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Tylenol & Alcohol: Acetaminophen Side Effects!

Can you take Tylenol PM Extra Strength after drinking alcohol? We got spanked when we suggested Tylenol & alcohol is not a good mixture.

We keep getting questions from readers who want to know about taking Tylenol & alcohol together. You might think that this question would be easily resolved. The various Tylenol labels are a bit confusing in our not-so-humble opinion.

One Reader is Justifiably Confused About Tylenol & Alcohol:

Q. A few years ago, my primary physician said that you don’t have to worry about consuming alcohol and taking acetaminophen together unless you are an alcoholic. What are your feelings on this? Am I damaging my liver if I have one drink while taking Tylenol?

A. In 2011, the FDA asked manufacturers to limit the amount of acetaminophen in prescription products to 325 mg per pill. In addition, the agency advised patients:

“Do not drink alcohol when taking medicines that contain acetaminophen.” 

The makers of Tylenol are far more lenient, though. They warn:

“Severe liver damage may occur if you take 3 or more alcoholic drinks every day while using this product.”

The FDA also warns against taking more than 4,000 mg of acetaminophen in a day. A high dose of acetaminophen can harm the liver even if alcohol is not a factor.

Perhaps the best way to tell if your own liver is holding up is to ask your doctor to run a liver function test. This blood test measures liver enzymes to assess liver health.

More Confusion About Tylenol & Alcohol:

Here is the warning on Tylenol Extra Strength Caplets:

“Liver warning: This product contains acetaminophen. Severe liver damage may occur if you take

  • more than 4,000 mg of acetaminophen in 24 hours
  • with other drugs containing acetaminophen
  • 3 or more alcoholic drinks every day while using this product”

Can NAC Reduce the Danger of Tylenol and Alcohol?

Q. I do a lot of outside work. To control the aches and pains, I take Extra-Strength Tylenol. Sometimes I drink a glass of wine with dinner.

I understand that alcohol can increase the risk for liver damage if you take acetaminophen. How much alcohol would it take to cause problems? I have also read that the supplement NAC can help protect you. Is it safe to take NAC on a daily basis?

A. As we noted above, the maker of Tylenol states that “Severe liver damage may occur if you take 3 or more alcoholic drinks every day while using this product.” It seems like you are well under that level, but we would still be cautious.

NAC is N-acetylcysteine. Toxicologists consider it an antidote to acetaminophen overdose. It enhances levels of the natural compound, glutathione, an antioxidant that is valuable for detoxification.

A mouse study did find that NAC “may be a useful tool for combatting the enhanced acetaminophen toxicity associated with alcohol ingestion” (Alcohol, Jan-Feb, 1987). A review in American Family Physician (Aug. 1, 2009) concludes that NAC :

“is a safe, inexpensive, and well-tolerated antioxidant with a well-defined mechanism of action.”

What About Tylenol & Alcohol with Tylenol PM?

This reader has a pertinent question about Tylenol PM Extra Strength:

Q. You’ve warned against taking acetaminophen while consuming alcohol. Just what do you mean? Don’t take the medicine if you’ve had a drink in the past week? Or just the same day? Or don’t swallow the pill with alcohol?

I have one drink daily, just one. Also, I’ve taken Tylenol PM nightly for a long time. Should I be worried? What problems might occur?

The answer about Tylenol & alcohol is more complicated than you might think:

The warning label on the Tylenol PM Extra Strength label is confusing to me:

It offers a liver warning that states:

“Severe liver damage may occur if you take 3 or more alcoholic drinks every day while using this product”

We hesitate to draw conclusions from such a warning, but some people might assume that if they “only” take 2 alcoholic drinks daily they would not risk liver damage. If you read on, though, you will discover this warning on the Tylenol PM Extra Strength label:

“When using this product:

  • avoid alcoholic drinks”

Here is how we answered the question about Tylenol & alcohol, especially for Tylenol PM Extra Strength:

Given your long history with Tylenol PM and a single daily drink, you might want to ask your doctor for a liver function blood test.

Another reader shared this scary story:

“I knew a young woman who regularly drank vodka and took Tylenol for headaches. Her liver was destroyed, and she ultimately died after a failed liver transplant. This combination can be deadly!”

The Manufacturer of Tylenol Was Not Happy About our Tylenol & Alcohol Answer Below:

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.

ACETAMINOPHEN SIDE EFFECTS:

  • 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 regularly 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 few alcoholic beverages, we think it would be a good idea to avoid pain relievers or headache remedies.

If you do drink alcohol, even just occasionally, we think you probably should find other ways to relieve your headaches or arthritis pain when you have had a few drinks. You may want to consider using home remedies or eating anti-inflammatory foods that are far less likely to damage your stomach or your liver.

Learn More:

You will find lots of options in our Guide to Alternative Treatments for Arthritis. Our book, Quick & Handy 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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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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Citations
  • Carter EA, "Enhanced acetaminophen toxicity associated with prior alcohol consumption in mice: prevention by N-acetylcysteine." Alcohol, Jan-Feb, 1987. DOI: 10.1016/0741-8329(87)90063-2
  • Millea PJ, "N-acetylcysteine: multiple clinical applications." American Family Physician, Aug. 1, 2009.
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