It’s a half right sort of thing. Overdose is acutely toxic to the liver. Dosage guidelines are safe unless you’ have impaired liver function (been drinking?), or you’re taking another drug that also has paracetamol (e.g. combo paracetamol/ibuprofen, painkillers for period cramps, etc). I’ve seen opiates compounded with paracetamol and I wouldn’t be surprised if it’s mostly to (try to) limit abuse.

Then again this is in contrast to NSAIDs like ibuprofen that can result in gastric bleeding even at the recommended dose.

I prefer paracetamol/acetaminophen for most uses but I’m pretty careful about how much and what else I’m taking.

I think it is disingenuous to call it toxic. You can even drink toxic doses of water, or ingest toxic doses of salt. Water and salt aren't toxic or dangerous.

Comparing it to water or salt is such a low bar add to be meaningless. Acetaminophen toxicity starts at less than twice the recommended dose, which isn’t hard to achieve if someone doesn’t read the guidelines (we generally expect otc medicines to be safe) or if they’re mixing drugs. And that’s for a healthy liver that’s not further burdened with alcohol or other hepatotoxic medicines.

If you forgot if you drank the glass of water, no harm. Same with salt.

If you forgot if you took your Paracetamol pill, accidentally taking another one would leave you with permanent liver damage.

It's like looking into the sun: normally, you flinch/blink away and are safe. But if you stare, and suppress or your reflex isn't working, you'll catch a life-long blind spot burned into your retina.

The therapeutic margin is just insanely small for anything OTC.

Interesting. Anecdotally we (myself, friends and family) never get prescribed Paracetamol here in Germany. It's always Ibuprofen. I always felt it was obvious, given the supposedly side effects of it.

Maybe not that obvious:

https://news.ycombinator.com/item?id=34273099

It is true that the medically useful/effectful dose is not that much lower than the truly damaging one, so this is one drugs where you absolutely should never surpass the determined safe doze (or course don’t do that with any other one either, but for example frontin/xanax is deliberately made in a way that even taking a whole box of it will just send you to a really deep sleep), but I don’t think that using it from time to time would be any worse than drinking a bit of wine during your date at a restaurant.

Same in the UK - Cocodamol was my default hangover cure for years and works a treat.

I’ve heard it said (by pharmacists) that paracetamol likely wouldn’t pass a clinical trial if it went through one with modern standards, though.

If you read paracetamol label, it's funny how it says something along the line "the mechanism of action is unknown" - they literally didn't know how it works for years - I think only recently that mechanism was discovered, but I am not sure. I

That’s kind of a frequent thing though. Why should the exact mechanism be known if they can determine its safety and effectiveness without it? It is kind of a white/black box testing question though.

It doesn't sound safe nor scientific. More like "magic" pills. Just take them and don't question.

Except that you can and are encouraged to question!

But if you were to tumble upon a magic pill that cures cancer, and you tested it extensively and indeed does so without any ill effect, would you wait to really understand the molecular mechanism of it before administering it?

A pain medication that didn’t cause organ damage wouldn’t be legal due to the legacy of the War on Drugs. Drug policy isn’t the most logical. Cannabis still isn’t legal in most of the world.

Even if GPs wanted to prescribe a safer painkiller, they are hamstrung by drug policy. So, they choose something that is a short term solution but has long term consequences because there are NO alternatives that aren’t a headache (i.e opioids).

Tylenol doesn't get you high, my dude.

Unfortunately, it causes acute liver failure so getting “high” from it isn’t something you even want to think about doing. I wish the danger of it was better known though.