Being Smart About Acetaminophen, by ShepherdFarmerGeek

Editor’s Introductory Proviso: SurvivalBlog and its editors do not give medical advice. Mentions of any medicine or medical treatment is for informational purposes only and are in no way endorsed or accredited by, or its principals. is not responsible for the use or misuse of any product advertised or mentioned in SurvivalBlog. – JWR

A big thanks to SurvivalBlog contributor DSV for their link to “Acetaminophen – Not Worth the Risk, by the Children’s Health Defense Team” cited in part in SB “The Survivalist’s Odds ‘n Sods” on July 30th.

Yes, Acetaminophen (Tylenol / Paracetamol to the Europeans) poisoning is a real problem caused not only by a quirk of metabolism in the liver, but by its inclusion in more than 600 Over The Counter (OTC) medical formulations, by children and others taking overdoses as a result of not reading the label and following the instructions, and people made careless by thinking that OTC meds can’t be “that dangerous.” Well, it can be.

DSV’s article raises some good questions, mostly about its use in children. And the only reason I’m writing about it is that we don’t have a whole lot of OTC painkillers to choose from and I wouldn’t want to leave preppers without a potentially useful tool that is safely utilized daily by thousands of medical professionals, clinics and hospitals worldwide. With opioid analgesics harder to obtain, and the potential for some serious pain and injuries ahead courtesy of TEOTWAWKI, preppers need options. And that includes Acetaminophen.


So, if you want to know more, start here: A short, interesting article about Acetaminophen toxicity.

Every last molecule of acetaminophen is always first metabolized in the liver to a highly toxic molecule – even without an overdose – which is then neutralized by Glutathione either from the liver’s stores or created from supplemental N-Acetyl-Cysteine (NAC), which the body uses to create Glutathione.

This first article’s suggestion to incorporate NAC with Acetaminophen into the same capsule tells me that taking NAC taken along with Acetaminophen does NOT affect the analgesia, only the toxic metabolite. Essentially, we could take lots of NAC (which is inexpensive as well as non-toxic) and it wouldn’t make the Acetaminophen any less effective as a pain reliever. That is good news indeed.

We learn from a Wikipedia piece: “NAC works to reduce paracetamol toxicity by replenishing body stores of the antioxidant glutathione. Glutathione reacts with the toxic NAPQI metabolite so that it does not damage cells and can be safely excreted.”

This Glutathione is incredibly important, and the master antioxidant.


Usually the body has enough glutathione in storage (liver) to deal with normal doses of Acetaminophen. When the body doesn’t have enough THEN you get toxic and even deadly effects. And what might cause us to have low reserves?

  • Poor Diet
  • Infections
  • Smoking
  • Stress
  • Effects of other medications
  • Aging
  • Injuries
  • Exposure to toxic chemicals
  • Extended use of Acetaminophen during injury healing

Some of these–most notably stress and injuries–are the very things we’re likely to have to deal with after the SHTF!

If you have been fighting off an infection, if there’s been any exposure to any other chemicals that your liver might have considered toxic (medications!, lawn and garden chemicals, crap in your food or drink, etc.), if you haven’t been eating right for the past few days (nausea, junk food binging, etc.) then you might be low or even dangerously low on Glutathione.

Of course, we ought to make sure our daily diets contain enough Glutathione and this won’t be an issue as long as we’re not old or ill or some other factor hasn’t reduced our liver’s Glutathione stores. But, since NAC is cheap, and unused Glutathione is stored in our livers, it only makes sense to me to take NAC every time we take Acetaminophen.


The Glutathione directly present in foods (like avocados, spinach, okra, etc.) is poorly absorbed.  But, your body makes its own Glutathione from foods like milk and whey and beef/chicken/fish and vegetables like broccoli, Brussels sprouts, cauliflower, kale, onions and garlic. During TEOTWAWKI your access to these foods will probably be limited, right?

NOTE: Be sure to get enough Selenium in your diet or supplements because Glutathione works together with Selenium (co-factor). Your multivitamin probably provides some, and foods like beef, chicken, fish, organ meats, brown rice, etc. also provide some. Fifty-five mcg (micro-grams) per day should optimize the effectiveness of your body’s Glutathione.


What do medical professionals do when a person has ingested a toxic amount of Acetaminophen (when the dose has exceeded their body’s presumed stores of Glutathione)?

According to the NIH a huge quantity of NAC is administered to overdose patients: an initial 16 grams of NAC, regardless of how much Acetaminophen they’ve ingested. (It usually comes in 600mg capsules, so that’s the equivalent of roughly 27 capsules. Of course ER’s give it by IV, not by capsules.)

Then this is followed by an additional 1.5 grams (1,500 mg) per hour via IV for the next 4 hours, and half that much again for the following 6 hours, decreasing, etc. That’s a lot of NAC (even so, the whole massive 20 to 70 hour treatment only costs about $50)! Even administered orally, very large doses of NAC aren’t toxic, and the worst that ever might happen would be vomiting (5% of patients) at very high doses.

