How to: not kill your liver, or, "Tylenol + alcohol = very bad"
The drug warnings on the back of any Tylenol/acetaminophen bottle usually say something along the lines of, "Talk to your doctor before you take Acetaminophen or other fever reducers if you drink more than 3 drinks with alcohol per day."

That's reasonable, right? I think most people would understand that to mean you're fine unless you're essentially an alcoholic or, ahem, an "enthusiastic" social drinker.

Not so. The stats are as follows:
Approximate threshold for risk of permanent liver damage in a non-drinker: 20 normal tablets (500mg each),
Approximate threshold for risk of permanent liver damage in someone after several drinks: as little as 8 normal tablets. That's otherwise considered a safe dosage if taken over the course of 24 hours, as recommended by the manufacturer.

This occurs due to the fact that both alcohol and acetaminophen depend on the same chemical within the liver (glutathione) in order to be removed from the body. Alcohol is easier for the liver to process, so it 'hogs' the liver's supplies of glutathione, leaving acetaminophen to only be partially metabolized - the byproducts of which are severely toxic. Additionally, liver supplies of this chemical can remain depleted well after the last drink was consumed - sometimes up to 48 hours afterward - and can be further depleted without proper nutrition before or after drinking.

So:
- Don't take anything containing acetaminophen after drinking*. As a very rough rule of thumb, consider abstaining for at least:
12 hours if you've had up to 3 drinks
24 hours if you've had up to 6 drinks
36 hours if you've had more than 6 drinks
(where a drink is a 12oz of 5% beer, 5oz 12% wine, a shot (1.5oz) of 40% hard liquor, or equivalent)
- Check your labels! You might find acetaminophen where you don't expect - NyQuil, Percocet, Vicodin may contain it, to name a few.
- Consider ibuprofen as an alternative, as it is metabolized differently and will not cause toxicity - but take it with food or a glass of milk if you can, as it's irritating to the stomach and esophagus over the long term.

*There is a way to prevent this toxicity, but it's not practical unless you know about it in advance as it requires a specific nutritional supplement - and with viable alternatives to acetaminophen available, you might as well not take the risk anyway. I will cover this in more detail in a future post.

- posted by vcmc @  9/05/2008 07:46:00 PM