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ISMP Medication Safety Alert

CAUTION: Liquid Tylenol for infants is more concentrated than other Tylenol liquids

A parent almost gave her 27-month-old child two teaspoonsful of Tylenol infant drops (acetaminophen) instead of two droppersful because she did not realize that the infant drops are much more concentrated than the children's elixir. Fortunately, she called her pharmacist before she gave the dose, and the pharmacist advised her not to give it. Some parents and healthcare professionals do not realize the difference between the two products, and some children have, in fact, received overdoses as a result. Overdoses of Tylenol are life-threatening.

Tylenol infant drops are available as 80 mg acetaminophen/ 0.8 mL; the elixir, on the other hand, is available as 160 mg/ 5 mL. If just 5 mL of the drops are given, the child would receive 500 mg acetaminophen. If the child weighed 15 lbs, it would take only two teaspoonsful of the drops (1000 mg) to overdose the child. In addition to these two strengths of acetaminophen, there are others on the market. Other manufacturers make the elixirs, suspensions and solutions in 120 mg/ 5 mL, 80 mg/ 2.5 mL, 80 mg/ 5 mL, 500 mg/ 15 mL, 80 mg/ 1.66 mL.

Reading the label instructions is extremely important with these products because an overdose of acetaminophen has no symptoms for several days, and at that point, treatment may not be successful. The pediatric drops indicate that a dropper is necessary for proper measurement but this is on the back panel and we think it's too easy to overlook.

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