Alcohol and Tylenol Can Be a Deadly Combination
Share this post
Why taking acetaminophen (paracetamol) for a hangover is a dangerous idea.
The over-the-counter pain medication acetaminophen is a surprisingly controversial drug. Sold under the brand name Tylenol in North America and known as paracetamol in other countries, acetaminophen can be taxing to the liver. Acetaminophen is the number one cause of acute liver failure in the West.,,
The risks of liver damage, liver failure, and death go way up when the drug is combined with alcohol. That’s because alcohol prevents the liver from quickly detoxifying acetaminophen. This allows toxic intermediary metabolites released during the breakdown of acetaminophen to build up and harm the liver.
The liver metabolizes drugs in two phases: Phase 1 and Phase 2. In Phase 1 detoxification, enzymes convert drugs and toxins into intermediate forms. These intermediate substances then go on to Phase 2 for processing. In Phase 2, conjugation makes the intermediary metabolites less harmful to the body. The metabolites are then made water-soluble (able to dissolve in water), so they can easily pass out of the body through the urine and feces.,
Alcohol prevents the liver from quickly detoxifying acetaminophen.
When a healthy, sober person takes acetaminophen, their liver begins the work of breaking down the drug. The acetaminophen passes through Phase 1 detoxification and is turned into an intermediate metabolite called N-acetyl-p-benzoquinone imine, or NAPQI. Although NAPQI is toxic, only tiny amounts of NAPQI are produced, and then are almost immediately neutralized in Phase 2 with the help of the antioxidant glutathione. All that remains after Phase 2 is a non-toxic substance that’s filtered by the kidneys and excreted out of the body.
When there’s alcohol in the body, however, the detoxification of acetaminophen isn’t so clean cut. Alcohol is known to enhance up Phase 1 detoxification in the liver and decrease Phase 2. This a harmful double-punch, as Phase 1 detoxification converts acetaminophen into the toxic metabolite NAPQI. With Phase 2 being slowed down, NAPQI starts building up in the livers of people who have been drinking.
The liver needs a good supply of glutathione to turn that toxic NAPQI into a harmless substance in Phase 2. Unfortunately, however, alcohol depletes glutathione stores, sabotaging Phase 2 detoxification and further contributing to the buildup of toxic NAPQI. Regular drinkers tend to have even lower glutathione levels, placing them at even greater risk of NAPQI buildup. (Curiously, however, alcoholics are at greatest risk of acetaminophen-related toxicity within their first few days of sobriety).,,,
Alcohol depletes glutathione stores, sabotaging Phase 2 detoxification.
As mentioned earlier, NAPQI is toxic to the body. As it builds up in the liver, it causes damage to the liver cells (hepatocytes), and can even kill them. This injury can not only cause acute liver failure (a medical emergency), but also death. In fact, many cases of acute liver failure are caused by combining alcohol with acetaminophen.,
Many cases of acute liver failure are caused by combining alcohol with acetaminophen (paracetamol).
Healthier hangover remedies
If you find yourself nursing a hangover this holiday season, skip the acetaminophen. Some healthier strategies for dealing with hangovers can include:
- Staying hydrated with water, electrolytes, bone broth, and/or green juice
- Eating some protein (even if you’re not hungry) to balance blood sugar levels and curb nausea
- B vitamins
- Milk thistle and other liver-loving supplements
- N-acetyl cysteine (NAC) – which increases glutathione production, and can also be an antidote to acetaminophen poisoning
- Getting some fresh air, going for a gentle walk
- Smelling peppermint oil and applying it to the temples – one study showed it worked as well as acetaminophen for headaches!
- Resting in a dimly-lit setting, or wearing an eye mask
ReferencesClick here to see References
 Lee WM. Acetaminophen (APAP) hepatotoxicity – isn’t it time for APAP to go away? J Hepatol. 2017 Dec;67(6):1324-31. doi: 10.1016/j.jhep.2017.07.005.
 Woolbright BL, Jaeschke H. Role of the inflammasome in acetaminophen-induced liver injury and acute liver failure. J Hepatol. 2017 Apr;66(4):836-48.doi: 10.1016/j.jhep.2016.11.017.
 “Acute liver failure.” Mayo Clinic [Internet]. Accessed December 10, 2021. Available at: https://www.mayoclinic.org/diseases-conditions/acute-liver-failure/symptoms-causes/syc-20352863
 Draganov P, et al. Alcohol-acetaminophen syndrome. Even moderate social drinkers are at risk. Postgrad Med. 2000 Jan;107(1):189-95. doi: 10.3810/pgm.2000.01.831.
