Tylenol and Alcohol

by on May 3, 2012


Adults who consume three or more alcoholic beverages per day should not use Tylenol (Acetaminophen) due to the increased risk for serious damage to the liver.  As such, patients who have been diagnosed with liver disease or cirrhosis—not necessarily from alcohol abuse—should not take Tylenol. Adults who drink socially should avoid drinking alcoholic beverages while being treated with Acetaminophen, as well. Patients with a history of alcoholism or liver disease should discuss these candidly with their physicians in order to define the best course of treatment depending upon the nature of the illness and its duration.

The manufacturers of Tylenol do not recommend its use by people who are having more than three alcoholic beverages a day.

Tylenol and Chronic Excessive Alcohol Comsumption

The use of alcohol during treatment with Tylenol is not recommended. Combining high doses of Tylenol and alcohol poses risk of liver damage and even acute liver failure leading to death if the condition is not treated.

Some studies suggest that chronic excessive alcohol use can put people at greater risk of liver damage even if they are not using alcohol during the treatment with Tylenol.

Tylenol is metabolized in the liver and is turned into inactive metabolites by conjugation with sulfate and glucuronide. A small percentage of acetaminophen is metabolized by the cytochrome P450 enzyme system and is turned into N-acetyl-p-benzoquinoneimine(NAPQI). This metabolite is neutralized by reacting with gluthatione. However, if NAPQI is not neutralized, it damages the liver cells.

Chronic alcohol use can make some of the cytochrome P450 enzymes more active. It can also cause decreasing of the quantity of gluthatione in the liver. Malnutrition commonly associated with alcoholism also contributes to higher toxicity of acetaminophen. Thus more acetaminophen is metabolized to NAPQI and there is not enough gluthatione to neutralize it which results in liver damage.

It is, however, thought that the use of alcohol during the treatment with acetaminophen in chronic alcohol users can have a protective effect as in this way the cytochrome P450 enzymes metabolize the alcohol instead of acetaminophen.

Still, there are not enough studies on this subject and there is debate between researchers. If you are regularly using alcohol, discuss the use of Tylenol with your doctor.

Tylenol and Occasional Alcohol Consumption        

Alcohol consumption can increase the toxicity of Tylenol. It is strongly recommended that you avoid the use of alcohol during treatment with Tylenol. Both Tylenol and alcohol are metabolized by the liver. In case you are drinking too much alcohol while being treated with Tylenol, your liver may have difficulties metabolizing acetaminophen. Acetaminophen doses higher than 4000 mg can cause acute liver failure. Liver toxicity may also occur in lower doses if acetaminophen is combined with alcohol. However, occasional moderate (a glass of wine, for example) consumption of alcohol in otherwise healthy individuals is not likely to cause major adverse reactions.

In case you regularly drink more than three alcoholic beverages a day or you have accidentally drunk more than this while being treated with Tylenol, call your doctor immediately. He or she will decide if you need treatment. Liver toxicity symptoms (nausea, vomiting, sweating, encephalopathy etc) do not develop straightaway. It usually takes 24 hours for them to occur. Treatment in this early period while no symptoms are yet noticeable is much more effective.