Acetaminophen (N-acetyl-p-aminophenol, APAP, paracetamol, Tylenol®) is the most commonly used drug for the treatment of pain and fever around the world. At the same time, APAP is capable of causing dose-related hepatocellular necrosis responsible for nearly 500 deaths annually in the U.S., as well as 100,000 calls to US Poison Control Centers and 50,000 emergency room visits. APAP toxicity dwarfs all other prescription drugs as a cause for acute liver failure in the United States and Europe, but is not regulated in any significant way. This presentation will highlight the ongoing controversy as to the role of this ubiquitous pain reliever, beginning with its history, pathogenesis of the liver injury, its recognition, treatment and outcomes.

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