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June 22nd, 2009
12:24 PM ET

Is it safe to take Tylenol after drinking?

By Elizabeth Landau
CNN.com Health Writer/Producer

Recently, after having dinner with a friend, my head felt achy and warm. As I reached for the bottle of Tylenol, I remembered that many medications have harmful side effects in combination with alcohol, and I'd just had a margarita at the restaurant. So, I left the pills on the desk and went to the Internet.

It seems that acetaminophen, the primary active ingredient in Tylenol, may lead to liver damage in combination with alcohol. Liver damage from chemicals is called hepatotoxicity. That's why the warning label on products similar to Tylenol say you should ask your doctor before taking the product if you drink more than than three alcoholic beverages per day.

But what about one drink? And how long should a person wait after consuming alcohol before taking acetaminophen-based drugs?

I scoured the Web and found that many people had asked similar questions on forums such as Yahoo! Answers. Various Web sites had some suggestions, but not much specific to the precise timing of safe consumption of this medication after an alcoholic drink. Confused, I just put a cold washcloth on my forehead and went to sleep.

For the benefit of CNN.com readers with similar questions, I looked into the issue further.

Dr. Elizabeth Roth, an internist at Massachusetts General Hospital, said drinking before taking the recommended dose of acetaminophen-based medications may not be a big issue for some people, although she does not advise it. In patients without underlying liver disease and who are not chronic alcoholics, acute alcohol intake is not a risk factor for liver damage from acetaminophen, she says.

"The bottom line is that for the otherwise healthy person without chronic liver disease or a history of alcoholism, they don't have to wait before taking two regular Tylenol after having a drink. But no medical advice fits all patients," she said in an e-mail.

Other factors can increase the likelihood of acetaminophen-related liver damage, including old age, poor nutritional status, co-existing illnesses, and particular genetic makeups. Moreover, the toxic dose among individuals can vary. A person's baseline levels of glutathione - a chemical involved in metabolism - play a role in the acetaminophen levels at which toxicity can occur, Roth said.

For alcoholics, acetaminophen-containing drugs such as Tylenol can be dangerous. According to one National Institutes of Health publication on alcohol and metabolism, liver damage effects may occur with as little of four to five "extra-strength" pills taken over the course of the day in people who consumed varying amounts of alcohol. Damage is more likely to occur when alcoholics take the pills after, rather than before, the alcohol has metabolized.

There is treatment for acetominophen poisoning - it's called N-acetylcysteine (NAC). But always consult your doctor before taking products similar to Tylenol if you think you may be at risk for liver damage as a result of that medicine. And remember that an overdose of acetaminophen, with or without alcohol, is dangerous.

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


soundoff (25 Responses)
  1. Henry

    I have known 3 cases of older women who did not drink that died of liver cancer and the thing they all had in common was taking Tylenol daily for arthritis pain. It says on the label "Do not take longer than 2 weeks" you ask me, I'll tell you acetaminophen is bad news.

    Why take the risk?

    HW

    June 27, 2009 at 10:29 | Report abuse | Reply
    • Roger

      Henry, that's a good question. Personally, I'd strongly prefer medications such as cold remedies (i.e. decongestants) be coupled with asparin or actually with nothing else active. I want the decongestant for sure. If I want pain medication, I can take that as needed (and in the safest way possible, thank you).

      Unfortunately, in my experience, many medications like tylenol sinus, which works great for me, come with Tylenol.
      You would THINK that in an increasingly health-conscious (among the educated) and aging society that more and safer alternatives would not only be available, but would be heavily advertised.

      So if I have a cold, I can choose to not sleep (not a good thing for the cold or me), take sometihing less effective or with unpleasant side effects, or take the risk of the Tylenol.

      I try to leave a WIDE margin of safety, like only taking a qarter of the maximum dose in a 24 hour period, so hopefully that's enough.

      December 30, 2012 at 15:18 | Report abuse |
  2. robin southern

    i drink occassionally and was prescribed motrin 800mg for my bulging disc (when in severe pain) by my orthopedic, however because i suffer from ITP i was yanked off of the motrin...the pain is horrible at times and altho i am in physical therapy, no one will administer a cortizone shot due to the blood condition...when in pain i do take the motrin regardless...pain is pain and i cannot sleep at times because the pain is increased when i am horizontal...sleep is imperative to basic functions...what else can i do??

    June 27, 2009 at 18:34 | Report abuse | Reply
    • Bob

      Smoke medical marijuana – or eat it. I know it sounds like advice from a stoner – i'm a registered nurse – it actually helps people with all kinds of ailments. It won't cure you – just like many other FDA approved drug out there – but it will help allieve symptoms.

