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How Long Should I Wait to Drink After Taking Tylenol?

Hexmage-PAHexmage-PA Registered User regular
edited April 2010 in Help / Advice Forum
I took four extra strength Tylenol yesterday. I took the last two somewhere between 3 and 5 PM. It's been over 24 hours. Would it be safe for me to drink tonight?

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  • LailLail Registered User regular
    edited April 2010
    Not a doctor, but I wouldn't worry about it.

  • CervetusCervetus Registered User regular
    edited April 2010
    http://www.tylenolprofessional.com/pharmacology.html

    The half-life in a normal adult of Tylenol is 2-3 hours, so a conservative estimate would say you have ~0.39% of the original Tylenol in your body after 24 hours. I'd say you're safe.

    The libertarian response to anything is, "Sure, that works fine in practice, but it doesn't fly in theory."
  • Hexmage-PAHexmage-PA Registered User regular
    edited April 2010
    Is that estimate taking into account that I used extra strength Tylenol?

    I'm frankly surprised that I can't find a straight answer with a simple Google search. I'd think this would be the sort of thing that should be common knowledge.

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  • CervetusCervetus Registered User regular
    edited April 2010
    I believe extra strength is just more of the same, so the ratio should still hold.

    The libertarian response to anything is, "Sure, that works fine in practice, but it doesn't fly in theory."
  • ScrubletScrublet Registered User regular
    edited April 2010
    You're safe. While you're right to be cautious, the amount of Tylenol you have to take for an acute overdose is really high. This applies to drinking on it too...while not particularly smart I couldtake Tylenol right now and drink my face off and be fine. Behind the scenes of course I haven't done my liver any favors but this one time stupidity wouldn't put me in the hospital.

    Don't quote halflife of tylenol though. It's not the Tylenol that interacts in the liver with alcohol to cause damage. It's what the liver creates from the Tylenol, something called NSAID I think. Something like that. I don't know its halflife bu I think it's longer than a couple hours.

    subedii wrote: »
    I hear PC gaming is huge off the coast of Somalia right now.
  • Hexmage-PAHexmage-PA Registered User regular
    edited April 2010
    I just checked the Tylenol packaging. It says "if you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take acetaminophen".

    That's vague and unhelpful.

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  • DjeetDjeet Registered User regular
    edited April 2010
    If you ate the max dose of tylenol and went on a bender your liver enzymes would be through the roof and it might take awhile for it to come down. Assuming you don't have a propensity towards liver disease already, doing this once in a blue moon probably isn't a big deal.

    That said Tylenol irritates the liver all by its lonesome, so if you are a regular drinker you should be aware of that and that combining your regular drinking habit with regularly consuming tylenol is setting you up for liver damage in the long run. The liver heals via fibrosis, so you don't grow back damaged liver cells.

    If you're concerned about lifestyle interaction with drugs (even OTC) you should probably go in for yearly checkups where they can do bloodwork and see if you're consistently off (e.g. consistently highly elevated liver enzymes).

    If you do go out drinking tonight, do be sure to drink plenty of water.


    Edit: To add to what Cervetus was saying, here's a nice article.

  • CervetusCervetus Registered User regular
    edited April 2010
    Huh, researching this has been very informative and helped me procrastinate.

    So it appears that the reason you don't mix alcohol and acetaminophen (Tylenol) is that chronic alcohol usage stimulates the P-450 2E1 metabolic pathway, and it's this pathway that converts acetaminophen into NAPQI, which is the thing that fucks up you liver. The real risk, then, is in drinking and then taking Tylenol, and not the other way around. Also based on this information the half-life of acetaminophen should still be the important piece of information on when you can drink again.

    The libertarian response to anything is, "Sure, that works fine in practice, but it doesn't fly in theory."
  • Hexmage-PAHexmage-PA Registered User regular
    edited April 2010
    I wondered why I kept seeing "don't take Tylenol after drinking" and not "don't drink after taking Tylenol".

    I did find this, though: "...historically moderate alcohol drinkers can resume imbibing one week after they've stopped taking acetaminophen."

    I generally only drink once a week, but when I do I have about 3 or 4 shots of vodka. I don't like the taste of beer, and I only drink so I can become intoxicated. I don't know if that qualifies me as a "moderate alcohol drinker" or not.

    I'm thinking it might be best if I just wait until next weekend to drink.

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  • CervetusCervetus Registered User regular
    edited April 2010
    Well it wouldn't hurt to not get drunk I guess. I was hoping to use your liver as a data point though. :(

    The libertarian response to anything is, "Sure, that works fine in practice, but it doesn't fly in theory."
  • Casual EddyCasual Eddy Fighting the War on String Registered User regular
    edited April 2010
    Hexmage-PA wrote: »
    I wondered why I kept seeing "don't take Tylenol after drinking" and not "don't drink after taking Tylenol".

