AnnaMaria
There’s a familiar bottle in millions of American homes—Tylenol PM. It promises relief from aches, helps you fall asleep, and eases restless nights. But one healthcare professional says this common medication deserves caution, especially with nightly use.
Dr. Ethan Melillo, a pharmacist in Rhode Island, doesn’t mince words. He openly warns that Tylenol PM is one of the drugs he dislikes most—not because it doesn’t work, but because people assume it’s harmless.
Tylenol PM: A Two-Ingredient Mix with Hidden Risks
Tylenol PM combines:
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Acetaminophen – relieves pain and fever
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Diphenhydramine – an antihistamine that causes drowsiness
While convenient, repeated or long-term use can carry serious risks.
Acetaminophen: Quiet Danger for Your Liver
Acetaminophen is widely used and usually safe—but it’s processed by the liver, producing a small toxic byproduct called NAPQI. Normally, your body neutralizes it with glutathione, but problems arise when:
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You exceed 4,000 mg per day (roughly eight Tylenol PM pills)
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You take it regularly over time
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Your glutathione levels are low (common in alcohol use, malnutrition, or certain health conditions)
If NAPQI builds up, it damages liver cells and can even cause liver failure.
Hidden danger: Acetaminophen is in many cold, flu, and sinus medications, making it easy to unknowingly exceed the safe limit.
Diphenhydramine: Sleep Now, Cognitive Risks Later
The second ingredient, diphenhydramine, makes you drowsy—but it’s an anticholinergic, which blocks acetylcholine, a chemical crucial for memory, learning, and cognitive function.
Long-term or daily use has been linked to:
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54% increased risk of dementia after three years of daily use
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Dry mouth, dizziness, confusion (especially in older adults)
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Urinary retention, raising risk of complications in the elderly
Even mild side effects can contribute to falls, delirium, and other age-related problems.
Acetaminophen May Change How You Perceive Risk
Studies suggest acetaminophen may dull emotions. One study found that people taking 1,000 mg rated risky activities—like skydiving or career changes—as less dangerous than those on a placebo.
It may also reduce empathy and positive emotions, subtly altering how you feel and interact with the world.
Safer Alternatives
Dr. Melillo doesn’t say to avoid Tylenol PM entirely—it’s fine occasionally. But nightly use is risky. Safer approaches include:
For sleep problems:
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Non-addictive sleep aids
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Melatonin or natural supplements
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Better sleep hygiene (screen limits, avoiding caffeine, consistent bedtime)
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Cognitive behavioral therapy for insomnia (CBT-I)
For pain relief:
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Use acetaminophen only as needed
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Rotate pain relievers rather than taking the same one daily
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Try heat therapy, massage, or gentle stretching
The goal is relief without long-term harm.
The Bottom Line
Tylenol PM may seem harmless, but the risks are real:
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Liver damage from acetaminophen
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Memory and cognitive problems from diphenhydramine
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Emotional dulling and potential dementia
Dr. Melillo’s advice:
“If you take this once in a blue moon, that’s fine. But it should not be your nightly solution—long-term complications are serious.”
Your medicine cabinet might be stocked, but your health deserves careful choices. Read labels, understand risks, and consult professionals when in doubt.
