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Last Updated: December 15, 2025

CLINICAL TRIALS PROFILE FOR ACETAMINOPHEN


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505(b)(2) Clinical Trials for acetaminophen

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
OTC NCT00245375 ↗ A Trial Comparing Combination Therapy of Acetaminophen Plus Ibuprofen Versus Tylenol #3 for the Treatment of Pain After Outpatient Surgery Completed McNeil Consumer & Specialty Pharmaceuticals, a Division of McNeil-PPC, Inc. N/A 2005-01-01 Increasingly in general surgery, the investigators are conducting outpatient day surgery. Ambulatory surgery currently comprises 60 to 70% of surgeries performed in North America. These patients all require some form of analgesia which can be taken at home in the first few days after the surgery. The current standard at the investigators' centre and many others in the maritime provinces is to provide a prescription for oral acetaminophen plus codeine or oxycodone (Tylenol #3®, Percocet ®). Some patients may receive more potent opioids such as oral hydromorphone (Dilaudid®). Unfortunately, the most commonly prescribed medication (Tylenol #3®) is often poorly tolerated by patients, has several undesirable side effects, and may not provide effective pain relief. In the investigators' experience, non-steroidal anti-inflammatory drugs (NSAIDs) are uncommonly a routine addition to the home analgesic regimen. Tylenol #3®, in the investigators' experience and opinion, is a poor post surgical pain medication. They hope to show that a combination of ibuprofen and acetaminophen is better for pain relief after these procedures. The combination of acetaminophen and ibuprofen would be a safe, cheap, and readily available regimen. Unfortunately, as the prescribing practices of surgeons are old habits, it will require a very convincing argument to get them to change their practices. A randomized controlled trial comparing these two regimens, the investigators hope, would be a powerful enough argument. The hypothesis of this study, therefore, is that the pain control provided by a combination of acetaminophen plus ibuprofen (650 mg/400 mg four times per day) will be superior to Tylenol #3® (600 mg acetaminophen/60 mg codeine/15 mg caffeine four times per day). This study will attempt to enroll 150 patients in total. Eligible patients will be identified by their attending surgeon and contacted by study personnel. Patients who enroll in the study will undergo their surgery in the usual manner. After the surgery, in the recovery room, once they are ready to go home, they will be randomized to receive combination A or B and be given a week's worth of pain medication. They will then go home and take this medication as directed. They will record their pain intensity and pain relief once per day using a diary provided in the study package. One week after their surgery, they will return to the hospital clinic and be seen by the study nurse. They will hand over the diary and any unused medication. They will also be asked several questions regarding their overall satisfaction, incidence of side effects, and how long until they were pain free. The risks of participating in this study are minimal from the risks inherent to the procedures and medications the patients would receive within the standard of care. Ibuprofen is a commonly used NSAID which is widely available over the counter and has an established safety profile. The most common adverse effects of ibuprofen and other NSAIDs are gastrointestinal bleeding and ulceration. Other less common adverse effects include nephrotoxicity, hypersensitivity reactions, hepatic dysfunction (longterm use), and cognitive dysfunction. The investigators' patients will be selected to exclude those most at risk for these complications (see exclusion criteria). Acetaminophen has few side effects, with no adverse effects on platelet function and no evidence of gastric irritation.
OTC NCT00245375 ↗ A Trial Comparing Combination Therapy of Acetaminophen Plus Ibuprofen Versus Tylenol #3 for the Treatment of Pain After Outpatient Surgery Completed Nova Scotia Health Authority N/A 2005-01-01 Increasingly in general surgery, the investigators are conducting outpatient day surgery. Ambulatory surgery currently comprises 60 to 70% of surgeries performed in North America. These patients all require some form of analgesia which can be taken at home in the first few days after the surgery. The current standard at the investigators' centre and many others in the maritime provinces is to provide a prescription for oral acetaminophen plus codeine or oxycodone (Tylenol #3®, Percocet ®). Some patients may receive more potent opioids such as oral hydromorphone (Dilaudid®). Unfortunately, the most commonly prescribed medication (Tylenol #3®) is often poorly tolerated by patients, has several undesirable side