    I did find this, though: "...historically moderate alcohol drinkers can resume imbibing one week after they've stopped taking acetaminophen."

    I generally only drink once a week, but when I do I have about 3 or 4 shots of vodka. I don't like the taste of beer, and I only drink so I can become intoxicated. I don't know if that qualifies me as a "moderate alcohol drinker" or not.

    I'm thinking it might be best if I just wait until next weekend to drink.

    it won't be a problem unless you consistently do it

    Elki wrote: »

    Casual Eddy: best poster 2014.
  • ScrubletScrublet Registered User regular
    edited April 2010
    Cervetus wrote: »
    Huh, researching this has been very informative and helped me procrastinate.

    So it appears that the reason you don't mix alcohol and acetaminophen (Tylenol) is that chronic alcohol usage stimulates the P-450 2E1 metabolic pathway, and it's this pathway that converts acetaminophen into NAPQI, which is the thing that fucks up you liver. The real risk, then, is in drinking and then taking Tylenol, and not the other way around. Also based on this information the half-life of acetaminophen should still be the important piece of information on when you can drink again.

    I looked this shit up extensively back when I was on vicodin, which has 500mg of acetaminophen per pill. It's bad no matter what order you do it in. Basically, your liver metabolizes acetam into something that is bad for your liver. To simplify the issue, this weakens your liver. So drinking is more of a problem. This is why you definitely don't want to take tylenol for a hangover on a regular basis...the mixing and matching is not good for it. However, this is all in a chronic case.

    For a one-time thing, like the OP, you would have to do 8-9 grams of tylenol to have a huge issue.

    subedii wrote: »
    I hear PC gaming is huge off the coast of Somalia right now.
  • ScrubletScrublet Registered User regular
    edited April 2010
    It also bears mentioning this isn't a bad thing to call attention to...as I understand it acetaminophen is the most commonly overdosed drug in the country. It's why every so often a huge to-do is made over restricting vicodin, percocet, and other addictive painkillers paired with acetaminophen.

    subedii wrote: »
    I hear PC gaming is huge off the coast of Somalia right now.
  • cmsamocmsamo Registered User regular
    edited April 2010
    Scrublet wrote: »
    Cervetus wrote: »
    Huh, researching this has been very informative and helped me procrastinate.

    So it appears that the reason you don't mix alcohol and acetaminophen (Tylenol) is that chronic alcohol usage stimulates the P-450 2E1 metabolic pathway, and it's this pathway that converts acetaminophen into NAPQI, which is the thing that fucks up you liver. The real risk, then, is in drinking and then taking Tylenol, and not the other way around. Also based on this information the half-life of acetaminophen should still be the important piece of information on when you can drink again.

    I looked this shit up extensively back when I was on vicodin, which has 500mg of acetaminophen per pill. It's bad no matter what order you do it in. Basically, your liver metabolizes acetam into something that is bad for your liver. To simplify the issue, this weakens your liver. So drinking is more of a problem. This is why you definitely don't want to take tylenol for a hangover on a regular basis...the mixing and matching is not good for it. However, this is all in a chronic case.

    For a one-time thing, like the OP, you would have to do 8-9 grams of tylenol to have a huge issue.

    Damn, this is worrying to me.

    Tylenol is not actually sold in the UK (where I am from) for whatever reason, but since I started taking it when in North America, I swore by it, and bought a bottle home with me. I've been taking it for hangovers for ever (because god damn it shifts them REALLY well compared to the UK shit we have).

    Seems like I should rapidly reconsider this approach....

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  • KlorgnumKlorgnum Registered User
    edited April 2010
    cmsamo wrote: »
    Scrublet wrote: »
    Cervetus wrote: »
    Huh, researching this has been very informative and helped me procrastinate.

    So it appears that the reason you don't mix alcohol and acetaminophen (Tylenol) is that chronic alcohol usage stimulates the P-450 2E1 metabolic pathway, and it's this pathway that converts acetaminophen into NAPQI, which is the thing that fucks up you liver. The real risk, then, is in drinking and then taking Tylenol, and not the other way around. Also based on this information the half-life of acetaminophen should still be the important piece of information on when you can drink again.

    I looked this shit up extensively back when I was on vicodin, which has 500mg of acetaminophen per pill. It's bad no matter what order you do it in. Basically, your liver metabolizes acetam into something that is bad for your liver. To simplify the issue, this weakens your liver. So drinking is more of a problem. This is why you definitely don't want to take tylenol for a hangover on a regular basis...the mixing and matching is not good for it. However, this is all in a chronic case.

    For a one-time thing, like the OP, you would have to do 8-9 grams of tylenol to have a huge issue.

    Damn, this is worrying to me.

