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Acetaminophen (APAP, Acetyl Para Amino Phenol) is an over the counter pain killer that has been used widely in pediatrics, adolescents, adults, and geriatrics for years as a substitute for aspirin (ASA). Unlike aspirin, acetaminophen is not contraindicated(i.e. not allowed) in the young, under twelve years of age with fever, or those either allergic to aspirin, have stomach disorders(ulcers, gastritis) or are on medications for thinning the blood (clot preventing medication). It is for mild to moderate pain of headache, toothache, menstrual cramps, muscle and arthritic pain, fever reduction, and for relief of cold symptoms, and is available in liquids, tablets, and suppositories for patient ranging from pediatrics to geriatrics and is usually a safe drug when taken in proper dose, for proper length, and with knowledge of side affects and warnings of avoidance of certain lifestyle habits.


APAP is contraindicated in patients with liver disease or a history of alcoholism and alcohol consumption must be moderate(3 or less alcoholic drinks per day while on 2 grams(2000 mg)or less of APAP daily. Patients with persistent viral flu symptoms who have stopped eating should discontinue using APAP for that period of time. Five years of persistent use of APAP along with regular ingestion of other analgesics may induce analgesic nephropathy. Generally, side effects of APAP are uncommon with "therapeutic doses" (proper doses for current problem for proper duration), however hepatotoxicity(liver disease) is possible with doses greater than 4 grams(4000 mg) per day in habitual drinkers or routinely ingest in fasting conditions.


For general everyday aches pain, the self medicating dose for adults should be 1 gram(1000mg) four times daily for 1-2 weeks, if lower doses were ineffective. It should be noted, some authorities now recommend no more than 2.5 grams per day. Although an OTC(over the counter) medication APAP may interact adversely with coumadin and increase its effects, alcohol and induced liver disease, or certain epileptic medicines-the phenytoins(Dilantin) which may both reduce the benefits of APAP and increase the risk of liver disease. Pregnant women or nursing mothers should first consult their physician prior to taking APAP since it can pass into breast milk and may harm the baby.

APAP is available for convenient dosing in tablets, capsules, suppositories, liquid, and granule form. It is important to know the concentration in any form for proper dosing, especially in the liquid form as the adult liquid versus the infant or toddlers. The infant liquid allows smaller volumes so has a higher concentration, 80mg/0.8ml (dropper dosage, 5ml/cc ==one teaspoonful)while the toddler and older children’s liquid and suspension are more dilute(160mg/5ml or cc). This means 1.6ml of the infant formulation ==5ml (one teaspoonful) of the older children’s liquid. This is a common administration error in a household with children of various ages.

Pediatric dosages are based upon age and body weight. Neonates: rectal suppository 10-15mg/kg (1kg= 2.2lbs) every 6-8 hours as needed Children: ages 2-12 years , orally 10-15mg/kg or rectally 15-20mg/kg every 4-6 hours as needed , ages >12, 325-650mg every 4-6 hours as needed up to 4 grams/day.


Many OTC medication formulations contain APAP, which must be taken into consideration for the total daily amounts as noted.

  • Actifed
  • Feverall
  • Sinutab
  • Anacin
  • Formula 44
  • Sudafed
  • Benadryl formulations
  • Goody’s Powders
  • Theraflu
  • Cepacol
  • Liquiprin
  • Triaminic
  • Contac
  • Midol
  • Tylenol Products
  • Coricidin
  • Nyquil
  • Vanquish
  • Dayquil
  • Panadol
  • Vicks
  • Dimetapp
  • Robitussin
  • Zicam
  • Dristan
  • St Joseph’s Aspirin-free
  • Elixir
  • Singlet

Many common prescription medications contain APAP

  • Endocet
  • Phenaphen
  • Fioricet
  • Sedapap
  • Hycotab
  • Tapanol
  • Hydrocet
  • Ultracet
  • Lorcet
  • Vicodin
  • Lortab
  • Zydone
  • Percocet


APAP side effects include low fever with nausea, stomach pain, loss of appetite, dark urine, clay colored stools, jaundice(yellow skin or eye color) and the common signs of allergic reaction including hives, difficulty breathing, swelling of the face, lips, tongue, throat which are medical emergencies.


The RX Consultant, Vol XIX, Number 11, December 2010. Vol IX, Number 5, May 2000 Vol IX, Number 5, May 2002 Vol X, Number 1, January 2001

Drugs.Com/Acetaminophen Tylenol.Com/news


My personal experience with APAP as a community, hospital pharmacist and now practicing podiatrist has been very favorable in its use for mild everyday aches, pains and fever reduction. I have recommended various OTC APAP/combination containing products to the pharmacy patient for brief symptomatic relief of cough/colds/congestion and have found patients tolerate well and have gotten relief when not also accompanied by infection, in which referral to their physician was necessary.

