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Ibuprofen is usually rated to be on the same level (damaging your kidneys rather than your liver during long term use) but from what I've read I believe the potential side effects are more extreme (i.e. the elevated stroke/heart attack risk).
Using any pain medication for prolonged periods of time without consulting a doctor is dangerous. Many people do it, and most are absolutely fine, but when things go wrong, things go terribly wrong.
Remember: Paracetamol is hepatotoxic, very strong for your liver. Never take it if you have been drinking alcohol or have a weak/damaged liver. Paracetamol is the worst thing you can have for hungover: it might reduce your headache but will hurt a liver that it's already under pressure by the alcohol you drank last night.
In moderation, as prescribed, shouldn't be bad. I'm more of an ibuprofen guy though (although I rarely take it).
Way back in the 80s he was commenting on how understudied and under published Acetaminophen toxicity was.
In particular, taking Tylenol for hangovers was (and still is) a common but very dangerous practice.
As others have said, it is crazy easy to overdose on the stuff and suffer liver damage.
The episode shows how even small overdoses of acetaminophen can cause fatal liver damage, while decades of FDA delays and confusing drug labeling left millions of Americans at risk.
The alternatives are worse - ibuprofen destroys your stomach lining if taken at the regular dose for too long.
The issue is that the overdose of Paracetamol is relatively similar to the effective, or safe, dose:
"(overdose) of paracetamol is caused by taking more than the recommended maximum daily dose of paracetamol for healthy adults (three or four grams),[38] and can cause potentially fatal liver damage. A single dose should not exceed 1000 mg ..." [1]
See the problem ? A mere 3x the single dose puts one in "potentially fatal liver damage" territory.
This problem is compounded dramatically in small children where errors in the estimation of the child's weight can put you half way to overdose before you even start. Now add a meniscus error as you fill a clear plastic cup in the middle of the night ... or Mom gives a dose at 5am without knowing that Dad already gave a dose at 2am ... ugh.
Compare this to Aspirin where the overdose is as high as 15-30x the effective dose.
I’ll note that if you aren’t used to taking Tylenol, be mindful of the difference between extra and regular strength. My dentist just wrote down a number of Tylenols to take every X hours, and I took them, but because they were extra strength I started hallucinating and chugging water during, I think, Detective Pikachu or some nonsense like it. My liver came out of it fine. But if I’d taken another handful poison control said they would have directed me to the ER. One more after that and it would have been permanent liver damage.
This is how the VA killed my dad :/
An aspirin here or there is probably fine but multiple day dosing of full dose aspirin for chronic pain has gotten a lot of middle age people to bleed out their GI tract and end up dead.