    Tylenol is not actually sold in the UK (where I am from) for whatever reason, but since I started taking it when in North America, I swore by it, and bought a bottle home with me. I've been taking it for hangovers for ever (because god damn it shifts them REALLY well compared to the UK shit we have).

    Seems like I should rapidly reconsider this approach....

    The active ingredient in Tylenol is Acetaminophen, also known as Paracetamol outside of North America (or so wikipedia tells me). There are a few drugs that are available in England that have the same active ingredient. You still shouldn't take them for a hangover, but you don't need to worry about running out of Tylenol.

  • Sharp101Sharp101 TorontoRegistered User regular
    edited April 2010
    Scrublet wrote: »
    Cervetus wrote: »
    Huh, researching this has been very informative and helped me procrastinate.

    So it appears that the reason you don't mix alcohol and acetaminophen (Tylenol) is that chronic alcohol usage stimulates the P-450 2E1 metabolic pathway, and it's this pathway that converts acetaminophen into NAPQI, which is the thing that fucks up you liver. The real risk, then, is in drinking and then taking Tylenol, and not the other way around. Also based on this information the half-life of acetaminophen should still be the important piece of information on when you can drink again.

    I looked this shit up extensively back when I was on vicodin, which has 500mg of acetaminophen per pill. It's bad no matter what order you do it in. Basically, your liver metabolizes acetam into something that is bad for your liver. To simplify the issue, this weakens your liver. So drinking is more of a problem. This is why you definitely don't want to take tylenol for a hangover on a regular basis...the mixing and matching is not good for it. However, this is all in a chronic case.

    For a one-time thing, like the OP, you would have to do 8-9 grams of tylenol to have a huge issue.


    Hmm. This is interesting to me. Excuse the long post incoming.

    I'm a migraine sufferer, it runs in the family. I have had bad ones every so often since I was young. Throughout College I remember them being pretty bad and I used to take a lot of Tylenol, aspirin and other things to combat these migraines. It wasn't uncommon to take 4-6 extra strength pills a day just trying to cope on bad days, sometimes a few days in a row or a few times a month. I can remember a few times it being bad enough that I puked several times over a few hours, but this has happened after about 8 Tylenol in 24 hours and when taking no pills at all.

    Of course, I also drank a lot in University. This didn't always agree with my headaches, but at first it wasn't a common trigger. Though high school then University my tolerance for alcohol got worse and worse until just after University I started to feel sick after 2 beers. In comparison, 4 years ago when I first met my girlfriend we split a 24 of cheap canned beer one night. I don't remember feeling that sick the next morning. Now I can manage maybe one, I probably wouldn't be able to finish a second without feeling sick. Needless to say after college (4 years ago) I've stopped drinking. Although latlely I can drink some liquor (Vodka) without problems. I haven't gotten wasted in years though.

    Just over a year ago my Doctor noticed some random enzymes in my liver were high. After another check they were fine, then a few months later funny again, then a few months later normal again. The specialist said it's nothing to worry about. Although I apparently have a little too much fat around my liver (I'm 5'10" 155lbs)


    Have I damaged my liver by taking too much acetaminophen and drinking a lot?

  • Raif SeveranceRaif Severance Registered User regular
    edited April 2010
    Only about 5% of the Acetaminophen that is metabolized is oxidized by the CYP 2E1 enzyme. This oxidation is what produces the harmful metabolite that destroys your liver. Your liver has a store of glutathione that works to neutralize this harmful metabolite. The way that acetaminophen becomes toxic is when you use up your store of glutathione by ingesting too large a dose. The goal is not to exceed 4 grams of acetaminophen a day.

    The most trouble you can get into with taking acetaminophen and drinking alcohol is within 12 hours after alcohol withdrawal. At this time your enzymes are induced (or elevated) but there is no alcohol to compete with the acetaminophen to bind to the CYP 2E1 enzyme. This allows for a greater chance for the acetaminophen to be metabolized to the toxic form. More of the toxic form means more glutathione is required to neutralize it. You only have a certain amount of glutathione stored and it takes time to replace it.

    So if you are using the 650 mg tabs the usual dosing is 1 tablet every 4 hours. This allows for 6 doses a day. If you are a moderate to heavy drinker (3 drinks a day) then I would probably recommend lowering the max dose to 3 g. Always read the ingredients of an OTC medication to see if it has any acetaminophen in it, especially if you are taking anything else that already has acetaminophen.

    Edit:

    As a general rule: You will be hard pressed to find any literature recommending combining alcohol with any medication. In other words, avoidance is your best bet followed by moderation.

  • corcorigancorcorigan Registered User regular
    edited April 2010
    Klorgnum wrote: »
    cmsamo wrote: »
    Scrublet wrote: »
    Cervetus wrote: »
    Huh, researching this has been very informative and helped me procrastinate.

