Jaundice skin

Can acetaminophen turn your skin yellow?

This is a commonly used drug - the active ingredient is acetaminophen ( it’s generally known by this name in US), but it is also sold as Tylenol or Paracetamol (UK & Australia). It is available in various dose sizes: 325mg, 500mg, and 650mg, but 500mg of Acetaminophen or Tylenol will be the same as 500mg Paracetamol.

It is used around the world, usually for mild to moderate pain or to decrease inflammation and fever. It can be given several times a day and is considered reliable and safe at a maximum dose of 4000mg over 24 hours. However - it is not sensible to take this maximum dose for prolonged periods without medical supervision. Probably because it is available as an over-the -counter (OTC) drug, people assume it is relatively harmless. It is safe, but, unlike some other OTC drugs, it is very important to stay within the maximum dose in 24 hours. Tragically, there have been a number of accidental deaths caused by individuals taking more than this and irreversibly damaging the liver. As with pretty much all drugs, people can be also be very sensitive to the drug and this can also cause serious symptoms.

The yellow skin you mention is generally referred to as jaundice. It can be caused by other drugs and diseases and is an excess buildup of bilirubin in the bloodstream. This is a yellow pigment that forms when the body breaks down red blood cells. Normally, the liver quite happily processes bilirubin and excretes it through bile. But in the case of an acetaminophen over-dose, devastating liver damage or liver poisoning (hepatotoxicity) can be caused and so it is unable to process the bilirubin. As a result, it accumulates in the bloodstream and this leads to the yellowing of the skin and eyes.

The usual recommended dose may need to be lower for people with liver disease or a history of excess alcohol use. And it can interfere with the effectiveness of some other drugs that are processed by the liver, especially those taken for liver disease. The following can be problematic:

If taking Warfarin, an anticoagulant, Acetaminophen can increase the risk of bleeding (anticoagulants thin the blood).

Some antidepressants, including SSRIs when taken with Acetaminophen can also increase the risk of bleeding.

Anticonvulsants may become less effective.

There are some antibiotics including fluoroquinolones, that can increase the risk of jaundice too when taken with it.

Mixed with barbiturates and some sedatives it can harm the liver too.

(These drugs will all have been prescribed by a doctor who will have warned of any unwanted drug-interactions and advised you to avoid them for the duration of treatment. )

Possibly the most common accidental damage is caused by people unwittingly taking other OTC medications that also contain acetaminophen. Unfortunately there isn’t a big margin between a potentially dangerous dose and the maximum safe dose.

It is important to stress that this is a very useful, commonly used, safe drug with relatively few side-effects when used as instructed and not mixed with anything counter-indicated. If it is taken in large amounts, then it can become very dangerous, and even cause liver failure, and in serious cases, this can happen in just a few days.

If your skin or eyes have a yellow hue (it is quite a distinctive, burnished yellow; if you’ve seen it before, you know it!) and have been taking acetaminophen for a prolonged period or in large doses, do please get a medical examination, as soon as possible. They will know pretty quickly if you are in any danger and hopefully can reassure you. I hope you are just asking out of interest!


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