The Common Medication Hepatologists Wish People Would Stop Taking So Casually

Over-the-counter medications are nothing if not convenient. If you feel a cold coming on, you can pop over to your local pharmacy and grab something to soothe symptoms so it's slightly less cruddy. Yet, hepatologists are begging people not to take common medications so casually. In fact, they say it's best to talk to your doctor before taking OTC medicines, even though you don't need a prescription.

"Since over-the-counter medications are easy to obtain, it's a common assumption that they are safe by default," Dr. Brian T. Lee, MD, a transplant hepatologist at Hoag Digestive Health Institute and director of the Hoag Liver Program, tells Parade. "This, unfortunately, isn't the case, and I see the consequences of this assumption frequently as a hepatologist."

OK-what does medication for a cold or backache have to do with the liver? A lot, as it turns out.

"The liver is responsible for metabolizing most medicines," Dr. Lee explains, noting that the liver has only so much capacity to metabolize medicines safely. When you take a dose that's higher than advised, use a medication too frequently or combine it with something like alcohol, it's possible to damage the liver.

"While concerning, the reality is that much of this type of harm is preventable, and the first step is understanding that just because a medication is available without a prescription does not mean it is harmless," Dr. Lee says. "Recognizing that is an important distinction and is where responsible use begins."

For this reason, hepatologists like Dr. Lee wish people would stop taking this common medication so casually.

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The Common Medication To Stop Taking So Casually, Hepatologists Say

"Acetaminophen overdosage is the most common cause of acute liver failure in the United States," states Dr. Veronica Loy, DO, a transplant hepatologist and the medical director of liver transplantation at Rush University Medical Center. Acetaminophen is the generic name for the active ingredient in brands like Tylenol.

The FDA is also begging people not to overuse acetaminophen, saying it can lead to overdose and "severe liver damage.

Dr. Lee says that acetaminophen-induced liver failure can happen in several ways. Unintentional overdoses, sometimes called "therapeutic misadventure," are common.

"This happens when patients are not trying to harm themselves, and most likely, they even believe they are taking the medication safely," Dr. Lee reports. "Then, they do something unknowingly harmful, like taking multiple products simultaneously without realizing that each contains acetaminophen. Common scenarios of this include mixing cold and flu medications, sleep aids and/or prescription combination pain medications."

Acetaminophen is a pain reliever, but it's often compounded with other cold and pain remedies, including NyQuil and Percocet, warns Dr. Lee F. Peng, MD, Ph.D., the chief of gastroenterology and hepatology at Hackensack Meridian Jersey Shore University Medical Center. All of these contribute to the safe dose of acetaminophen, even if you're taking Tylenol as directed.

Plus, you can find Tylenol in Extra Strength, which contains 500 milligrams of acetaminophen (regular Tylenol has 325 milligrams of acetaminophen).

The dose per day isn't the only part of the label to pay attention to. Dr. Lee points out that OTC medicines will also say how many days in a row you can take them. "Liver injury also occurs when someone consistently exceeds the maximum recommended dose over consecutive days, even if each dose is not extreme," he explains. "It can also happen at lower doses in people with underlying liver disease, those who have poor nutrition or other risk factors."

Alcohol use is one of those risk factors (which is why acetaminophen and alcohol don't mix). "Regular alcohol intake also increases the risk of liver toxicity from acetaminophen use, making smaller doses of acetaminophen potentially toxic," says Dr. Anurag Maheshwari, MD, a hepatologist at Mercy.

Related: We Asked 3 Hepatologists What To Drink in the Morning for Liver Health and They All Said the Same Thing

How Much Acetaminophen Can You Take?

"The average healthy adult can tolerate up to 4,000 milligrams of acetaminophen in 24 hours," Dr. Loy states. "That is about eight regular Tylenol or six Extra Strength Tylenol."

Still, she says it's crucial to check your other medicines to make sure you're not getting acetaminophen through other sources, too, noting that alcohol use or steatosis of the liver can lower your limit for safe use of acetaminophen. Dr. Loy says that people with liver problems are advised to cap acetaminophen intake at 2,000 milligrams daily.

Dr. Loy warns that even regular, moderate alcohol use can impact your liver's ability to handle medications, including acetaminophen.

Your best bet? "We recommend that patients do not drink alcoholic beverages while taking Tylenol because of the potential serious liver damage that can result from consuming two separate substances that both can damage the liver at the same time," Dr. Peng says.

Besides, alcohol won't heal that flu or back pain any faster-if anything, it'll drag them out.

Related: ‘I'm a Hepatologist-This Is the One Thing I Tell Every Patient With Fatty Liver Disease To Do Before Anything Else'

Alternatives to Acetaminophen

When used correctly, acetaminophen is considered safe to use. However, you may be interested in alternatives.

"The most common OTC alternatives for acetaminophen are NSAIDs, such as ibuprofen and naproxen sodium," Dr. Lee says. "These medications work differently from acetaminophen and are effective for pain and inflammation. However, they carry their own risks, including irritating the stomach or increasing the risk of ulcers or gastrointestinal bleeding."

People with liver disease may be able to use acetaminophen, and everyone needs to use any medication as directed. "NSAIDs should be used cautiously in chronic liver disease and are generally avoided in cirrhosis, especially in the setting of ascites, kidney dysfunction...and low platelet counts," Dr. Lee says, adding that you may also be able to try more natural strategies instead of reaching for acetaminophen, like heat, ice, physical therapy and rest.

Related: This 1 Vitamin May Reverse a Common Health Condition, According to a Hepatologist

Hepatologists' Tips for Safe Medication Use

Over-the-counter medication can be safe and effective, but it's important to understand that they aren't without risks. To manage these risks and protect your short and long-term health, hepatologists recommend:

1. Seek advice from an expert. Dr. Loy suggests reviewing the risks and benefits of certain OTC medications with you so you can make an informed choice: "What you may see on social media or word of mouth may not apply to everyone."
2. Tell your provider about all medications you take, including over-the-counter products. Since medications and supplements can interact with one another, Dr. Lee says it's possible they can make underlying conditions worse and contribute to liver damage. So, you'll want to flag any medications you're already taking with your provider during your risk-benefit discussions.
3. Follow the instructions on the label. Dr. Maheshwari stresses that this one is huge. "Unfortunately, some people have a habit of just taking a handful and not paying attention to the exact dose-they can be consuming something that is strongly advised against."
4. Do not take a higher dose because a medication "isn't working." Dr. Lee emphasizes that "more medication" doesn't always mean "more benefit." "With acetaminophen, exceeding the recommended dose may not provide better pain relief, but it does increase the risk of liver injury. If the labeled dose is not controlling the pain or fever, that is a signal to call your doctor, not to take more medicine."

Up Next:

Related: 2 Supplements You Should Never Take if You Want To Protect Your Liver, According to Hepatologists

Sources:

• Dr. Brian T. Lee, MD, a transplant hepatologist at Hoag Digestive Health Institute and director of the Hoag Liver Program
• Dr. Lee F. Peng, MD, Ph.D., the chief of gastroenterology and hepatology at Hackensack Meridian Jersey Shore University Medical Center
• Dr. Veronica Loy, DO, a transplant hepatologist and the medical director of liver transplantation at Rush University Medical Center
• Dr. Anurag Maheshwari, MD, a hepatologist at Mercy
• Acetaminophen Toxicity. National Center for Biotechnology Information.
• Don't Overuse Acetaminophen. FDA.
• Acetaminophen. National Center for Biotechnology Information.
  
  

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This story was originally published June 6, 2026 at 7:50 AM.