tylenol bottles

Q. Your warning about regular consumption of alcohol and acetaminophen has the potential to misinform your readers about the use of pain relievers by people who drink…When acetaminophen is used as directed it does not pose any increased risk for the occasional, moderate drinker.

A. As a spokesperson for McNeil Consumer Health Care (the manufacturer of Tylenol brand acetaminophen), you should recognize that heavy drinkers are at increased risk of liver damage when they take acetaminophen. The question we answered, to which you are responding, was from a woman whose husband “drinks a lot of wine” and takes Tylenol for headaches.

Liver Problems

We shared her concern about liver toxicity. The FDA used to warn, “If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take acetaminophen or other pain relievers/fever reducers. Acetaminophen may cause liver damage.”

In 2011 the FDA took a much tougher stance. It advised: “not drinking alcohol when taking acetaminophen.”

We think that people have been far too casual about acetaminophen. This pain reliever is found in so many over-the-counter products and prescription pain relievers that it is a bit mind boggling.

It is relatively easy to take an allergy medicine that contains a substantial dose of acetaminophen and then double up with a headache remedy that also contains acetaminophen. Add a glass or two of wine or a couple of beers to the mix and you may be poisoning your liver. Here are some unexpected complications of acetaminophen.


  • Nausea
  • Liver damage/Liver failure
  • Headache
  • Rash
  • Allergic reaction (anaphylaxis, which can be life threatening)
  • Kidney damage
  • Anemia
  • High blood pressure
  • Asthma

Bottom Line:

We think it inadvisable to drink alcohol and take Tylenol (acetaminophen). And by the way, aspirin might not be such a good idea either. Alcohol can dissolve away the protective mucous lining in the stomach. Taking a standard dose (two tablets) of aspirin after a night on the town could lead to significant stomach irritation and possibly even an ulcer. Ditto for NSAIDs like ibuprofen or naproxen. You’ve heard the saying about “don’t drink and drive.” We think it also applies to many pain relievers. If you are going to have a couple of alcoholic beverages, we think it would be a good idea to avoid pain relievers or headache remedies.

If you drink alcohol, even just occasionally, we think you need to find other ways to relieve your headaches or arthritis pain. You may want to consider some home remedies or anti-inflammatory foods that are far less likely to damage your stomach or your liver.

You will find lots of safer options in our Guide to Alternative Treatments for Arthritis. Our book, Quick & Hand Home Remedies also has lots of suggestions about safer ways to deal with headaches, fibromyalgia or joint pain. You can find all our books here.

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  1. tom

    I asked 2 pharmacists. Both said just wait 2-4 hrs between 325 mg tyl and 1 or 2 alc drinks, is harmless for person w/ no other insinuating issues.

  2. Larry

    Taking N-acetyl cysteine helps to avoid Tylenol toxicity.

  3. Eleanor K.

    The person who drank wine and used acetaminophen may not have realized he was allergic to wine. I discovered that years later when I stopped drinking alcoholic beverages and my headaches disappeared. Before that I used pain killers and sinus medicine almost daily. Beer is equally as bad.

  4. Marian C.

    I know all about this upon the advice of a doctor. Due to a back condition I take a lot Tylenol. Thanks for the advice.

  5. TD

    “Do not take this medicine while consuming alcohol.” I’ve seen this a thousand times. What does it mean? Don’t take the medicine if you’ve had a drink in the past month? Past week? Today? If you’re going to have a drink tomorrow? I’ve had ONE drink daily and I’ve taken Tylenol PM nightly (but not available now) for ten years with no problems. See why it’s confusing?

  6. mb

    Be advised!! if you drink especially a”regular” drinker-DO NOT TAKE TYLENOL(ACETAMINOPHEN) IN ANY FORM!!I knew a young woman who regularly drank vodka and regularly took tylenol for headaches-her liver was destroyed and she ultimately died after a failed liver transplant.this combination is DEADLY!

  7. jas

    I have taken 6 to 8 extra strength Tylenol caplets once a month, every month for the last 30 years strictly for menstrual cramps. I’ve never smoked or drank alcohol in my entire life. The worst thing I consumed all my life was Coke (soda) daily and have no major medical issues. I never took any other medications/painkillers as I cannot tolerate them and tend to be very sensitive to drugs and stimulants.
    I abstain from all caffeine. Through a CT scan for another possible medical issue, I incidentally discovered that I have fatty liver infiltration. Is it possible that all those years of extra strength Tylenol did something to my liver or is this more about a sub par diet and years of soda drinking? Due to menopause, I have not been taking Tylenol at all for the last year. Does Tylenol “weaken” the liver and it’s ability to function when taken properly?

    • evoc

      It is three years since your post. I trust you are still alive and well. It was recently on the news that the maker of acetaminophen now states the extra strength dose is too much and will cause liver damage. We are now advised to use the lower dose.

  8. rr

    Thank you for continuing to warn consumers about the toxic effect of acetaminophen and other pain relievers on the liver. A member of my family has severe liver problems which were exacerbated by being advised to take, and freely prescribed, pain medication. The ignorance of the public, as well as many health professionals about this issue is alarming. You are to be commended for not backing down from your message, and continuing your good work as consumer and patient advocates!

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