In my daily podiatry practice of sports injuries treating sprains, strains, fractures and post operative patients, APAP as a first line analgesic with or without a NSAID (non-steroidal anti-inflammatory) and along with adjunct proper treatment has proven very beneficial. In cases where more pain was present or a complicated serious problem presented, the use of APAP and tramadol provided significant and adequate relief. My next choice, again patient- dependent is an APAP combination with a hydrocodone (semi-synthetic codeine derivative; Lorcet, Lortab, Vicodin) which has proven to be a good substitute over an APAP/oxycodone medication (Percocet, etc.)

Over the years many consumer warnings and events have occurred with APAP as with other consumer products, medications, or foods. I recall the cyanide-APAP incident of the 1980s practicing community pharmacy in Chicago while attending podiatric medical school. Today we again hear warnings of the popular APAP. The consumer is constantly bombarded with information, of ‘varied source reliability” about various products, often ‘heightened by an aggressive news media’. Any consumable, and APAP is no exception, should be used with caution and the respect if deserves. Often the belief is OTC products, oral or topical (applied the skin) are harmless, benign. All these do affect body processes, even vitamins, when used within proper guidelines for the proper indications and time frame and with no contraindications, are generally beneficial and safe. It is important to realize all the ‘meaningful helpful” friends, relatives, media, etc. should not replace the experience, education, and knowledge of the patient’s physician, who knows all abut the patient’s history and drug consumption/tolerance past experiences.

Hopefully this article has provided more insight about APAP, and that its use for you, the reader is helpful as an analgesic when needed, and may of limited need for your life!!!


Harvard Health


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ORTHOTICS for multiple types of foot pain
best buy in a pre-made orthotic
click link below


ORTHOTICS for heel and arch pain for those who must wear dress shoes
click link below


I've been doing some aggressive research lately (it's how I found your incredible website) and realize now that my symptoms are not consistant with the diagnosis. Jennifer

Hunterville, NC
….after reviewing your amazing site (great for the avg. jill). So thank you very much!!!


I am really, really impressed with your plain-speak explanations for the various conditions.


This was an extremely helpful site. I have an appointment on the 18th and your info. Was right on target…..


A well organized site containing much information written in a manner that the average reader can comprehend.


Ontario, Canada
I found your website and articles most interesting.


Thank you for a quick response. I think your site is the best information site on foot pain and I have viewed many.


(location unknown)
I came to your website, via www.foot-pain explained .com which I think is also your website? I thought explanations for different types of problems were well addressed and thoughtfully stated for the patient in mind.


New York
You have an amazing and extremely informative site. I enjoyed looking through all of the data and stats.


Memphis, TN
Thanks again so much for the information in the article. Very interesting.


Great article. I have had plantar fasciitis since I was in high school……..

J. Simmons

(location unknown)
Dear Dr. Mitnick, The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics. I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again. Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.

Yours truly,

J.C. Forbes

Thanks for the Response, you hit it on the head.


Redondo Beach, CA
Thank you for your time and expertise in answering my question…..


(location unknown)
First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems. Last June I started having pain and swelling at …….


(location unknown)
First of all, thank you for having all this useful information available in one place. I've been through most of your website and based on my research, pain and evaluations I think I've narrowed things down quite a bit.

Pete M.

(location unknown)
Thank you for the best site I have found when researching foot pain.

Glenda B.

Madison, Alabama
Thanks for replying so quickly. I was a bit concerned. I think your website is great, and chock full of info.....


Denison, TX
Dr. Marc, Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" Thanks Very Much,


West lafayette, IN
Dear doubt you get positive comments re your site...May I please be added to the list of your admirers. In all of my years of web surfing I would say your site is right there with the very best. Thank you for taking the time to write the terrific info you provide and for putting things into laymen terms for us mere mortals. I pray you have much on going success and thank you again for a deed well done. As for me I did not find much help for my symptoms and will continue on my quest. Were you anywhere in the South I would make and appointment...Thanks again dear sir...m.e.

Michael E.

Tampa, Florida 33624
Hi. This is a great site! I'm a healthy middle aged woman who is in good health, but.....


Just a wee word of thanks for your wonderful website...It is a terrific service...Thank you for providing your knowledge and help...With highest regards, m ebeling

Michael D. Ebeling

Tampa, Florida 33624

Thanks for a most interesting website, which has helped a lot.



