Does Tylenol Prolong the QT Interval?
No, Tylenol (acetaminophen) does not prolong the QT interval and is not listed among medications that cause QT prolongation in any major guidelines or drug safety databases.
Evidence-Based Assessment
The provided evidence comprehensively reviews medications that prolong the QT interval across multiple high-quality guidelines and systematic reviews, and acetaminophen is notably absent from all lists of QT-prolonging medications 1, 2.
Medications That Actually Prolong QT
The established QT-prolonging drug classes include:
Antiarrhythmics:
- Class IA agents (quinidine, procainamide, disopyramide) 1
- Class III agents (sotalol, dofetilide, ibutilide) 1, 2
- Amiodarone (marked prolongation but lower torsades risk) 1, 2
Psychiatric Medications:
- Antipsychotics (thioridazine, haloperidol, chlorpromazine, pimozide) 1
- Tricyclic antidepressants (amitriptyline) 2
- SSRIs (citalopram, escitalopram at higher doses) 2
Antimicrobials:
- Macrolides (clarithromycin, erythromycin, azithromycin) 1
- Fluoroquinolones (moxifloxacin, levofloxacin) 1
- Antifungals (ketoconazole) 1
Other Agents:
- Antiemetics (ondansetron, domperidone) 1
- Methadone 1
- Antimalarials (chloroquine, hydroxychloroquine) 1
Clinical Implications
Acetaminophen remains a safe analgesic choice for patients with:
- Baseline QT prolongation 2
- Risk factors for torsades de pointes (female sex, age >65, hypokalemia, hypomagnesemia) 1
- Concomitant use of other QT-prolonging medications 1
- Congenital long QT syndrome 2
Common Pitfall to Avoid
Do not confuse acetaminophen with other over-the-counter medications that may contain antihistamines (like diphenhydramine combinations), as some antihistamines like hydroxyzine can prolong QT 3. Pure acetaminophen formulations carry no QT prolongation risk 1, 4, 5.