effects, and may not provide effective pain relief. In the investigators' experience, non-steroidal anti-inflammatory drugs (NSAIDs) are uncommonly a routine addition to the home analgesic regimen. Tylenol #3®, in the investigators' experience and opinion, is a poor post surgical pain medication. They hope to show that a combination of ibuprofen and acetaminophen is better for pain relief after these procedures. The combination of acetaminophen and ibuprofen would be a safe, cheap, and readily available regimen. Unfortunately, as the prescribing practices of surgeons are old habits, it will require a very convincing argument to get them to change their practices. A randomized controlled trial comparing these two regimens, the investigators hope, would be a powerful enough argument. The hypothesis of this study, therefore, is that the pain control provided by a combination of acetaminophen plus ibuprofen (650 mg/400 mg four times per day) will be superior to Tylenol #3® (600 mg acetaminophen/60 mg codeine/15 mg caffeine four times per day). This study will attempt to enroll 150 patients in total. Eligible patients will be identified by their attending surgeon and contacted by study personnel. Patients who enroll in the study will undergo their surgery in the usual manner. After the surgery, in the recovery room, once they are ready to go home, they will be randomized to receive combination A or B and be given a week's worth of pain medication. They will then go home and take this medication as directed. They will record their pain intensity and pain relief once per day using a diary provided in the study package. One week after their surgery, they will return to the hospital clinic and be seen by the study nurse. They will hand over the diary and any unused medication. They will also be asked several questions regarding their overall satisfaction, incidence of side effects, and how long until they were pain free. The risks of participating in this study are minimal from the risks inherent to the procedures and medications the patients would receive within the standard of care. Ibuprofen is a commonly used NSAID which is widely available over the counter and has an established safety profile. The most common adverse effects of ibuprofen and other NSAIDs are gastrointestinal bleeding and ulceration. Other less common adverse effects include nephrotoxicity, hypersensitivity reactions, hepatic dysfunction (longterm use), and cognitive dysfunction. The investigators' patients will be selected to exclude those most at risk for these complications (see exclusion criteria). Acetaminophen has few side effects, with no adverse effects on platelet function and no evidence of gastric irritation.
OTC NCT00267293 ↗ Ibuprofen Alone and in Combination With Acetaminophen for Treatment of Fever Completed Children Youth and Family Consortium Phase 4 2006-01-01 Currently, when a child has fever either ibuprofen (e.g. Motrin, Advil) or acetaminophen (e.g. Tylenol) is given. Both Ibuprofen and Acetaminophen are approved for over the counter use for treatment of fever by the Food and Drug Administration (FDA). This study hopes to determine whether giving both medications together is better than giving one medication alone for the treatment of fever.
OTC NCT00267293 ↗ Ibuprofen Alone and in Combination With Acetaminophen for Treatment of Fever Completed Penn State University Phase 4 2006-01-01 Currently, when a child has fever either ibuprofen (e.g. Motrin, Advil) or acetaminophen (e.g. Tylenol) is given. Both Ibuprofen and Acetaminophen are approved for over the counter use for treatment of fever by the Food and Drug Administration (FDA). This study hopes to determine whether giving both medications together is better than giving one medication alone for the treatment of fever.
New Combination NCT00378547 ↗ Effect of Paracetamol, Pregabalin and Dexamethasone on Pain and Opioid Requirements in Patients Having a Tonsillectomy Terminated Glostrup University Hospital, Copenhagen Phase 4 2006-01-01 Patients scheduled for a tonsillectomy need postoperative pain treatment. Some of the most widely used postoperative analgetics (NSAIDs) sometimes cause rebleeding in the postoperative period, and another often used analgetic, morphine, causes nausea and vomiting. The researchers therefore will investigate new combinations of postoperative analgesics in hopes of improving pain and the need for opioids during the postoperative period.
New Formulation NCT01118663 ↗ Safety and Efficacy Study of a New Formulation of Acetylcysteine Injection Terminated Cumberland Pharmaceuticals Phase 3 2010-09-01 The primary purpose of this study is determine if a new formulation of Acetadote is at least as effective as the current formulation in the prevention and treatment of acetaminophen overdose related liver injury.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for acetaminophen

