Drinking and Tylenol: The Risks and Precautions to Take

More than 60 million Americans use Tylenol weekly. This is to say that at least one of every five Americans uses Tylenol. 

At the same time, 85.6% of American adults report drinking alcohol during their lifetime. Thus, it stands to reason that a large population takes alcohol and Tylenol together. In fact, studies show that individuals who drink alcohol are more likely to take high doses of acetaminophen. This is because Tylenol can ease alcohol hangover symptoms, such as headaches.

But is this combination safe? We’ll discuss this and more. 

What Is Tylenol and How Does It Work? 

Tylenol is an over-the-counter painkiller containing the active ingredient acetaminophen. It relieves pain by inhibiting enzyme activity (specifically, the COX-3 enzyme) in the brain and nervous system. 

• How Long Does Tylenol Stay in the Body?

According to a study on 32 healthy participants, acetaminophen’s half-life (the time it takes for its concentration in blood to half) is 2.7 hours. Since the body takes a duration equal to five half-lives to eliminate any substance, Tylenol stays in the body for up to 13.5 hours.  

This number increases in cases of:

• Liver disease, because the liver metabolizes acetaminophen. 
• Kidney disease, because the kidney is responsible for acetaminophen excretion.
• Old age, because the body's organ functions and metabolism decrease with age. 

• Tylenol Dosage and Administration

Tylenol dosage varies based on age and body weight. In general, though, doctors recommend against exceeding a dose of 75 mg per kilogram of body weight. 

Patients can take this dose orally (in tablet or syrup form) or healthcare professionals can administer it intravenously. 

• How Much Tylenol Is Too Much?

39% of people who take more than 4,000 mg of acetaminophen for more than three consecutive days while also consuming alcohol show biochemical signs of liver injury. In other words, users should not exceed 4,000 mg of acetaminophen daily. 

However, this varies considerably on a case-by-case basis. Thus, for a more personalized answer, please consult a healthcare professional. 

Tylenol Side Effects

Common Side Effects

Serious Side Effects

Nausea

Vomiting

Loss of appetite 

Abdominal cramps

Constipation 

Itchiness 

Rashes 

Jaundice (yellowish discoloration of skin and eyes)

Clay-colored stool

Dark urine

Anaphylactic reaction 

Toxic epidermal necrolysis (a dangerous dermatological condition characterized by skin peeling and blistering) 

Acute generalized exanthematous pustulosis (sudden onset of small red skin boils)

Stevens-Johnson syndrome (a rare and dangerous skin condition marked by painful rashes and blisters around the eyes, face, and genitals)

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Alcohol and Tylenol: A Health Risk?

Combining small alcohol and Tylenol doses is generally safe. A study on 102 healthy participants taking a cumulative 4,000 mg dose of Tylenol for two consecutive days while consuming moderate alcohol quantities reported no major side effects.   

However, long-term misuse can lead to major problems, such as liver and kidney failure. 

• Why Is Combining Acetaminophen and Alcohol Dangerous?

The liver, as discussed, is the main organ that metabolizes and breaks down Tylenol. The end products of this process are toxic and can damage the liver (among other organs). Luckily, the liver contains ample stores of glutathione, a chemical that detoxifies these dangerous metabolites. 

Long-term alcohol misuse and excess Tylenol use both deplete glutathione reserves. This leaves the body (and liver) vulnerable to acetaminophen metabolites should the user take Tylenol. 

• Liver Damage: A Consequence of Combining Tylenol and Alcohol

Combining Tylenol and alcohol can lead to irreversible liver damage, the symptoms of which include:

• Yellowish tinge to the eyes and skin
• Darkening of urine
• Changes in stool color
• Loss of appetite
• Nausea and vomiting
• Weakness and fatigue
• Weight loss
• Abdominal pain
• Itchy skin 
• Lower limb swelling
• Stomach fluid buildup, leading to bloating and ulcers 
• Confusion and memory Loss

If you experience any of these symptoms, please get in touch with your healthcare provider immediately. 

• Can I Drink Alcohol After Taking Tylenol? 

In general, users should wait at least 24 hours after their last Tylenol dose before consuming alcohol. Given Tylenol’s 2.7 hour half-life, the 24-hour interval allows the body to eliminate it. 

Who Is at Risk of Liver Injury When Combining Alcohol and Tylenol?

The following individuals are at an increased risk of developing liver injury when combining alcohol and Tylenol:

• People who consume more alcohol than recommended. This stems from the glutathione depletion (discussed above) associated with alcohol misuse. In a study on 79 Tylenol users with liver injury, the survival rate in low-quantity alcohol drinkers was twice that of heavy alcohol users. 
• People who take greater than recommended Tylenol doses. As discussed, taking more than 4,000 mg of Tylenol puts users at a 50% greater risk of developing liver failure. 
• People with a body-mass index (BMI) greater than 35 kg/m2. 80.2% of 1,000 participants with BMIs of more than 35 developed liver injury (regardless of their Tylenol and alcohol use). This is because these patients have greater liver deposits, which leads to liver scarring and dysfunction. 
• Those with pre-existing liver disease. Since the liver metabolizes Tylenol and alcohol, liver disease increases risk of further injury when combining these two substances. 
• Those who eat an incomplete diet. Studies show a deficient diet increases the risk of acetaminophen overdose and liver injury. This is because the liver needs energy to break down Tylenol. Without it, acetaminophen remains in the body longer, raising one’s risk for liver damage. 
• Those who take liver-toxic medication. Understandably, hepatotoxic medications (such as isoniazid and rifampicin) increase risk of acetaminophen-related liver injury by up to 50%.  

How to Reduce Your Risk of Liver Damage

Here are some best practices that can reduce the risk of liver damage when taking acetaminophen and alcohol:

• Limiting acetaminophen dosage to 4,000 mg daily for no more than three days.  
• Limit alcohol intake to a maximum of three drinks per day. At the same time, total weekly intake should not exceed seven drinks. 
• Take only one acetaminophen product at a time. Several over-the-counter medicines contain acetaminophen. Taking more than one acetaminophen product increases liver damage risk. 

Tylenol (Acetaminophen) Alternatives 

Many safer Tylenol alternatives exist for alcohol users who need to manage pain. These include:

• Non-steroidal anti-inflammatory drugs (NSAIDs). Research shows fewer liver associated injuries when combining alcohol and NSAIDs. The reasons for this remain under investigation. 
• Topical analgesics. Users apply these over-the-counter pain-killers directly to aching areas. Thus, only small quantities of the medication enter the bloodstream, making it a safe Tylenol alternative. 

As always, please consult your healthcare provider when taking any new medication. 

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