PEBC MCQ Pain, Musculoskeletal & Rheumatology question: nighttime cold remedy containing acetaminophen

PEBC MCQPain, Musculoskeletal & Rheumatology

TM, 45, healthy, takes 2 extra-strength acetaminophen 500 mg tablets every 4 hours while awake (about 6 doses a day) for a sprained ankle, plus a nighttime cold remedy containing acetaminophen 650 mg. Which counselling point is most important?

a. His total intake exceeds the 4 g daily maximum
b. Take the extra-strength tablets with food to protect his liver
c. Switch to regular-strength 325 mg tablets at the same schedule
d. Stop the cold remedy at night but keep his daytime doses

Show the answer and explanation

Answer: a. His total intake exceeds the 4 g daily maximum

Six doses of 1,000 mg (6 g) plus 650 mg from the cold product totals about 6.65 g/day, well above the 4 g/day maximum in Health Canada's acetaminophen labelling for adults, raising the risk of liver injury. Even without the cold remedy, 6 g a day exceeds the maximum; regular-strength 325 mg tablets on the same schedule still total about 4.55 g with the cold remedy; and taking acetaminophen with food does not protect the liver. Patients should check all products for hidden acetaminophen. Source: Health Canada, Acetaminophen labelling standard: maximum 4,000 mg in 24 hours (2016 update; checked 2026); acetaminophen product monograph (DPD, checked 2026).

Common mistake

Missing hidden acetaminophen in combination cold products.

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