Is it safe to drink while taking Tylenol?

You pulled a muscle in your back during your workout yesterday, so you take a couple of extra strength Tylenol, then go out to dinner with friends and have a glass of wine. Did you just create a potentially harmful combination of substances?

You probably didn’t do damage, if you took the recommended dose of Tylenol and only had one drink. But technically, mixing alcohol and acetaminophen (sold over the counter as brand-name Tylenol) can cause problems for your liver.

“Unless your doctor tells you otherwise, you should usually avoid drinking alcohol while taking [pain relievers and fever reducers],” says Daniel Kim, MD, a family physician in New York City.

It’s not necessarily a hard-and-fast rule, however, as Dr. Kim says how much alcohol you can safely drink while taking these drugs depends on a number of factors: what medication you’re taking and how much your dosage is, your individual tolerance, how often you drink, and your overall health.

Here’s what you need to know about the safety of mixing Tylenol and alcohol, including how and when it may be okay to combine them, possible side effects of drinking while on Tylenol, and who shouldn’t take them together at all.

How do Tylenol and alcohol interact?

When you take over-the-counter pain relievers and drink alcohol, it can harm your health in a number of ways, Dr. Kim says. Depending on what kind you take, side effects include damaging your liver, making you more likely to bleed in your gut, and slowing down your central nervous system.

In particular, mixing Tylenol and alcohol can increase the risk of liver damage because both substances are processed and broken down by the liver. Consuming both at the same time can essentially force your liver to work overtime and make it harder for this essential organ to perform its usual functions.

This is because of how our liver responds to alcohol consumption. Erika Gray, Pharm.D., co-founder of Toolbox Genomics, says that when you drink alcohol, the production of a toxic metabolite called N-acetyl-p-benzoquinone imine (NAPQI) increases, while the level of an antioxidant called glutathione decreases. Because glutathione is responsible for binding to NAPQI and inactivating it to protect your liver, regular alcohol use will cause you to have naturally higher NAPQI levels.

These levels can become even more toxic, Dr. Gray adds, when you take Tylenol and alcohol at the same time because Tylenol also increases NAPQI. Essentially, combining the two substances makes it harder for your liver to perform its usual detox process and counteract the damage.

Is it safe to mix alcohol with Tylenol?

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Although it’s not best practice, it’s possible to consume some alcohol while taking Tylenol. But Dr. Gray says it’s important to understand the potential risks. “Anytime you consume alcohol and/or Tylenol, your body uses [glutathione to inactivate] the toxic metabolites from the two products, so the more alcohol and/or Tylenol you consume, the [less glutathione will be] available to your body to help protect your liver,” she explains.

This means that a moderate amount of alcohol (one drink a day for women and two a day for men) may be safely mixed with Tylenol, but you should still take caution to limit your use of both Tylenol and alcohol when combining the two. Dr. Gray says the maximum recommended dose of Tylenol per day is 4,000 milligrams, and that it’s generally safe to consume a moderate amount of alcohol as long as you’re keeping your Tylenol dosage under that.

That said, it’s extremely important to be aware of other potential sources of acetaminophen in your medication regimen; it is found in many combination medications and pain management medications, such as Excedrin Migraine or Theraflu, making it easy to take too much accidentally.

If you’re closely monitoring your Tylenol intake and planning to consume an alcoholic drink, Dr. Gray says it doesn’t matter whether you drink alcohol first and then take Tylenol or vice versa, nor does it matter how much time passes between your intake of either substance.

So instead of worrying about how long after taking Tylenol you can drink alcohol or vice versa, focus more on drinking in moderation and avoid binge drinking: “If you [decide to] drink and take Tylenol, it would be wise to limit the amount of alcohol to two standard drinks for men and one for women,” Dr. Gray says.

Who should not mix Tylenol and alcohol?

Otherwise healthy people without existing liver disease can follow the recommendation to moderate—rather than restrict—alcohol intake when taking Tylenol. But if you’ve been diagnosed with cirrhosis of the liver, elevated liver enzymes, low glutathione levels, or any other liver condition, Dr. Gray warns, you limit your Tylenol intake to 2,000 milligrams or less per day and avoid drinking alcohol entirely.

