Why you should never, ever take Tylenol after drinking.
Acetaminophen (also known as Paracetamol, and sold under the brand name Tylenol in North America) is a contentious drug, and one that I typically recommend my patients avoid taking.
That’s because acetaminophen can be hard on the liver, and the difference between a dose of the drug that can ease pain and a dose of the drug that can cause liver failure is quite small – just a few pills. It’s been speculated that if acetaminophen were invented today, that it likely would not be approved as a non-prescription medication.
The number one cause of acute liver failure in the West?
You guessed it: acetaminophen.
Thankfully, most people recover if they call poison control or get to the emergency room in time. But the risks of acetaminophen-related liver damage, liver failure, and death go way up when the drug is combined with alcohol. That’s because alcohol compromises the liver’s ability to properly detox acetaminophen.
I explain the gist of things in this video (pretty much everything I just said above), but keep reading below if you like knowing how stuff works – I go into the details of why and how Tylenol + alcohol make such a dangerous combination.
The liver detoxifies and metabolizes drugs (among other agents) in two phases: Phase 1 and Phase 2.
In Phase 1 detoxification, the liver uses enzymes (from the cytochrome P450 family) to convert toxins into intermediate forms, which are then passed on to Phase 2.
In Phase 2, these intermediate metabolites are neutralized in a process known as conjugation. Conjugation makes the metabolites less harmful to the body, and also converts them into water-soluble forms so that they can easily pass out of the body through the urine and feces.
Phase 2 detoxification relies on a few molecules, notably the antioxidant glutathione.
When we take acetaminophen, our livers begin the work of breaking down the drug. The acetaminophen passes through Phase 1 detoxification and is turned into the intermediate metabolite known as NAPQI. Although NAPQI is quite toxic, in a healthy person with good liver function who takes no more than the recommended dose of acetaminophen, only small amounts of NAPQI are produced. These tiny amounts of NAPQI are then almost immediately neutralized in Phase 2, with the help of glutathione.
After Phase 2 is completed, all that remains is a non-toxic substance that is filtered through the kidneys and excreted out of the body.
So, under normal circumstances, our bodies can detoxify acetaminophen. But when there’s alcohol in the system, things get dicey.
When acetaminophen and alcohol are combined:
Alcohol speeds up Phase 1 detoxification in the liver and decreases Phase 2.
While it may sound like a good thing that alcohol increases Phase 1, it’s actually quite harmful – especially when combined with acetaminophen. Remember: Phase 1 detoxification converts acetaminophen into the toxic metabolite NAPQI.
While normally Phase 1 detoxification of acetaminophen creates only a small amount of NAPQI – which is then quickly conjugated in Phase 2 detoxification – alcohol slows down this operation. NAPQI starts building up.
Alcohol also depletes the body’s glutathione stores, further compromising Phase 2 detoxification (recall that Phase 2 detoxification relies on glutathione). Those who drink alcohol on a regular basis are likely to have lower glutathione levels than the rest of us, placing them at even higher risk of harm from NAPQI.
If Phase 2 cannot keep up with Phase 1, that leaves a lot of toxic NAPQI floating around in the liver. This can cause significant harm to the hepatocytes (liver cells), with effects like hepatocellular damage and necrosis. This can result not only in acute liver failure, but also death.
One-third (1/3) of all cases of acute liver failure are caused by combining alcohol with acetaminophen.
That is why I will never take Tylenol within 24 hours of drinking so much as a single glass of wine.
Love your liver!
A good liver cleanse should include more than just vitamins and supplements: It must also include abstinence from alcohol, caffeine, perfumes, chemical-laden cleaning products, most commercial bodycare items, and other toxins.
Loving the liver also entails eating sulfur-rich foods like broccoli and kale to boost glutathione production, consuming plenty of antioxidant-rich foods like fresh berries, eating enough fiber (to bind up those toxins and push them out into the stool), drinking plenty of filtered water (to flush out those toxins through the urine), moving the body (to get the blood moving and push toxins out through the sweat), and getting good quality rest.
But even if a New Years cleanse isn’t on your to-do list, please: