Using data recorded in an inpatient electronic Medication Administration Record system, Zhou et al reported patients' actual acetaminophen exposure and identified important factors associated with supratherapeutic dosing of acetaminophen. Among hospitalized patients, 60.7% received acetaminophen, and of these, 6.6% exceeded the 4-g/d recommended maximum. Patients receiving greater doses of acetaminophen tended to have significant elevations in alkaline phosphatase level, although a causal relationship cannot be concluded. A significantly higher risk of supratherapeutic dosing was observed in patients who received scheduled administrations (hazard ratio [HR], 16.6; 95% CI, 13.5-20.6), multiple product formulations (HR, 2.4; 95% CI, 2.0-2.9), or the 500-mg strength formulation (HR, 1.9; 95% CI, 1.5-2.3). Interventions to reduce the incidence of these risk factors may prevent supratherapeutic acetaminophen dosing in hospitalized patients.