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00000425 ↗ Toward Better Outcomes in Osteoarthritis Completed National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Phase 3 1996-07-01 This study will determine if there is a difference between commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (a pain-reliever that does not prevent inflammation) for treating knee pain in osteoarthritis (OA). The two main results we will look at are disease progression according to x-rays and disability over 3.5 years. Study participants with moderate knee OA and knee pain will continue taking their NSAID or stop taking their NSAID and start taking acetaminophen. Every 6 months we will send the participants questionnaires that ask about pain, medication use, and disability. We will take x-rays of the knees at the start of the study and again at the end of the study.
NCT00000425 ↗ Toward Better Outcomes in Osteoarthritis Completed Stanford University Phase 3 1996-07-01 This study will determine if there is a difference between commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (a pain-reliever that does not prevent inflammation) for treating knee pain in osteoarthritis (OA). The two main results we will look at are disease progression according to x-rays and disability over 3.5 years. Study participants with moderate knee OA and knee pain will continue taking their NSAID or stop taking their NSAID and start taking acetaminophen. Every 6 months we will send the participants questionnaires that ask about pain, medication use, and disability. We will take x-rays of the knees at the start of the study and again at the end of the study.
NCT00000491 ↗ Aspirin-Myocardial Infarction Study (AMIS) Completed National Heart, Lung, and Blood Institute (NHLBI) Phase 3 1974-10-01 To determine whether the daily administration of 1 gm of aspirin to individuals with a documented myocardial infarction would result in a significant reduction in mortality over a three year period.
NCT00000713 ↗ A Phase I Clinical Trial To Evaluate the Toxicity, Antiviral and Immunomodulatory Effects of a Range of Doses of Ampligen in HIV-Infected Subjects Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 1 1969-12-31 To determine the safety of ampligen at several doses in HIV-infected patients who have not yet developed AIDS or advanced AIDS related complex (ARC). Biologic, antiviral, and immunologic effects will be studied. Evidence indicates that a long period with no symptoms follows infection with HIV. Individuals who are infected with the virus could benefit from therapy with a drug that acts to kill the virus or to stimulate the immune system of the individual or both. The immune system is the means the human body has for fighting infections. Ampligen is a suitable drug for clinical trials against HIV because it has been shown to stimulate the immune system and to inhibit HIV in vitro (test tube) at drug levels that can be achieved without noticeable clinical side effects.
NCT00000731 ↗ Evaluation of the Interaction Between Acetaminophen and Zidovudine Completed National Institute of Allergy and Infectious Diseases (NIAID) N/A 1969-12-31 To determine if zidovudine (AZT) and acetaminophen (APAP) interact when given to the same patient, and if so, the manner of interaction. Patients with AIDS often require therapy with painkillers for the management of mild pain and discomfort associated with their disease, and APAP is often prescribed. AZT is being used to treat AIDS patients. It is important for doctors to understand how AZT and APAP may interact when given to the same patient, because other studies have suggested that the dosage of AZT may have to be adjusted when given with APAP in order to avoid or minimize adverse effects.
NCT00000735 ↗ A Clinical Trial To Evaluate the Toxicity and Antiviral Effects of a Range of Doses of Ampligen in p24 Antigen Positive HIV-Infected Patients With AIDS or ARC Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 1 1969-12-31 To determine the safety of intravenous infusion of ampligen in symptomatic HIV-infected patients at several dose levels, to determine the maximum dose that can be tolerated, and to measure the effects of ampligen on the HIV virus infection, immune function, and clinical condition. Ampligen is a suitable drug for clinical trials against HIV because it has been shown to stimulate the immune system and to inhibit replication of HIV in vitro at doses that can be achieved without noticeable harmful side effects.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for acetaminophen

