Is Tylenol Safe for People With HF?

There are several drugs that should not be used in people with heart failure (HF). We went over some of these drugs that should be avoided in a previous article.

A common complaint for people with HF is chronic pain. In fact, one study found that up to 85% of people with HF experience pain. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil),  are generally not recommended for people with HF. This is because NSAIDs have been associated with an increased risk of stroke and heart attack.^1,2

Acetaminophen

A common question that people with HF have is whether Tylenol, also known as acetaminophen, is a safe alternative to manage pain.

What is acetaminophen?

Acetaminophen is not in the NSAID classification of medications. That is because acetaminophen is not an anti-inflammatory.  It reduces pain and fever, but it does not reduce inflammation like ibuprofen does. This is generally why NSAIDs are often more effective in treating muscle and joint pain compared to acetaminophen.³

Is acetaminophen safe for people with HF?

Acetaminophen is generally safe in people with HF, but there are a few exceptions, such as:³

• People with a previous hypersensitivity or allergic reaction to acetaminophen should not take it.
• People who are on the blood thinner, warfarin, should not take as much acetaminophen due to a potentially fatal interaction. The interaction between the two agents can lead to bleeds that can be significant. A recent study found that up to 18% of people on warfarin still take acetaminophen (4), but many may not know that a reduction in acetaminophen consumption is required. The maximum dose of acetaminophen is generally 1.3 grams to 2 grams a day, about half of that of people not on warfarin.
• People with active liver disease, such as hepatitis, or liver dysfunction should only use acetaminophen if approved by their doctor.

Maximum dose of acetaminophen

For most adults, the maximum dose of acetaminophen is 4 grams daily split throughout the day, every 4 to 6 hours. For a regular acetaminophen tablet of 500 mg, that equates to 8 tablets total daily. If you take the Tylenol Arthritis product, which is the extended-release formulation, the maximum dose is 6 tablets daily.³

As always, check with your doctor or pharmacist what the upper limit of acetaminophen you can take daily. There are many conditions that warrant less acetaminophen use.

Safety alerts

Continued use of high doses of acetaminophen, greater than 4 grams a day, increases the risk of liver damage. Some people are surprised to know that acetaminophen is found in many over the counter products, such as cough and cold products. It is also found in some prescription pain products, such as Tramacet. If you are unsure whether the products you take contain acetaminophen, ask your pharmacist.

Do you take acetaminophen to manage your pain? If so, do you find it effective? Share your experiences below! 

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