 Black M, Raucy J. Acetaminophen, alcohol, and cytochrome P-450. Ann Intern Med. 1986 Mar;104(3):427-9. doi: 10.7326/0003-4819-104-3-427.
 Grant DM. Detoxification pathways in the liver. J Inherit Metab Dis. 1991;14(4):421-30. doi: 10.1007/BF01797915.
 Hedgpeth B, et al. A review of bioinformatics tools to understand acetaminophen-alcohol interaction. Medicines (Basel). 2019 Jul 25;6(3):79. doi: 10.3390/medicines6030079.
 McClain CJ, et al. Potentiation of acetaminophen hepatotoxicity by alcohol. JAMA. 1980;244(3):251-3. doi:10.1001/jama.1980.03310030027020.
 Videla LA, Valenzuela A. Alcohol ingestion, liver glutathione and lipoperoxidation: metabolic interrelations and pathological implications. Life Sci. 1982 Nov 29;31(22):2395-407. doi: 10.1016/0024-3205(82)90743-3.
 Puri P, et al. Alcohol consumption is associated with the severity and outcome of acute liver injury/failure. Liver Int. 2020 Feb;40(2):360-7. doi: 10.1111/liv.14327.
 Krähenbuhl S, et al. Acute liver failure in two patients with regular alcohol consumption ingesting paracetamol at therapeutic dosage. Digestion. 2007;75(4):232-7. doi: 10.1159/000111032.
 Riordan SM, Williams R. Alcohol exposure and paracetamol-induced hepatotoxicity. Addict Biol. 2002 Apr;7(2):191-206. doi: 10.1080/13556210220120424.
 Bunchorntavakul C, Reddy KR. Acetaminophen (APAP or N-Acetyl-p-Aminophenol) and acute liver failure. Clin Liver Dis. 2018 May;22(2):325-46. doi: 10.1016/j.cld.2018.01.007. Epub 2018 Feb 9.
 Chu A. “Can I drink alcohol with Tylenol?” GoodRx Health [Internet]. Dec 3, 2021. Accessed Dec 10, 2021. Available at: https://www.goodrx.com/acetaminophen/tylenol-and-alcohol
 Larson Anne M. Acetaminophen hepatotoxicity. Clin Liver Dis. 2007 Aug;11(3):525-48. doi: 10.1016/j.cld.2007.06.006.
 Göbel H, et al. Peppermint oil in the acute treatment of tension-type headache. Schmerz. 2016 Jun;30(3):295-310. doi: 10.1007/s00482-016-0109-6.
Share this post
Dr. Erica Zelfand
Keeping Your Immune System On Guard
Six supplements that support healthy immune system function Let’s face it: we are surrounded by a veritable sea of viruses, bacteria, and other infectious agents. What keeps these nasties at bay, in addition to physical barriers such as the skin and mucus secretions, is the immune system. If pathogens happen to gain entry, the…
Fitting Exercise into Your Day
How to Fit Excercise Into a Busy Schedule Many of us struggle to find time for exercise, yet exercise is crucial for cardiovascular health, weight management, detoxification, and even mental and emotional health. The work day is long, and just fitting in the basics of grocery shopping, laundry, and getting from point A to…
Pine Bark for Blood Vessels Big and Small, Part 1 of 2
A natural solution for high blood pressure, hemorrhoids, and varicose veins At first glance, the ailments of high blood pressure, hemorrhoids, and varicose veins seem to have little in common. As any holistically trained healthcare provider knows, however, these conditions all share one common cause: poor vascular health. Also known as the circulatory system,…
Change Your Habits, Change Your Life
The key to success is in the cues As the year comes to a close, people often think about their goals for the year ahead. Eating more healthfully, getting more exercise, and losing weight are at the top of many New Year’s resolutions. A resolution is an intention, which is an important first step…
Botanicals for Asthma and Lung Health
Herbal tools to help you beat asthma and lung infections As we’ve learned all too well recently, we can’t take lung health for granted. Severe respiratory infections are on the rise, in addition to the chronic burdens of asthma, allergies, and air pollution., On top of that, many of us are experiencing smoke and…
Herbs to Help You Adapt During Times of Stress
Herbs from around the world to help with stress, fatigue, and the chaos of life “What doesn’t bend breaks,” as the saying goes, and the degree to which we are expected to “bend” is ever increasing. Our ability to stay focused, adaptable, and calm is of the essence in our fast-paced, outcome-oriented culture. Although…