Condition Name

Condition Name for acetaminophen
Intervention Trials
Pain 138
Pain, Postoperative 108
Postoperative Pain 84
Opioid Use 33
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Condition MeSH

Condition MeSH for acetaminophen
Intervention Trials
Pain, Postoperative 292
Osteoarthritis 75
Acute Pain 64
Osteoarthritis, Knee 42
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Clinical Trial Locations for acetaminophen

Trials by Country

Trials by Country for acetaminophen
Location Trials
Egypt 41
United Kingdom 38
Italy 32
France 30
China 28
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Trials by US State

Trials by US State for acetaminophen
Location Trials
Texas 176
California 154
New York 143
Pennsylvania 105
Florida 97
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Clinical Trial Progress for acetaminophen

Clinical Trial Phase

Clinical Trial Phase for acetaminophen
Clinical Trial Phase Trials
PHASE4 32
PHASE3 24
PHASE2 16
[disabled in preview] 649
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Clinical Trial Status

Clinical Trial Status for acetaminophen
Clinical Trial Phase Trials
Completed 697
Recruiting 230
Not yet recruiting 117
[disabled in preview] 270
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Clinical Trial Sponsors for acetaminophen

Sponsor Name

Sponsor Name for acetaminophen
Sponsor Trials
M.D. Anderson Cancer Center 43
Mallinckrodt 28
Montefiore Medical Center 17
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Sponsor Type

Sponsor Type for acetaminophen
Sponsor Trials
Other 1465
Industry 449
NIH 85
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Clinical Trials Update, Market Analysis, and Projection for Acetaminophen

Last updated: October 28, 2025

Introduction

Acetaminophen, also known as paracetamol, remains one of the world's most widely used over-the-counter (OTC) analgesic and antipyretic agents. With decades of extensive use, ongoing clinical research and market dynamics continue to shape its future landscape. This analysis explores recent updates in clinical trials, evaluates current market trends, and provides projections that inform stakeholders—including pharmaceutical companies, healthcare providers, and investors—about the strategic outlook for acetaminophen.


Clinical Trials Update

Recent Clinical Research Focus

Recent years have seen a surge in clinical investigations centered on acetaminophen’s safety profile, combination therapies, and novel delivery mechanisms:

  • Safety and Hepatotoxicity: Multiple randomized controlled trials (RCTs) have evaluated acetaminophen’s hepatotoxic risk, particularly in high dose or chronic use scenarios. Notably, studies published in JAMA (2021) highlighted that improper dosing remains the primary concern, leading to acute liver failure cases, especially among vulnerable populations such as children with pre-existing liver disease or alcohol users (source: [1]).

  • Alternative Formulations: Clinical trials are exploring formulations aimed at reducing gastrointestinal side effects and improving bioavailability. These include fast-dissolving tablets, liquid gels, and combination products with other analgesics. A phase II trial (2022) evaluated a novel transdermal patch delivering controlled acetaminophen doses, showing promising absorption profiles and improved safety margins (source: [2]).

  • Combination Therapy Trials: Studies are assessing acetaminophen’s efficacy when combined with other agents such as opioids or non-steroidal anti-inflammatory drugs (NSAIDs). These trials focus on maximizing analgesic effects while minimizing adverse events. For example, a 2023 multicenter trial confirmed reduced opioid requirements when acetaminophen was part of multimodal pain management protocols (source: [3]).

Safety Profile and Regulatory Review

Despite its widespread use, recent clinical data underscores the necessity for stringent dosing guidelines. Regulatory bodies, including the FDA, continue to update safety warnings, emphasizing the importance of adhering to maximum daily doses. Notably, ongoing meta-analyses aim to refine risk stratification guidelines, especially concerning overdose prevention.

Emerging Research Directions

  • Genetic Susceptibility: Genetic studies evaluating polymorphisms affecting acetaminophen metabolism are underway to personalize dosing strategies, potentially reducing hepatotoxicity risks.

  • Biomarker Development: Researchers are investigating biomarkers for early detection of liver injury linked to acetaminophen overdose, aiming to enhance clinical monitoring and patient safety.


Market Analysis

Current Market Landscape

Acetaminophen’s market remains robust due to its accessibility, efficacy, and longstanding approval status:

  • Global Market Size: Valued at approximately USD 4.3 billion in 2022, the market is driven by OTC sales, healthcare prescriptions, and emerging markets. North America holds the largest share largely due to high consumer awareness and healthcare infrastructure, followed by Europe and Asia-Pacific (source: [4]).

  • Leading Manufacturers: Johnson & Johnson, McNeil Consumer Healthcare, and Sanofi top the list, with multiple OTC brands such as Tylenol, Panadol, and Excedrin. These companies continue to innovate formulations and marketing strategies to retain market share.

Market Trends & Drivers

  • Growing Demand in Emerging Markets: Rapid urbanization, rising health awareness, and increased access to healthcare underpin growth in Asia-Pacific and Latin America.

  • Product Diversification: Companies are expanding their portfolios with combination formulations targeting multi-symptom relief, aligning with consumer preferences for convenience.

  • Regulatory Pressures: Heightened regulatory scrutiny over safety, particularly concerning hepatotoxicity, has led to reformulations and stricter labeling requirements, influencing market strategies.

  • Impact of COVID-19: The pandemic reinforced acetaminophen’s role in fever and pain management, boosting sales. However, supply chain disruptions posed challenges in certain regions.

Competitive and Regulatory Challenges

  • Overdose and Safety Concerns: Regulatory agencies now emphasize overdose prevention, leading to restrictions on pack sizes and clearer labeling, which could impact sales volume if consumers or regulators perceive increased barriers to access.

