Reuters

If you cannot find Tylenol pain reliever at your local CVS store this flu season, it might be because that store is no longer stocking it.

CVS this month changed how it stocks Tylenol at its stores in the wake of manufacturing problems at the drug's maker, Johnson & Johnson, that have disrupted supplies for more than three years.

Under the new plan, CVS will try to have Tylenol in stores in each market, but will not have it in every store, spokesman Michael DeAngelis said.

The company is getting enough Tylenol to stock about half of its 7,400 U.S. stores, and it changed the stocking of Tylenol to eliminate empty spots on shelves where the medication would have been.

The move by the drugstore unit of CVS Caremark Corp, the second largest such unit in the United States, could be a sign of the difficulty J&J faces as it tries to fix quality-control problems and rebuild its Tylenol business.

A spokesman for J&J's McNeil Consumer Healthcare unit, which makes Tylenol, did not return Reuters' calls seeking comment.

Since 2009, faulty manufacturing has prompted J&J's McNeil unit to recall millions of bottles and packages of Tylenol, Benadryl, Motrin and other over-the-counter medicines.

At the same time, CVS and other retailers have been putting more emphasis on their private-label products, which cost less than brand-name products but can be more profitable for retailers.

The length of time it has taken for J&J to upgrade its factories and ramp up manufacturing of Tylenol has given consumers plenty of time to try the store brand and decide whether they want to pay more for Tylenol, Stephanie Prymas, Consumer health analyst at market data researcher Euromonitor International, said.

"That's a pretty long time for private-label to gain some credibility," Prymas said.

In 2009, before the recalls started, Tylenol had 56 percent of the U.S. market share for acetaminophen, the chemical name of Tylenol, according to Euromonitor. In 2012, that was down to 24 percent. At the same time, private-label market share has grown from 32 percent to 62 percent.

Prymas said that private-label products are more accepted now than 20 years ago, when deaths linked to cyanide-tainted capsules caused Tylenol to be pulled from store shelves. Private-label offerings are now more commonplace and trusted, she said.

"We're kind of expecting private label to hold on more tenaciously to what they have captured," Prymas said.

A visit to a CVS store on Chicago's North Side on Sunday showed no obvious signs that Tylenol extra strength pain reliever for adults had ever been on the shelves or any spaces for the medication had to be restocked. Instead, the shelves were well-stocked with the CVS brand.

DeAngelis declined to say whether the supply of Tylenol had changed in recent weeks to prompt the new distribution plan.

A spokesman for Walgreen Co, the largest U.S. drugstore chain, said that company has seen no change in its supply of Tylenol products.

By Rachel Rettner
My Health News Daily

Taking even slightly too much Tylenol over a period of several days can lead to an overdose with deadly consequences, a new study says.

The study looked at what are called "staggered overdoses," in which a person repeatedly exceeds the daily recommendation through small overdoses. This is in contrast to the more familiar single overdose, when a person takes too many pills at once.

In the study, staggered overdoses of acetaminophen  (which is found in Tylenol and other pain releivers) were more deadly than single overdoses, even though people who experienced staggered overdoses typically took smaller total amounts of acetaminophen than those who experienced a single overdose.

Doctors may not identify staggered overdoses right away, researchers added. People with a staggered overdose may have levels of the drug in their blood below what a standard blood test would indicate as an overdose, even when their liver is badly damaged.

People taking acetaminophen should stay within the recommended limits of the drug and take even less of it when they are on other painkillers, said study researcher Kenneth Simpson of the University of Edinburgh in Scotland. The researchers defined an overdose as taking more than 4,000 milligrams of acetaminophen in a 24 hour period. The Food and Drug Administration also sets the maximum dose at 4,000 milligrams.

And, Simpson said, doctors should realize the criteria used to identify overdose patients do not work as well for staggered overdoses.

The study was published online in the British Journal of Clinical Pharmacology.

Simpson and colleagues examined information from 663 patients with liver problems caused by acetaminophen (also known as paracetamol) who were admitted to an Edinburgh hospital between 1992 and 2008.

The researchers found that nearly a quarter of them (161 patients) had taken staggered overdoses.

On average, staggered overdose patients took 24 grams (24,000 milligrams) of acetaminophen, typically over several days. Single-overdose patients consumed 27 grams (27,000 milligrams) at once, or six times the recommended dose for a whole day.

A total of 60 patients died from a staggered overdose, and 140 patients from a single overdose. This equates to a mortality rate of 37.3 percent among the staggered overdose group, and 27.8 percent in the single overdose group. Staggered overdose patients also were more likely to have liver and brain problems, require kidney dialysis and need help with breathing.

Close to 60 percent of the staggered overdose group said they had taken the drug to relieve pain, including abdominal or muscular pains, headache or toothache.

During a staggered overdose, the drug likely builds up in the liver and kills the cells, Simpson said.

Staggered overdose patients may have fared less well because they did not receive the appropriate treatment soon enough, or because they had been drinking alcohol along with acetaminophen, he said.

The new study "sheds light on the fact that the maximum recommended daily dose should be strictly adhered to," said Dr. Joshua Lenchus, an associate professor of clinical medicine at the University of Miami Miller School of Medicine.

Acetaminophen also appears in combination with other drugs in certain prescription products. In January the Food and Drug Administration asked all manufacturers of acetaminophen to lower the dose in a single tablet to 325 mg. Even at this dose, people who take two tablets every four hours for 24 hours come close to the 4,000 mg limit. (Packets of regular Tylenol pills, which contain 325 mg, say: "Do not take more than 12 tablets in 24 hours.")

"It's pretty easy for people to take just a couple of tablets every four hours," Lenchus said.

Doctors need to consider the possibility of overdoses when patients come to the hospital after taking acetaminophen, even if the patients have not obviously taken many pills at once, Lenchus said.

7 Foods You Can Overdose On

7 Weirdest Medical Conditions

Abuse of Prescription Opioid Pain Medication A 'Vast Problem'