There is no suggestion in the treatment literature of administering NAC relative to the amount of Acetaminophen that was ingested to create the original overdose. The goal is to flood the liver with more Glutathione/NAC that it can even accommodate, especially considering that the treatment protocol is generic, and liver sizes and liver health will vary considerably from person to person. No one really knows how much Glutathione any particular person has in store, so the doctors give a for-sure maximum dose.


The medical literature is very clear that Acetaminophen poses extra risks to children and babies and fetuses. You’re going to have to administer it very carefully and only as a last resort for analgesia. Just remember: ALL of the OTC painkillers can have serious side effects. Study up and make your best choice.

Research non-drug pain relieving options such as deep relaxation or aromatherapy with Eucalyptus oil. It works! And talking to the victim (child or not) really does help (distraction!!!).

You might also want to experiment with Transcutaneous Electrical Nerve Stimulation (TENS) – units these days are inexpensive, sold over the counter and online and are very compact.

Or consider “vibratory analgesia.”  Yes, that’s a useful thing. I’ve used it for decades now to mask pain while sleeping. Just be sure you’re getting a vibrating pad with a strong enough motor – most vibrating chairs and pads are just sad with their tiny little motors – my vibrating recliner has motors the size of a quart bottle.

Combining TENS with Vibratory Analgesia works even better!

And don’t forget that ice and instant ice packs help with pain too – just don’t give the victim frostbite!!!

(And here’s a freebie: a little cough at the instant of an injection or momentary pain like pulling a splinter helps block the pain impulse! No, really. Read all about it here.


My family now takes two 600 mg NAC capsules for every two 500 mg Acetaminophen tablets, so our Glutathione levels can’t be depleted. Or to err on the side of caution, if we’re possibly already depleted (as in the list above), we just take another NAC capsule and we’re good. Yes, Acetaminophen/Tylenol is a useful drug, but you’ve got to be smart about it so it doesn’t become toxic!

Keep this in mind if you’re using the Prepper’s Pain Protocol (PPP) for extreme pain:

So… Be nice to your liver (and your children!)…

Trust God. Be prepared. We can do both! – ShepherdFarmerGeek

JWR Adds:  NAC is available through


    1. “N-acetyl cysteine (NAC) is a stable form of the non-essential amino acid cysteine. It is a sulfur-containing amino acid that acts as a stabilizer for the formation of protein structures, and promotes the formation of glutathione.* Glutathione is a powerful free radical scavenging compound that also helps to maintain normal, balanced immune system function.*

      It is a non-prescription supplement. NAC is available through

  1. You are quite welcome. I do like to forward natural health articles as MANY of the natural health information tools are being quieted by Google, FB, Pintrest among others. Amazon even has stopped selling some books. Whole Foods discontinued selling an alternative health magazine that the store sold many of. Google searches are intentionally putting previous top search result articles, to name on specifically, Dr Mercola. His articles,which cover many natural health issues have been erased from search results when they were always in the first responses. First they came for Alex Jones etc. Now natural health. I realized it prior to it being noted on some news articles that many natural health sites are no longer coming up in Google search results. Had I not known of Dr Mercola and gone to his site I would now never had found out of his wealth of information he has a daily free newsletter. While every one may not agree with everything said by him, the articles are well written and sourced. These voices must be allowed to heard. Today in his daily email he has written his responses to a few questions presented by the Washington Post. They contacted him to interview and he did so in writing and is putting his replies on his site. Thank you ShepherdFarmerGeek for expanding on this subject. God Bless

  2. My understanding is that the military puts acetaminophen (Tylenol) in their medical IFAKs because it is one of the few pain killers that does not promote bleeding. A big consideration if a patient is approaching shock from blood loss in a wound. It seems to me that it is the LAST painkiller anyone would want to reject.

    (Scroll down to page 8, section 10 “Analgesia”

  3. I do want to briefly mention that the supplement Milk Thistle (or its extract, Silymarin) can also be used for treating Acetaminophen overdose. It can treat an astonishingly wide range of health issues, all probably related to its healing effects on the liver. We stock it deep.

    Take a minute to scan this article by the National Institutes of Health:

    Milk Thistle is not very expensive and is available at Amazon.

    We’ve even successfully used it to treat sick dogs and cats!!

    (And thank you Don Williams for that NAEMT link – nicely summarized for easy use.)

    Trust God, be prepared, the time is NOW…

  4. Ordered. Thanks for the article and the link.

    I recall the days in the early nineties with the 25th ID and eating “Lightfighter Candy”. If an 800mg horsepill of Ibuprofen was good, take TWO for the aching feet, legs, back, knees, shoulder strain, etc., from road marches and physical fitness tests and air assault school and infantry stuff and artillery manhandling tasks.

    Praise God Almighty I am not totally destroyed yet.

    Thanks again for the education.

  5. Moderation and restraint can reduce the risk.

    Being old and partly broken, I’ve had some practice. One can learn to tolerate and manage to a degree to avoid drugs. I’ll only use a low dose, and only once daily, and only when I can no longer think, or function when otherwise, it is absolutely necessary. Taking pain pills should be deliberate, not habitual. Thus the risk of side effects is greatly reduced. Yes, it restricts how much work I can perform. But then there is also a point where no drug is effective enough. So one must adapt. It is healthier to adapt sooner rather than latter, than risk the side effects of any drug, aspirin, IB, or acetaminophen. A prescribed drug also has an impact on the liver, and adding an additional load is pushing safe limits. I take nothing on a regular basis, but have modified my life to compensate. Without our health, we have nothing on this earth.

  6. In an adult, assuming they aren’t in liver failure or suffering from hepatitis or cirrhosis, the standard accepted daily limit of acetaminophen is 4,000 mg per day.

    So, the simple math works out to be that if you are taking 500mg tablets of Tylenol, you can take 8 pills/day safely. If you are taking 325 mg pills, then you may have 12/day.

    I would caution readers to exercise care to make sure you calculate the TOTAL Acetaminophen daily intake, and hence stay below the 4,000 mg/day cap to avoid liver damage.

    There are some hidden sources besides the obvious Tylenol…some pain pills (Vicodin, Norco, Percocet all contain 325 to 500 mg of Acetaminophen), as well as many OTC cold, arthritis, and headache medications. Always look at the individual components of these combo medications to see if any contain acetaminophen.

    While acetaminophen is one of the safest pain medications we have available to us, either OTC or by Rx, it does require vigilance to not exceed this safety threshold. I administer it frequently (it can be given in oral, rectal, or IV forms) as it works well to control pain and is not a narcotic/opioid which can cause addiction or other side effects, and I have enjoyed a smooth track record using it in my hospital by paying attention to this dosage limit.

    I have treated acetaminophen overdose, both intentional and unintentional, multiple times in my career. Some patients’ livers are so badly damaged that they may require a liver transplant in order to avoid death, so this is no laughing matter. Unfortunately, several of these cases have involved a patient inadvertently consuming too much Acetaminophen in aggregate because they didn’t realize that their Tylenol, Vicodin, and Excedrin Migraine cocktail all contained sources of the same drug.

    Please be especially vigilant when administering to children. Please follow the weight-based guidelines provided on the packaging/bottle label.

    That said, please don’t vilify Tylenol. It’s safe and effective when used properly; it actually has far fewer side effects than most medications; and it is available OTC without a Rx and in mass quantities at any retail store for a low price. It should be in your core preparedness medication stockpiles along with an NSAID such as Advil/Motrin/Ibuprofen. In fact, the Tylenol medication helps to potentiate the NSAID and vice versa, so I often times recommend my patients to take the two in combination.

    1. Thank you for ‘weighing in’ on this. If one day I must perform to the utter limit, I’ll know the generally safe daily dosage, and developed a higher tolerance, that together will allow me to endure longer.

      I tend to avoid all medications. Another reason to not over medicate, or use drugs for deadening pain, is that pain is there for a reason. It signals that our body is damaged in some way. If one turns down the volume, so to speak, we can ignore it longer, and work longer, and do more damage to that body part. I have found with my particular case, that learning to know when to back off and rest, actually allows the body to strengthen the damaged connective tissue. If enough rest is given, over time, less pain is felt, and endurance improves. When the pain subsides, this is the signal to get physical once again. A prudent cycle of exercise and rest is best. Sitting around is bad thing, but over exercising a broken body can be worse, as the broken part can be damaged further. Put another way. If one is strength training, more strength and endurance can be gained, if there is plenty of rest, yet not too much, in between work outs.

      I do indeed use small doses, and the combination of IB and Tylenol, when it’s bad, but also found that a thoughtful and disciplined approach applies a sensible amount and type of exercise, is just as important in my particular situation. It is also likely that my approach is not for everyone.

  7. To follow up on Tunnel Rabbit’s comment about not over-using or avoiding many medications:

    These medications (Tylenol and NSAIDs) are good for safely treating pain, especially without opioid narcotics. However, if you use them on a daily basis, please expect that they may not provide you as much relief as you would hope for when you have a new pain or injury.

    The inverse of this situation is from a medical mission trip I was able to be a part of a few years back. The group I went with performed medical care combined with evangelism in remote villages of the Amazon River area of Brazil. Many folks there have never, or only rarely, seen a nurse or doctor in their lifetimes. When we dispensed Tylenol or NSAIDs like Advil, the relief that they got was amazing because their bodies were “naive” to these medications.

    My point? Use them when needed, but if you can avoid chewing them like candy every day of your life, they will likely work better when you really need them.

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