“If you would like to protect your liver and have a good quality of life as you age, abstaining from [combining] alcohol and Tylenol where appropriate is critical,” she says.

Side effects of mixing Tylenol and alcohol

Many people can take the recommended dose of Tylenol and consume one or two alcoholic beverages without experiencing any side effects, but sometimes these substances don’t play nicely together. Dr. Kim says mixing Tylenol and alcohol can lead to side effects, including:

• Upset stomach, including nausea and vomiting
• Increased drowsiness
• Ulcers and gastrointestinal bleeding in the stomach or intestines
• Kidney damage
• Liver damage
• Sudden liver failure, which could be fatal

Mixing alcohol with other painkillers

Tylenol belongs to a category of drugs known as analgesics/antipyretics, or pain relievers and fever reducers. Other pain relievers have analgesic and antipyretic properties, too, but technically belong to a category of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs) because they also help relieve inflammation. These include aspirin, ibuprofen (sold under the brand names Advil and Motrin), and naproxen (sold under the brand name Aleve). NSAIDs can often be used interchangeably with Tylenol to treat pain and fever.

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That said, Dr. Kim notes the risks of mixing alcohol with pain relievers can vary depending on the type of drug you’re taking: Tylenol and alcohol can cause liver damage when taken together, while NSAIDs plus alcohol can increase the chance of upset stomach and GI bleeding.

It’s important to note that these are all over-the-counter (OTC) pain relievers. Prescription painkillers, especially opioids like oxycodone or hydrocodone, should never be mixed with alcohol, says Dr. Kim.

The risks from mixing painkillers with alcohol depend on several factors, such as the type and amount of medicine and alcohol taken, the person’s general health, and how well they handle these substances, Dr. Kim explains, but in general, mixing alcohol and painkillers can cause serious or even fatal consequences, including:

• Slowing down of the central nervous system, causing extreme drowsiness, poor balance, and loss of awareness
• Respiratory depression, which can make it hard to breathe and result in coma or death
• Severe liver injury or acute liver failure, which can be life-threatening
• Increased risk of overdose

“Most of the time,” notes Dr. Kim, “you shouldn’t drink alcohol while taking painkillers or antipyretics to make sure you stay safe and avoid problems.”

How to take Tylenol safely

Always check with your healthcare provider before taking acetaminophen, in case it’s contraindicated for any other existing health conditions you have or other medications you take. Dr. Gray says other medications that shouldn’t be combined with Tylenol (or may require a lower dosage of Tylenol) include Dilantin (phenytoin) and Tegretol (carbamazepine), though there are others that may interact as well. It’s always a good idea to ask for medical advice or check with your pharmacist about the safety of combining Tylenol with other drugs.

Furthermore, Dr. Gray says, some foods can decrease the absorption of Tylenol or delay its effects. This includes foods containing pectin, such as apples, citrus fruits, and plums, so you may want to avoid taking Tylenol at the same time as eating these foods.

The bottom line: Stick to the recommended dose and moderation

Generally, healthy people without a history of liver problems may be able to combine the recommended dosage of Tylenol with a limited amount of alcohol from time to time without experiencing side effects, though regular consumption of alcohol can make it harder for your liver to clear away damage-causing metabolites, especially when you’re also taking Tylenol.

So, while drinking the occasional beer or glass of wine after taking a single dose of Tylenol is unlikely to cause damage for otherwise healthy people, the best practice is to avoid the two as much as possible. This will not only reduce your risk of side effects but also help keep your liver healthy as you age.

Sources

• Is Acetaminophen Safe to Take When You’re Drinking? Cleveland Clinic (2020)
• The Role of Glutathione in Protecting against the Severe Inflammatory Response Triggered by COVID-19. Antioxidants (2020)
• What is a standard drink? National Institute on Alcohol Abuse and Alcoholism (Online)