      November 27, 2011 at 17:09 | Report abuse |
  3. Ben

    I think it's interesting that this post was posted just a week or so ago, and now the FDA has finally come out and said they are taking a closer look at the safety of acetaminophen. I struggle understanding the real politics and priorities of the FDA. Who are they really protecting, Dr. Gupta? Are they legitimate? From a natural health industry perspective, we are usually a bit on the leery side of the trust spectrum...if that makes any sense. Example: some people lost their sense of smell, many just temporarily, from Zicam over a ten year period. The FDA came down hard and it was all over the media. This story has kind of been quiet in my opinion in the media and thousands of people have suffered liver damage, liver failure and even death over many many years.

    July 1, 2009 at 11:35 | Report abuse | Reply
    • Will

      Ben, I've seen this on the media for years. I've mentioned it to people before when they were about to take acetaminophen after drinking and their response is invariably something like "meh, everything's bad for you".

      January 2, 2011 at 13:46 | Report abuse |
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    Julia Swenson

    August 31, 2010 at 11:09 | Report abuse | Reply
  5. Kate Simpson

    Cool content. When will I get the additional information?

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    December 2, 2010 at 14:05 | Report abuse | Reply
    • Adam

      Thats true, you wouldn't be tinkag the drug very often so it probably wouldn't have a chance for you to become immune to it. It's definitely advisable to see your doctor for these types of infections. While tylenol and advil will help lesson the fever and pain, you still need something stronger to wipe out the actual virus.[]

      October 11, 2012 at 19:24 | Report abuse |
  6. Phil

    So you tell us what we knew, you warn us that it's worse to take the acetaminophen after the the alcohol has metabolized, but you don't tell us how long to wait after alcohol to avoid possible problems.
    10 days? 10 weeks?
    How long for a habitual drinker of 3 beers a day? How about for double that, 6 drinks a day? (It's a lot to me but I have a relative that drinks a sixpack a day). I am assuming that he is at risk, how long till that risk dissipates?

    For that matter, what about binge drinking?

    Thanks for the info and the great site!
    Phil

    December 16, 2010 at 14:30 | Report abuse | Reply
  7. Bobbert

    Yeah, it's amazing to me that this is legal and unregulated, and honestly under-reported, and weed is still banned. Seems like Tylenol has killed more people than that plant ever will. : /

    April 16, 2011 at 09:45 | Report abuse | Reply
  8. Frank

    Goodness... Do people really "need" to take Tylenol (chemicals)?? What would happen if you were suddenly stranded on an island for years without any? Would that be your first choice to have with you? Would you survive without it? I know people who take 2 every morning as a method of prevention. Our bodies have adapted to hundreds of thousands of years of evolution to combat the common cold and headaches but we pitch chemicals at it. It's best to find the cause and change your ways when possible than to coat it with chemicals and contaminate the whole unit (body) instead. Unbelievable. In many years from now people will look back and say: how ignorant they were. – It's okay to hurt a bit now and then! (And that's right, I never take pills... and I'm still here.)

    December 30, 2012 at 19:34 | Report abuse | Reply
    • Anna

      I agree with Frank for the most part. Growing up in my household, drugs were never the cure. When I had a cold, my mother never gave me cold medicine and when I had a head ache there was no tylenol given. I learned to push through the pain and my body learned to fight it off. I had a strong immune system and I was rarely sick. Now that I am 24 I have babysat a lot of children, I have watched mother after mother given their small children every sort of pain relief under the sun. I feel bad for them, their immune system won't learn to fight it. (What doesn't kill you makes you stronger).

      I will however say that pain medication prescribed by a doctor to deal with pain that causes you to not be able to function in day to day life is fine. but should be limited. If the Doctor says you can take 8 pills a day, try to get through the day on only 4.

      April 25, 2013 at 19:07 | Report abuse |
    • Jay

      "blessed" by good health. Hah. A pill is never the answer.

      June 23, 2014 at 23:18 | Report abuse |
    • Off-topic Timmy

      Of course a pill can be an answer. Why should someone endure pain if it can be safely relieved?