Dear Dr.Mitnick

I usually do my research on the Mayo clinic website. I think your website is the most informative site I have found when researching foot pain.

I thank you for putting together this incredible website.


Dragica W.


....I have been told that it is not hard enough to be cut off. Please help, I am not sure what to do now! THANKS FOR A WONDERFUL AND VERY HELPFUL SITE!


South Africa

You have an unusually clear, informative and well-written website for laypersons. Thank you for that.

Matthew W.

Mansfield Ctr, CT

First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.


Placentia, California

First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)


Unknown location

I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

Ric J.

Unknown location

I greatly admire someone like you who would donate and dedicate so much time and effort to helping strangers with no compensation. Truly, it is uncommonly kind. And your site is so intelligently arranged.

Ron R.

Pacific Grove, CA

I used to work for a podiatrist (front desk) back during summers in college years ago, so I know the benefits of good care. Again, I want to thank you for an EXCELLENT website. It was so great to get to your site (top of google search) and actually find all the answers I needed EASILY and QUICKLY! Clearly you put a ton of work into it and I really appreciate it.

All the best,


Alameda, California

By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!


Thank you for your very interesting and informative site!


Hi. I come to your site often looking for information. It is really informative and I appreciate it very much. I have RA and have been having considerable amount of foot pain...... Dee RN

Thanks very much for the wonderful informative site.


New Zealand

Thank You for my answer! I have been schedule for a bone density scan, allingment, and I am in the process of getting orthotics made, and checking out the natural remedies. Thank again! What a great web site!



Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

Cindy H.

I searched the internet everywhere for a clear description and illustration of my symptoms/problem. was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.

Thanks, Kathy

1st of all THANKS A LOT for your great site......


Thank you so much for your response. I will let you know how I am doing if you would like. Your website is awesome!


South Carolina
Hello! I want to thank you for such an informative website! I found you based on my ankle pain search and am happy to realize that there may be a relatively simple cause and solution....


unknown location

...Thanks for your fantastic service.


Arlington, VA

Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)

Kelly W.

San Clemente, CA

Dr Marc is fantastic...He seems to know exactly what you are feeling with the problems you are having. I wish he was in my home town so I could go to him with my problems!!!!!!!!!!!!!


location unknown

Great insights! Thanks Doc, you're the best.


location unknown

I have been experiencing foot pain of various sorts and am working to figure out what it is. I found this site and can only say BRAVO!! What an excellent site! The time it must have taken to put all this together must've been a daunting task! I am sure it has helped so many people. Thank you so very much for doing this.


location unknown

Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.


Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!


Staying at home after hallux surgery I spend quite a lot of time seaching info useful for avoiding problems which might come back. Today I found your site and I am .... delighted it happened. It's one of the best site I found last days.



Thanks for taking time to read and answer so many questions. It is truly a public service!


Seattle, WA

I just wanted to say that I am very greatful for this website!!


location unknown

Also, and importantly, just want to praise this web site. Thorough and thoughtfully presented, it certainly must be of considerable assistance to anyone with a foot problem. Terrific -- and very interesting.I trust the address comes up easily for those seeking information.


New Jersey

Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.


location unknown

Wow, that is exactly the information needed!!! thank you thank you thank you!!! I appreciate this help so very much from Marc Mitnick DPM. Excellent information and help to improve One's life.


location unknown

Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!


Evansville, IA

Dear Marc

I just want to say thank you for the quick response and the good info. I find it amazing and a super nice thing that you do here by answering medical questions at no charge.

Russ W.

location unknown

Your website is full of a lot of helpful information, and I am very impressed with the time in which you responded to my post. Thank you again for your time and consideration in your response.


location unknown

Thank you very much for the information, I will consider it. Excellent web site.


San Diego, CA

Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!


Albany, NY

Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,

Jill S.

location unknown



Whichita, KS

thanks again, this site is very helpful.


Boston, MA

Like others have stated...This site is amazing and I am so thankful that it was created.

....Keep up what your doing. Your a life saver.



Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.



Wonderful advice

by: Anonymous

This is the best site for foot problem info.

Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown
Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.

Barb D.

I just wanted to say that I am very greatful for this website!! I have had a fusion in my rt foot and am finally getting a little bit better......


location unknown
Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!


Thank you for your response. You have provided some great insight (to my question)....


location unknown
Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!! This website is terrific!!!! Thank-you again!


North Carolina
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...


location unknown

Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown
Your webpage is excellent, I commend you on sharing your knowledge to the public.


New Jersey

Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown

I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!


Lenoir, NC

Thank you so much Doc for a quick and thorough response!


Bellevue, WA

I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!


location unknown

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