    So it appears that the reason you don't mix alcohol and acetaminophen (Tylenol) is that chronic alcohol usage stimulates the P-450 2E1 metabolic pathway, and it's this pathway that converts acetaminophen into NAPQI, which is the thing that fucks up you liver. The real risk, then, is in drinking and then taking Tylenol, and not the other way around. Also based on this information the half-life of acetaminophen should still be the important piece of information on when you can drink again.

    I looked this shit up extensively back when I was on vicodin, which has 500mg of acetaminophen per pill. It's bad no matter what order you do it in. Basically, your liver metabolizes acetam into something that is bad for your liver. To simplify the issue, this weakens your liver. So drinking is more of a problem. This is why you definitely don't want to take tylenol for a hangover on a regular basis...the mixing and matching is not good for it. However, this is all in a chronic case.

    For a one-time thing, like the OP, you would have to do 8-9 grams of tylenol to have a huge issue.

    Damn, this is worrying to me.

    Tylenol is not actually sold in the UK (where I am from) for whatever reason, but since I started taking it when in North America, I swore by it, and bought a bottle home with me. I've been taking it for hangovers for ever (because god damn it shifts them REALLY well compared to the UK shit we have).

    Seems like I should rapidly reconsider this approach....

    The active ingredient in Tylenol is Acetaminophen, also known as Paracetamol outside of North America (or so wikipedia tells me). There are a few drugs that are available in England that have the same active ingredient. You still shouldn't take them for a hangover, but you don't need to worry about running out of Tylenol.

    You can buy it from practically any shop in the UK in 500 mg tablets for about 20p for 16 (or if you're foolish and buy a brand name version, about £3). Half the country takes the stuff every Saturday and Sunday morning after getting sloshed the night before.

    I can't comment on whether that is a good idea or not.

    Ad Astra Per Aspera
  • AvicusAvicus Registered User regular
    edited April 2010
    I would recommend that if possible try and use NSAIDs for pain relief and not APAP. NSAIDs like ibuprofen and aspirin are much, much easier on the body requiring lots to cause damage.

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  • ScrubletScrublet Registered User regular
    edited April 2010
    Yea Ibuprofen can be hard on your kidneys but it takes a lot. Only time that happened to me was when I got very sick during an Air Force pilot physical when I was still involved with that. I didn't want to get home so I wound up taking a fuckton of tylenol. This resulted in me having to make a urologist appointment because they were concerned about the trace amounts of blood showing up in my urine. Guess why? :D But that was seriously me taking like 3 every 4 hours for a day or two there.

    subedii wrote: »
    I hear PC gaming is huge off the coast of Somalia right now.
  • Raif SeveranceRaif Severance Registered User regular
    edited April 2010
    Avicus wrote: »
    I would recommend that if possible try and use NSAIDs for pain relief and not APAP. NSAIDs like ibuprofen and aspirin are much, much easier on the body requiring lots to cause damage.

    This is sort of a yes and no. It is true that NSAIDs don't cause the liver toxicity associated with acetaminophen, but they are implicated in gastric bleeding much more so. The very thing that makes them anti-inflammatory is what makes them cause this GI bleeding. They prevent prostaglandins in your body from forming arachadonic acid which is good if you don't want your body to mount an inflammatory response. This is bad since your stomach uses prostaglandins to help protect the lining from acidic erosion.

    Habitual drinkers (>3 drinks/day) generally have problems with ulcers already due to the alcohol, so taking an NSAID on top of that might be problematic.

  • AvicusAvicus Registered User regular
    edited April 2010
    Avicus wrote: »
    I would recommend that if possible try and use NSAIDs for pain relief and not APAP. NSAIDs like ibuprofen and aspirin are much, much easier on the body requiring lots to cause damage.

    This is sort of a yes and no. It is true that NSAIDs don't cause the liver toxicity associated with acetaminophen, but they are implicated in gastric bleeding much more so. The very thing that makes them anti-inflammatory is what makes them cause this GI bleeding. They prevent prostaglandins in your body from forming arachadonic acid which is good if you don't want your body to mount an inflammatory response. This is bad since your stomach uses prostaglandins to help protect the lining from acidic erosion.

    Habitual drinkers (>3 drinks/day) generally have problems with ulcers already due to the alcohol, so taking an NSAID on top of that might be problematic.

    It takes alot to cause ulcers. If you already have ulcers or forming ones yes it is going to make them worse. But it isn't dangerous to the average person. You can take tons of ibuprofen without any adverse effects. I know a guy who takes nurofen+ (back pain, has surgery in a month, nurofen+ ended up being cheaper than the prescription codeine but is weaker overall) and he takes around 14 a day under doctor supervision.

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