Acetaminophen, the pain and fever reliever, is often an ingredient in the medicines people take for cold, cough and flu symptoms, and it is in more than 600 medications, prescription and nonprescription. If both of your boxes list it, take no more than one over-the-counter medicine that contains it.
How the same ingredient ends up in two boxes
A cold and flu product can carry acetaminophen beside other medicines, such as a nasal decongestant, an antihistamine, a cough suppressant or an expectorant, and a box of plain pain and fever tablets may hold acetaminophen too, and then both boxes hold the same ingredient.
Taking two cough and cold products at the same time can put one drug into you twice, since they may contain the same active ingredients, and taking them together could cause an overdose. A prescription can be the second source as well: acetaminophen is used in many commonly prescribed medications in combination with pain relievers such as codeine, oxycodone and hydrocodone. Other prescription pain relievers can contain it too, so ask about any pain prescription, not only these three, at the pharmacy that filled it. Take a prescription and an over-the-counter medicine that both contain acetaminophen only if a health care professional has advised you to.
A brand you have bought for years still needs checking. Many over-the-counter medicines may have similar brand names with different active ingredients, and makers sometimes change a product's ingredients, dosages or warnings. Read the label each time you use the product, and look on the front of the package for a flag or banner announcing a change.
Where the box says what is actually in it
The medicines inside any over-the-counter box are named on its Drug Facts label, under Active ingredients: the substances in the product that cause the intended therapeutic effect, with the amount of each in a single dosage unit. On a cold and flu product that section can hold several names, so read all of them before you rule acetaminophen out.
The heading is easy to find, because under FDA regulation the labels on all OTC medicines, from a bottle of sunscreen to a bottle of cough syrup, have information listed in the same order and arranged in a consistent style. Once you have found Active ingredients on one box, you know where to look on the next. How much to take, how to take it, how often and for how long are under Directions, for that one product alone. When both boxes list acetaminophen, ask a pharmacist, with both boxes in front of them, which one to take. Under Warnings you will find, among other things, when not to use the product, conditions that may require advice from a doctor before taking it, possible interactions or side effects, and pregnancy or breastfeeding warnings.
A prescription is labeled differently. Its ingredients are listed on the container label, and there the word acetaminophen is not always spelled out in full: abbreviations such as APAP, Acetaminoph, Acetaminop, Acetamin and Acetam may be used instead. Ask the pharmacy that filled the prescription whether it contains acetaminophen.
On any label, prescription or nonprescription, abbreviations such as APAP and AC may be written in place of the word acetaminophen, so look for them on both boxes. Neither list is complete, so ask the pharmacist about any short form you do not recognize.
What taking acetaminophen twice over can do
Taking too much acetaminophen can lead to overdose and severe liver damage, sometimes serious enough to require liver transplantation or cause death. Taking more than one product that contains it is one way to take too much by accident, and so is not following the directions on the label carefully.
If you drink three or more alcoholic drinks every day, do not take a cold product containing acetaminophen, and if you have a history of liver disease, talk with your own doctor before you take one. According to MedlinePlus, if you are pregnant, are planning a pregnancy or are breastfeeding, talk with your doctor before taking acetaminophen, including about the risks and benefits of using it during pregnancy.
Some people may have no symptoms after an overdose, symptoms may take several days to appear, and when they do, they may at first look like flu or cold symptoms. Symptoms of an overdose may include:
- nausea and vomiting
- abdominal pain
- confusion
- jaundice, a yellowing of the skin and eyes
- loss of appetite or sweating
- extreme tiredness or flu-like symptoms
- unusual bleeding or bruising
Several of those are also what a bad cold feels like. If both boxes list acetaminophen and you have already taken both, call Poison Help at 1-800-222-1222 now, even if you feel well: taking two products with the same active ingredient could cause an overdose, and after more than the recommended dose, medical help is needed immediately, even without any symptoms. Keep both packages in your hand, since the label has important information for the expert on the line. Poison Help is free and confidential, open at any hour of any day and answered by a pharmacist, nurse, doctor or other poison expert, and it takes questions as well as emergencies, so you do not need to be sure anything is wrong before you dial.
If whoever took them has collapsed, had a seizure, has trouble breathing or cannot be woken, call 911 immediately.
Who can check your medicines, and what they need from you
Your pharmacist or your own doctor can help you work out whether a product you take contains acetaminophen, if you ask. What they need from you is the whole list, because a check covers only what is on it. That means every prescription and nonprescription medicine, vitamin, mineral and dietary supplement you take, including a cold product bought somewhere other than a pharmacy. Dietary supplements carry a Supplement Facts panel, and the Drug Facts requirements do not apply to them, so name each one to the pharmacist.
At the counter, make a habit of telling your pharmacist what other medications and supplements you take, and asking whether taking acetaminophen in addition to them is safe. Bring both boxes if you can, since the answer depends on what each one holds. When a doctor prescribes something new, ask whether it contains acetaminophen, and tell them about all your other medicines, prescription and nonprescription, and your supplements. Asking at the appointment tells you ahead of time whether a cold product would double up on the new prescription.
If pain and fever are still there after treatment, take no more than directed, and call your own doctor's office about symptoms that do not go away on an over-the-counter medicine instead of reaching for the second box. If you read the label and still have questions, ask your doctor, pharmacist or other health care professional.
In NicoCares weight care, report any cold product you start to your care team promptly, in a secure message through Spruce Health, the app they answer in, since a weekly weight medicine may affect how some other medicines work (see A weekly weight medicine can change how some of your other tablets work). For a dose you have already taken, call Poison Help at 1-800-222-1222 rather than send a message, which carries no stated reply time.