      June 23, 2014 at 23:20 | Report abuse |
  9. Ray Rhodes

    Frank your comments show a smug arrogance that seems to show you think yourself wiser and better than others simply because you have been blessed either genetically or environmentally with a healthy comfortable life and have not encountered serious ailments or injury, yet. If you live a long, healthy, pain free life you will be one of the fortunate few who don't endure some physical hardship at some point in thier life. Frank would you deny help to those who are suffering because you yourself are not suffering? Problems with drugs come from greedy companies that push more and newer drugs, doctors that over prescribe and patients that yes ignorantly don't use moderation as thier guide. Also Frank your ignorance may be showing about human adaptation to illness vs. virus and bacteria. Natural selection which allows the strongest most resistant virus to survive and reproduce plays only a small role in human reproduction which relies on love and pair bonding if you will and provides our strength through diversity but assures that some parts of a population will always be at the mercy of quickly adapting pathogens, without, of course, the miracle of modern medicine.

    January 2, 2013 at 02:03 | Report abuse | Reply
    • Jay

      No. Just, no. We have been fine without things like tylonol for hundreds of years, centuries, even. We will live through the pain as we always have. Have your crutch, I am good, thanks.

      June 23, 2014 at 23:22 | Report abuse |
    • Off-topic Timmy

      Fine. Nobody said YOU had to take anything. But don't pretend that you have any understanding of medicine or have any business advising anyone else as to what is best.

      There are many medications that have made life better for people. There are many that have made life POSSIBLE for people. No, Tylenol might not be necessary, but there's nothing noble about "enduring" pain. Doing so doesn't make you a better, stronger person, dear.

      June 23, 2014 at 23:27 | Report abuse |
  10. Erika

    While I have no known liver issues and am generally in excellent health, I would still like to know a time frame to shoot for between alcohol and tylenol. Better safe than sorry, as they say. If I've had one drink, how soon can I take Tylenol without the two over-laping? If I've taken a standard dose of Tylenol, how soon can I have a drink without the two conflicting? Is it as long as the pain killer is in effect? Or perhaps a full 12 hours for the body to flush it from the system? I was disappointed you spent the time to "look into it further" for us.... and yet did not provide an answer! It's not enough to shrug your shoulders and say, 'if you're healthy it's probably no big deal'.

    March 25, 2013 at 17:32 | Report abuse | Reply
  11. Richard

    The first thing she does is run to the Internet for answers. And Yahoo of all places, a purveyor of misinformation, cutting and pasting from other sources, and basically wouldn't know a reporter from a grapefruit. Finally, she consults Dr. Elizabeth Roth, a real doctor, the person she should have gone to in the first place and saved us a lot of time. CNN: find professionals with higher standards.

    August 22, 2013 at 17:10 | Report abuse | Reply
  12. Oxford Healthcare

    This is such a great article! I hear stories stemming from the old, "trustworthy", Yahoo answers all the time and wonder, 'how can people really trust that?'. Its great to see someone really taking a look at the real issues. It is important for patients to seriously consider their thoughts when their doctor probes them for their questions at the office. Did you know even home herbal remedies may interfere with prescription pills that could have a harmful side effect on your body? Medicine can be awfully confusing. Best to leave your questions to the doctors not Yahoo Answers. We tackled the subject on our blog here: https://www.militarymentalhealth.org/blog/2013/04/the-dangers-of-mixing-alcohol-with-medications-a-nurses-perspective/#comment-40598

    September 6, 2013 at 11:39 | Report abuse | Reply
    • Oxford Healthcare

      Correct Link to Post: http://www.oxford-healthcare.com/blog/medication-and-drinking/

      September 6, 2013 at 11:40 | Report abuse |
  13. Jeff

    My doctor said it is okay to take a couple of Tylenol after drinking a few beers. Just don't go overboard or do it every day.

    October 11, 2013 at 18:35 | Report abuse | Reply
  14. Headachine with a side of wine

    You have to remember, that as people are seeking a simple ys or no answer, their head is throbbing... I think I have read of enough and will continue searing the internets for my answer.

    February 24, 2014 at 21:26 | Report abuse | Reply
  15. Lawrence

    I don't understand the logic that medicine is inherently bad because early man didn't have it. That they "pushed" through the pain and were somehow better in the process. Or how if I use medicine it's a crutch. I am severely nearsighted. Should I stop using glasses and contacts? Should my mom stop using asthma medication or do you think my dad should just "suck it up" and deal with diabetes on his own? Maybe I should just have the dentist pull all my teeth when there's a cavity.

    Preposterous, of course. But if you use any form of modern medicine, dentistry, you take a vitamin supplement, or you have a hearing aid, or anything like that don't lecture the world about how weak the rest of us are because you refuse to take a Tylenol with a headache.

    September 27, 2014 at 10:39 | Report abuse | Reply

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