, 218 from

Food and Drug Administration (FDA). (2014). All manufacturers of prescription combination products with more than 325 mg of acetaminophen have discontinued marketing. Retrieved May 8, 2018 from

Food and Drug Administration (FDA). (2013). National Council for Prescription Drug Practices (CPDP) Recommendations for Improved Prescription Container Labels for Medicines Containing Acetaminophen version 1.1. Retrieved May 8, 2018 from

Food and Drug Administration (FDA), Center for Drug Evaluation and Research. (2011). Acetaminophen Overdose and Liver Injury—Background and Options for Reducing Injury. Regulations Statement. Retrieved May 8, 2018 from

Goldberg E. (2017). Acute liver failure in adults: Etiology, clinical manifestations and diagnosis. Mayo Clinic. Retrieved May 8, 2018 from

Hodgman MJ, Garrard AR. (2012). A review of acetaminophen poisoning. Critical Care Clinics 28:499–516.

Hughes GJ, Patel PN, Saxena N. (2011). Effect of acetaminophen on international normalized ratio in patients receiving warfarin therapy. Pharmacotherapy 31(6):591–97. Doi: 10.1592/phco.31.6.591.

Jaeschke H, McGill MR, Ramachandran A. (2012). Oxidant stress, mitochondria, and cell death mechanisms in drug-induced liver injury: Lessons learned from acetaminophen hepatotoxicity. Drug Metabolism Reviews 44:88–106. Doi:10.3109/03602532.2011.602688.

Ji P, Wang Y, Li Z, et al. (2012). Regulatory review of acetaminophen clinical pharmacology in young pediatric patients. J Pharm Sci. 101:4383–89. Doi: 10.1002/jps.23331.

Kirschner RI, Rozier CM, Smith LM, Jacobitz KL. (2016). Clinical Toxicology (Phila). 54(1):40–46. Retrieved May 8, 2018 from

Lee WM, Larson AM. (2010). Unrecognized acetaminophen toxicity as a cause of indeterminate acute liver failure. Hepatology. Retrieved May 8, 2018 from

Mahmoudi GA, Astaraki P, Mohtashami AZ, Ahadi M. (2014). International Medical Case Reports Journal, Vol 8. Retrieved May 8, 2018 from

Mayo Clinic (2017). Acetaminophen (Oral Route, Rectal Route). Retrieved May 8, 2018 from

McGill MR, Sharpe MR, Williams CD, et al. (2012). The mechanism underlying acetaminophen-induced hepatotoxicity in humans and mice involves mitochondrial damage and nuclear DNA fragmentation. J Clin Invest. 122(4):1574–83. Doi:10.1172/JCI59755.

Medical Dictionary, The. (2018). Acetaminophen. Retrieved May 8, 2018 from

Medicine Net. (2018). Acetaminophen, Tylenol, and others. Retrieved May 8, 2018 from

Miller TC, Gerth J. Overdose: Behind the Numbers. ProPublica. Retrieved May 8, 2018 from

Mosbergen D. Tylenol Overdose Risk is Staggering; Acetaminophen Safeguards Remain Insufficient: Report Dec 6, 2017. HuffPost. Retrieved May 8, 2018 from

National Institutes of Health (NIH). (2013). Acute Liver Failure: Liver Toxicity by Acetaminophen. Retrieved May 8, 2018 from

Pascal P, Klinger-Gratz W, Ralvenius, E, Kato A, et al. (2017). Acetaminophen relieves inflammatory pain through CB1, cannabinoid receptors in the rostral ventromedial medulla. Journal of Neuro Science 38(2):322–34. Retrieved May 8, 2018 from

Patient Education Institute (PEI). (2018). Website XPlain. Retrieved May 8, 2018 from

Rumack BH, Peterson RC, Koch GG, Amara IA. (1981). Acetaminophen overdose: 662 cases with evaluation of oral acetylcysteine treatment. Arch Intern Med. 141(3 Spec No):380–85.

Rumack B., Yarema MC, Green JP, et al. (2017, February). Clinical Toxicology (Phila). 5(2):102–108. Retrieved May 8, 2018 from

Thomas AM, Lewis JH. (2018, May). Nonacetaminophen drug-induced acute liver failure. Clinics in Liver Disease 22(2):301–24. Doi: 10.1016/j.cld.2018.01.006.

Toyoda Y, Kashikura K, Soga T, Tagawa Y. (2017). Metabolomics of an in vitro liver model containing primary hepatocytes assembling around an endothelial cell network: Comparative study on the metabolic stability and the effect of acetaminophen treatment. Journal Toxicology Science 42(4):445–54. Retrieved May 8, 2018 from

Tylenol for Healthcare Professionals. (2018). Doctor’s Practice Patient Resource Library 2018. Retrieved May 8, 2018 from

Wikipedia. (2018a). Paracetamol. Retrieved May 8, 2018 from

Wikipedia. (2018b). Paracetamol toxicity. Retrieved May 8, 2018 from

Wikipedia. (2018c). NAPQI. Retrieved May 8, 18 from

Yang G, Zhang L, Ma L, et al. (2017). Glycyrrhetinic acid prevents acetaminophen-induced acute liver injury via the inhibition of CYP2E1 expression and HMGB1-TLR4 signal activation in mice. Int Immunopharmacology Sep;50:186–93. doi: 10.1016/j.intimp.2017.06.027. Epub 2017 Jun 29. Retrieved May 8, 2018 from

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