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Mixing alcohol and acetaminophen—How can I reduce my risk for side effects?

Dear Alice,

I have been taking OTC cough/cold/flu preps for about a week. These all contain acetaminophen with the subsequent warnings against using if one imbibes due to possible liver damage. Is there a period of time I should wait (I'm better now) after I stop using the OTCs before I can resume enjoying my "more than 3 alcoholic beverages" per day to allow the acetaminophen to metabolize?

Dear Reader, 

It's great that you’re reading the warning labels of your over-the-counter (OTC) cold/flu medication in detail! Heeding the instructions and warnings of any medication is the way to go and acetaminophen is no exception. Heavy or chronic alcohol consumption in conjunction with acetaminophen use can exacerbate their toxic effects and can lead to liver damage or even acute liver failure. While you note the "more than three alcoholic beverages per day" message on the label, consuming more than three standard drinks per day is above the recommended daily limit for anyone. With that said, how efficiently your body metabolizes these substances (and thus, how much time you may want to wait between ingesting one after the other) also depends on additional individual factors. There are, however, strategies for lowering the risk of taking acetaminophen while consuming alcohol. 

As you may know, acetaminophen is a versatile drug used primarily for pain and fever relief. It eases mild to moderate pain such as headaches, muscle aches, toothaches, cold/flu-related aches, and menstrual (period) cramps. Though it’s commonly used and available OTC, excess acetaminophen may cause liver damage. While most of the acetaminophen is broken down and excreted from the body right away, some of the drug is converted into a byproduct that is toxic to the liver. If an individual continuously takes acetaminophen for an extended period, this toxin can build up in the liver and cause significant damage. The risk of the damage also depends upon the amount consumed, the individual’s body, and any other drugs, alcohol, or supplements taken with the acetaminophen. The general guidelines for adults are to take between no more than 325 to 500 milligrams (mg) by mouth every four to six hours, and not to take more than 4,000 mg of acetaminophen per day. You may want to consult a health care provider for custom recommendations, especially if your body’s processing ability is compromised. Consuming too much acetaminophen could result in an overdose. Symptoms associated with an overdose from acetaminophen are as follows: 

  • Nausea 
  • Vomiting 
  • Loss of appetite 
  • Sweating 
  • Extreme tiredness 
  • Unusual bruising or bleeding 
  • Upper right stomach pain 
  • Yellowing skin or eyes 
  • Flu-like symptoms 

List adapted from MedlinePlus

Drinking alcohol while taking acetaminophen may inhibit your body’s ability to fully metabolize both substances. To breakdown the toxic byproducts of acetaminophen and alcohol, glutathione (GSH), an amino-acid derivative that is an antioxidant, is required. When the liver’s store of GSH is depleted, the level of toxins in the liver can rise, potentially making it more susceptible to the negative effects of both substances. Extended use of these substances together may lead to acetaminophen-induced liver damage (a form of hepatotoxicity) or even acute liver failure. 

To prevent your liver from working overtime, it may help to know roughly how long it takes your liver to process these substances. Your metabolism depends on a host of factors, such as your age, weight, genetics, diet, time of day, environment, dose ingested, and sex. Generally, for alcohol, it takes about one hour to break down one ounce of alcohol (this converter helps determine how many standard drinks are in your glass of wine or bottle of beer), and it’s recommended to keep weekly alcoholic consumption to 14 standard drinks or less for males and 7 standard drinks or less for females. As for acetaminophen, it has a half-life (the time it takes the body to reduce the amount of substance by one-half) of two to three hours, which means it's eliminated from the body relatively quickly. However, since how long it takes to metabolize varies by person, here are some strategies to lower risk: 

  • Follow the label or prescription instructions for dosage amounts and timing of doses. 
  • Try not to take more acetaminophen than recommended or for longer than needed, even if the recommended dose doesn’t make you feel better. 
  • Try to avoid taking multiple medications with acetaminophen at the same time and consult your health care provider about the possible interactions between acetaminophen and other medications you’re taking. 
  • Try keeping alcoholic drinks to a max of two a day for men and one a day for women when taking acetaminophen or avoid alcohol entirely while taking acetaminophen. 
  • Avoid taking acetaminophen (or consult a health care provider) if you have a pre-existing liver condition or are a moderate or heavy drinker. 

List adapted from MedlinePlus

Hopefully these tips will help you take it easy on your liver! 

Cheers, 

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Last updated Nov 25, 2022
Originally published Jul 01, 2005