Acetaminophen is a commonly-used analgesic in the US and, at doses of more than 4 g/day,
can lead to serious hepatotoxicity. Recent FDA and CMS decisions serve to limit and monitor
exposure to high-dose acetaminophen. This literature review aims to describe the exposure to
and consequences of high-dose acetaminophen among chronic pain patients in the US. Each
year in the US, approximately 6% of adults are prescribed acetaminophen doses of more
than 4 g/day and 30,000 patients are hospitalized for acetaminophen toxicity. Up to half of
acetaminophen overdoses are unintentional, largely related to opioid-acetaminophen
combinations and attempts to achieve better symptom relief. Liver injury occurs in 17% of
adults with unintentional acetaminophen overdose.