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The answer depends on both the dosage and your drinking habits
The dance floor’s hopping, the drinks are flowing and the bass is pounding. Or is that just your head?
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Headaches aren’t anybody’s favorite party favor. But you may find yourself wondering if it’s bad to take acetaminophen — more commonly known as Tylenol® or paracetamol — for a headache during or after a boozy evening.
Hepatologist Christina Lindenmeyer, MD, has the answers.
In most cases, taking a normal dose of acetaminophen during or after a night of drinking shouldn’t cause liver damage. A “normal” dose is to up to 1,000 mg over a four-to-six-hour period and a total of no more than 4,000 mg in a day.
But if you combine regular, moderate alcohol use with repeated daily doses of acetaminophen, it can make the liver more susceptible to a condition called acetaminophen toxicity.
Here’s the thing: the bar for moderate alcohol use may be a bit lower than you’re imagining. According to the CDC, your alcohol consumption qualifies as moderate if you consume no more than one drink a day for women and no more than two drinks a day for men. They define heavy drinking as imbibing eight or more drinks for women, or 15 or more drinks for men in the course of a week.
Generally speaking, if you’re going to drink at a party or other social event and you take a couple of doses of acetaminophen the next day for your hangover, you should be fine. But if you regularly engage in heavy drinking or binge drinking, you’re better off only using acetaminophen in rare instances — and avoiding daily doses greater than 2,000 mg.
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As it does for many medications, your body metabolizes acetaminophen in the liver. When you take the recommended dosage, your liver converts most of it into a benign substance that’s removed in your urine. Your body also converts a very small amount of that metabolized acetaminophen into a toxin that can be harmful to your liver. Luckily, our bodies produce a secondary substance, glutathione, that helps minimize the toxic effects.
If you take too much acetaminophen — or if your liver doesn’t have enough glutathione stored up — the toxic metabolite can accumulate in your body and damage your liver.
So, where does alcohol fit in this picture? Your liver cells also metabolize alcohol. In fact, both acetaminophen and alcohol use glutathione to temper their toxic effects.
“Over time, chronic, heavy alcohol intake depletes your liver of its glutathione stores, which can lead to problems when acetaminophen is added to the mix,” Dr. Lindenmeyer says.
It’s easy to underestimate Tylenol, because so many of us grow up with it in our homes. And it seems to pop up everywhere!
According to the American Liver Foundation, acetaminophen is an ingredient in over 600 different over the counter and prescription medications. That makes it the most common drug ingredient in America. It also goes a long way toward explaining why overdoses happen so often: Approximately half of them are accidental.
Acetaminophen may be familiar, but that doesn’t mean it doesn’t have side effects. In addition to the risk of liver toxicity, Tylenol can cause a number of unpleasant side effects, including:
As you’ve probably noticed, alcohol use causes several of those symptoms, too. So, when you mix alcohol and acetaminophen, the potential side effects can become more severe. Examples include bleeding ulcers in your stomach or intestines and rapid heartbeat.
According to Dr. Lindenmeyer, the biggest risk you take when you combine alcohol and Tylenol is liver failure. According to a 2019 study in The Lancet, acetaminophen toxicity accounts for nearly half of the cases of acute liver failure in North America and about a fifth of the liver transplant cases in the U.S. It can also cause kidney failure and painful inflammation of the pancreas (pancreatitis). Left untreated, these complications can be deadly.
Signs of acetaminophen toxicity to look out for (in addition to the ones we’ve already mentioned) include:
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If you think you’re experiencing acute acetaminophen toxicity, it’s important to act fast, even if you don’t feel particularly unwell. Call 911, go to the emergency room or call a poison control center.
Learning how to drink responsibly is important. So is learning how to medicate responsibly! Here are some tips Dr. Lindenmeyer says can help minimize your risk of complications on the rare occasion that you may need to mix acetaminophen and alcohol.
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Acetaminophen is an old standby for a reason. It’s a great (and safe) option for relieving pain and cooling fevers when taken correctly. While it’s safer when you’re sober, it’s generally OK to take Tylenol after you’ve had a drink or two, max. But overdoses and acetaminophen toxicity can happen, so follow dosing instructions to the letter and contact your provider if you have any questions about whether to take Tylenol, or how to do it safely.
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