What Older Adults Should Know About Acetaminophen

The common over-the-counter medication comes with benefits, and also some risks

Kristen Fischer,

AARP

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Published September 29, 2025

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Considering more than 70 percent of adults age 50 and older experience joint pain, a common symptom of aging, and millions more face acute injuries and battle routine illnesses, it’s safe to say pain relievers are popular among the 50-plus crowd. And one that’s often recommended is acetaminophen, better known by its brand name, Tylenol.

It’s “an effective and useful medication for fever and mild pain syndromes in older adults,” says Dr. R. Sean Morrison, professor and chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai.

And in most instances, it’s safe, says Dr. James S. Powers, professor of geriatrics at Vanderbilt University Medical Center.

Still, like any medication, there are some risks and considerations for older adults. Here’s what you should know the next time you reach for the pain reliever.

What is acetaminophen?

This medication is a pain reliever and fever reducer. It’s often used for mild to moderate pain from muscle aches, osteoarthritis and headaches.

Acetaminophen, a nonopioid, is known in many countries as N-acetyl-para-aminophenol (APAP) or paracetamol. It can be taken orally, rectally or intravenously, and it’s available over the counter (OTC) and by prescription.

The medication does not reduce inflammation; nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen are better for that. But those options come with their own risks for older individuals, such as bleeding, heart attack and stroke.

Is acetaminophen safe for older adults?

Acetaminophen is safe for most older adults when taken as directed, Powers says. However, there are a few risks and potential side effects, which is why it’s always important to talk to your doctor before taking any medication.

Liver damage: Acetaminophen can cause liver damage, so some people need a lower dosage or shouldn’t use it at all. Ask your doctor if you should take acetaminophen if you have liver disease or consume three or more alcoholic beverages per day. Drinking alcohol causes the liver to convert more of the acetaminophen into toxic byproducts, which can accumulate and cause damage to the organ.
Drug interactions: Nonprescription medications for pain, colds, coughs and fever can interact with acetaminophen, as can some prescription drugs. Many medications contain acetaminophen, so be aware if you’re taking one of those before you take plain acetaminophen, because taking both could mean you’re getting too high a dose.
Diabetes risks: Taking acetaminophen could be risky if you have diabetes. A 2019 study in the Journal of the American Geriatrics Society found that acetaminophen was linked with a higher risk of stroke in elderly nursing home residents who had diabetes.
Bleeding risks: The medication may raise your risk of bleeding in the digestive tract. A 2024 report in Arthritis Care & Research on 180,483 people over age 65 showed an association between those who took acetaminophen regularly and a higher risk of peptic ulcer bleeding and lower gastrointestinal bleeding.
Blood pressure risks: That same study found a link between acetaminophen use and high blood pressure. A 2022 report in Circulation showed that those with hypertension who took acetaminophen daily for two weeks had increases in blood pressure.
Chronic kidney disease risk: The 2024 report in Arthritis Care & Research and a 2020 report on five studies in Kidney Research and Clinical Practice highlighted a link between acetaminophen use and chronic kidney disease, though it’s rare.

Acetaminophen is a short-term solution

Your risk for side effects does not increase if you take acetaminophen regularly, so long as you stick to the dosage guidelines, Powers says. Many experts recommend that adults 65 and older consume no more than 3,000 milligrams (mg) daily — and that taking more than 4,000 mg in 24 hours can lead to severe liver damage — but it’s always important to check with your doctor or pharmacist about dosing.

Michelle A. Chui, a professor at the University of Wisconsin – Madison School of Nursing who has studied OTC medication safety, says acetaminophen should be taken “strictly” for short-term, mild pain like headaches or muscle soreness and should not be taken for long-term pain.

If you’ve been taking it for more than two weeks, talk to your doctor to be sure there’s nothing more serious going on, Chui says. In some cases, doctors can authorize it for the long term but will likely monitor your liver function.

If acetaminophen doesn’t seem to be working, it is “critical” not to take more than your doctor recommends, Chui says. In that case, it may be best to look into what’s causing the pain or switch to prescription-level pain medication, she adds.

According to MedlinePlus from the National Library of Medicine, you should call your doctor if you experience any of the following side effects when you take acetaminophen:

Rash or hives
Itching
Difficulty breathing or swallowing
Red, peeling or blistering skin
Swelling in your face, tongue, throat, eyes, lips, hands, feet, ankles or lower legs
Hoarseness

Symptoms of an acetaminophen overdose can include:

Nausea
Vomiting
Sweating
Extreme fatigue
Flu-like symptoms
Unusual bleeding or bruising
Pain in the upper right part of the stomach
Yellowing skin or eyes
Appetite loss

Acetaminophen interactions

Taking acetaminophen with any of the following medications typically is not recommended, according to the Mayo Clinic:

Articaine
Carbamazepine
Exenatide
Imatinib
Isoniazid
Pixantrone
Pneumococcal 13-valent vaccine, diphtheria conjugate
Probenecid

These medications, when taken with acetaminophen, can raise your risk of side effects:

Acenocoumarol
Fosphenytoin
Lixisenatide
Phenytoin
Warfarin
Zidovudine

Is acetaminophen lurking in other medicines?

Yes. More than 600 OTC and prescription medications contain acetaminophen. If you’re taking acetaminophen and add another acetaminophen-containing medicine, you could be getting too much, the U.S. Food and Drug Administration warns.

Check the label for mentions of APAP, AC, acetaminophen, acetaminoph, acetaminop, acetamin, or acetam — these mean that the medication contains acetaminophen. You can also double-check with your doctor or pharmacist to see if other medicines you take contain acetaminophen.

Acetaminophen is in OTC medicines such as Vicks, Zicam, Triaminic and Excedrin.

Common prescription drugs that contain acetaminophen include Endocet, Oxycodone, Percocet, Hydrocet, and Vicodin, the American Liver Foundation reports.

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Kristen Fischer is a contributing writer at AARP based at the Jersey Shore. She has also written for Health, WebMD, and McKnights and is the author of Zoo Zen: A Yoga Story for Kids.