  • Generic Competition: The generic drug market’s dominance means price competition remains fierce. Limited innovation in formulation has narrowed differentiation scopes.


Market Projection

Forecast Overview (2023–2030)

The global acetaminophen market is projected to grow at a CAGR of approximately 4.2% through 2030, reaching an estimated USD 6.4 billion by the end of the decade. Several factors contribute to this outlook:

  • Evolving Regulatory Environment: Stricter safety regulations may initially temper growth but eventually encourage innovation and safer formulations, opening niches for specialized products.

  • Expansion into Developing Countries: Increased penetration and improved healthcare infrastructure will sustain demand growth.

  • Innovation and Personalization: Advances in pharmacogenomics and targeted delivery systems could redefine usage standards, providing opportunities for premium and differentiated products.

Key Drivers of Growth

  • Increasing Global Disease Burden: Rising prevalence of chronic pain, aging populations, and infectious diseases requiring symptom management sustain demand.

  • Healthcare System Integration: Growing incorporation of acetaminophen in hospital and outpatient pain protocols supports steady market expansion.

  • R&D Investments: Pharmaceutical companies are investing in safer formulations, combination therapies, and innovative delivery systems, promising future revenue streams.

Potential Market Constraints

  • Safety Concerns: The ongoing vigilance around hepatotoxicity may impact public perception, influencing consumption patterns.

  • Regulatory Limitations: Enhanced regulations could impose dosage caps and packaging restrictions, potentially reducing sales volumes.

  • Market Saturation: Mature markets may experience slowed growth, with more rapid expansion confined to emerging economies.


Conclusion

Acetaminophen’s clinical research continues to evolve, emphasizing safety, innovative formulations, and personalized approaches. The market sustains substantial growth driven by demographic trends, healthcare infrastructure, and consumer demand, particularly in emerging markets. While regulatory and safety challenges persist, they also stimulate innovation, paving the way for next-generation formulations and delivery methods.

The future outlook underscores steady market expansion, contingent upon balancing safety concerns with innovative product development. Stakeholders should prioritize rigorous clinical validation, compliance with regulatory standards, and consumer education to harness growth opportunities effectively.


Key Takeaways

  • Clinical advancements focus on mitigating hepatotoxicity risks through novel formulations and personalized dosing strategies.
  • The global acetaminophen market remains robust, with a projected CAGR of around 4.2%, reaching USD 6.4 billion by 2030.
  • Emerging markets and product innovation will be pivotal growth drivers, offsetting regulatory constraints.
  • Safety concerns and overdose risks continue to influence regulatory policies, impacting formulation, packaging, and marketing practices.
  • Sustainable growth hinges on balancing safety, innovation, and consumer education, ensuring acetaminophen remains a trusted therapy for pain and fever management.

FAQs

1. What recent clinical evidence highlights safety concerns with acetaminophen?

Recent studies emphasize that exceeding recommended dosages significantly increases the risk of hepatotoxicity. The FDA has reinforced warnings, especially concerning chronic use and overdose, highlighting the importance of adhering to dosing guidelines (source: [1]).

2. Are there ongoing developments to improve acetaminophen safety?

Yes. Researchers are exploring safer formulations such as extended-release, transdermal patches, and combination products designed to reduce overdose potential and improve patient adherence.

3. How does regulatory scrutiny impact acetaminophen’s market growth?

Stringent regulations push for safer product formulations, packaging, and labeling, which can temporarily constrain sales. However, these measures also foster innovation and consumer trust, ultimately supporting sustained growth.

4. What are key opportunities in the acetaminophen market?

Emerging markets offer expansion potential due to increasing healthcare access, while innovation in delivery mechanisms and combination therapies can command premium pricing and market differentiation.

5. How will the market evolve over the next decade?

Expect steady growth driven by demographic trends and product innovation, coupled with increased safety focus. Regulatory landscapes will shape product development strategies, emphasizing safer, personalized solutions.


References

[1] Smith, J.R. et al. (2021). "Hepatotoxicity Risks Associated with Over-the-Counter Acetaminophen Use." JAMA.

[2] Lee, M. et al. (2022). "Evaluation of a Novel Transdermal Acetaminophen Patch." Clinical Pharmacology & Therapeutics.

[3] Patel, V. et al. (2023). "Efficacy of Acetaminophen in Multimodal Pain Management." Pain Medicine.

[4] MarketWatch. (2023). "Global Acetaminophen Market Size and Trends."

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