No, using Tylenol isn't killing ‘at least 100,000’ people per year

You probably don’t spend much time thinking about the safety of the bottle of Tylenol tucked inside your medicine cabinet, but a post circulating on social media seems to want you to do just that.

"Did you know that Tylenol is the #1 cause of acute liver failure in the US with 27% of people dying & kills at least 100,000 per year from its use?" read the April 21 Facebook post.

It also alleged Tylenol is unsafe for pregnant women and children and concluded by promoting the use of herbal remedies instead.

The post was flagged as part of Facebook’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Facebook.)

PolitiFact found no evidence to suggest Tylenol itself is the No. 1 cause of acute liver failure in the U.S. And there are simply too few overdose-related deaths per year to ever reach 100,000 per year.

(Screengrab from Facebook)

Acetaminophen, the main active ingredient in Tylenol, is a commonly used fever reducer and pain reliever. 

It is the most common drug ingredient in the U.S. and each week 23% of adults use a medication that contains acetaminophen, according to the Consumer Healthcare Products Association. Tylenol contains acetaminophen, but so do many other over-the-counter drugs, such as NyQuil, DayQuil and Excedrin.

As with all medications, some people might have an allergic reaction, and everyone has to follow the dosage instructions.

The label on a box of regular strength Tylenol, for example, warns of the potential for severe liver damage if the medication is taken incorrectly.

Annette Reichel, a spokesperson for Tylenol, said the drug has over 60 years of use to show that it is safe. 

"When used as directed at recommended doses, Tylenol does not cause acute liver failure," Reichel said. "However, per the Tylenol (over-the-counter) Drug Facts label, severe liver damage may occur if an individual takes more than 4000 mg of acetaminophen in 24 hours." 

For Extra Strength Tylenol, that means liver damage may occur if someone took two 500-milligram caplets over the recommended dose within a single day. That’s not a lot of pills, a fact that has raised concerns that the dosage guidelines should be tighter. That doesn’t, however, change the data problems with this claim. 

Acetaminophen has been tied to acute liver failure, the condition mentioned in the post. In fact, research referenced by the U.S. Food & Drug Administration shows that acetaminophen is the No. 1 cause of acute liver failure in the U.S.

Many medications contain acetaminophen, however, meaning that Tylenol, by itself might not be the leading cause of acute liver failure.

Dr. William Lee, a professor of internal medicine at the University of Texas Southwestern Medical School, has researched the connection between acetaminophen and acute liver failure for more than 20 years. 

His research into acetaminophen and acute liver failure has continued to show that acetaminophen overdose, both accidental and intentional, is the "leading cause of acute liver injury and acute liver failure in the developed world."

"I think that’s a little specious to blame it on Tylenol, specifically, because (acetaminophen) is such a ubiquitous product," Lee said. 

About 1,600 to 2,000 cases of acute liver failure occur in the U.S. each year, according to the U.S. Centers for Disease Control and Prevention and Lee’s research. The condition is considered rare. Far from all cases are fatal.

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One 2005 study conducted by Lee and University of Washington Medical Center researchers found that of 275 patients who were diagnosed with acetaminophen-induced acute liver failure, 178 patients (65%) survived, 74 (27%) died without transplantation and 23 (8%) underwent liver transplants.

That 27% mortality finding could be the origin of the 27% in the Facebook post, but the finding was not linked to Tylenol specifically.

From 1990 to 1998, FDA research indicated there were about 458 deaths per year related to acetaminophen-associated overdoses. 

Even if each of the people who died from overdosing on acetaminophen had taken Tylenol — and there is no indication that that is the case — that number is still nowhere near the 100,000 deaths the post alleges.

Lee said the most he has found is about 250 acute liver failure cases per year — only some were due to acetaminophen, and fewer still were fatal. Even assuming his nationwide registry missed cases, "you’re never going to get up to" 100,000 deaths per year.

"There’s no way that’s correct," Lee said.

He said that there are many people who use acetaminophen medications safely every day to manage chronic pain. When people follow the dosing limitations included with the medication, "they’re never going to get into trouble with that level of medication," Lee said.  

A post claimed that "Tylenol is the #1 cause of acute liver failure in the US with 27% of people dying and kills at least 100,000 per year from its use."

Acetaminophen is the active ingredient in Tylenol and hundreds of other medications. 

Acetaminophen overdose is the leading cause of acute liver failure in the U.S., but the condition is rare — there are around 2,000 cases annually — and not always fatal. 

About 450 deaths per year are related to acetaminophen-associated overdoses, according to the FDA. That number is nowhere near 100,000 deaths — and there is no reason to think that each of those deaths was due to Tylenol, specifically. 

We rate this claim False.