(NOTE: Tylenol is a trade name for acetaminophen. Another generic name
for the same drug is paracetamol. The terms are used more or less
interchangeably.)
Some sources recommend that those who drink alcohol should not use
Tylenol at all, since there may be a risk of liver damage. Other
authorities say that Tylenol can safely be used within four to six
hours of consuming alcohol. Your example, of taking Tylenol and then
drinking alcohol five hours later, would probably not be unsafe, but
if you are a frequent drinker, you may want to consider giving up
Tylenol altogether to minimize the risk.
The alcohol/acetaminophen syndrome (whose existence has not yet been
proven to a medical certainty) seems to be related to long-term
drinking habits, not just to the amount of alcohol consumed at one
sitting. It should be emphasized that this kind of liver damage, under
normal circumstances (moderate drinking while taking small amounts of
Tylenol), is quite rare. Some of the news articles that have discussed
this have led people to think that if you drink a beer and then pop a
Tylenol, you'll drop dead on the spot. That's just not so. However,
there may be a risk; for most people it is a very small risk. But, if
you are among those on the losing side of this bet, the consequences
can be very serious.
"Acetaminophen should not be used by those who generally consume three
or more alcohol-containing drinks per day and those with liver
problems. The government has recently required cautions on all
acetaminophen products warning against the use of acetaminophen with
alcohol, which carries a risk of hepatic toxicity."
American Society of Consultant Pharmacists: Clinical Review
http://www.ascp.com/public/pubs/tcpsupp/1999/suppa/cr_treatment.shtml
"Acetaminophen should not be taken after alcohol consumption, because
the liver, when engaged in alcohol breakdown, cannot properly dispose
of acetaminophen."
http://infopedia.ruv.net/pa/Paracetamol.html
"Chronic moderate to heavy alcohol use potentiates the toxic effects
of acetaminophen. Reports in recent years have drawn attention to the
development of acute toxic effects on the liver in long-term alcohol
users who have ingested acetaminophen, with therapeutic intent, in
doses generally considered to be nontoxic (<10 g/24 hr) (2-6). Severe
hepatotoxicity may occur after ingestion of as little as 4 g in 24
hours. This phenomenon is referred to as the alcohol-acetaminophen
syndrome...
Unfortunately, it is not possible to give guidelines for safe alcohol
ingestion with acetaminophen use... Because the minimum safe dose of
acetaminophen is not known in the setting of chronic alcohol use, it
seems prudent in such situations to avoid acetaminophen altogether,
especially during brief periods of abstinence."
Post-Graduate Medicine Online: Alcohol-acetaminophen syndrome
http://www.postgradmed.com/issues/2000/01_00/draganov.htm
"Dr. Eric Dahl, head physician of Ole Miss's Student Health Center,
says that Tylenol as well as other pain relievers can be harmful.
'The problem is synergism,' Dahl said. 'Synergism is where the force
of two is greater than their sum. Both of these drugs (alcohol and
Tylenol) are metabolized in the liver.'
When a person consumes too much of the drugs together, they can
combine to harm the liver. Dahl says that how much a person can handle
of the two drugs varies...
Statistics show that close to only one in 1,000 to 100,000 people have
side effects after taking over-the-counter pain relievers.
'The vast majority of people get away with (mixing pain relievers and
alcohol),' Dahl said. 'You can't predict who will have what response.'
Dahl says that after consuming alcohol, as a general rule, one should
avoid taking Tylenol or an ibuprofen such as Advil for six hours,
depending on whether the alcohol was taken on an empty stomach and the
amount of alcohol consumed."
The Daily Mississippian: Combining Tylenol, alcohol can result in
serious consequences
http://dm.olemiss.edu/archives/97/9710/971006/971006N2alcohol.HTML
"The only real risk with Tylenol comes with alcohol use, that is when
you can see kidney and liver impairment. So try not to drink alcohol
within 4 hours of a dosage.
sources cited:
Compendium Of Pharmaceuticals and Specialities, Thirty-fourth Edition.
Canadian Pharmaceutical Association.
Ottawa, Ontario, Canada.
isbn 0-919115-97-7,
English, 1999."
The Creaky Board
http://www.creakyjoints.com/ubb/Forum6/HTML/000002.html
One more point. Other painkillers carry risks when combined with
alcohol, too. In fact, other over-the-counter painkillers are probably
less safe than Tylenol for regular drinkers. This medical abstract
sums the situation up rather well:
"Analgesic consumption poses special risks for regular users of
alcohol. Among the numerous adverse health effects are acetaminophen
toxicity and gastrointestinal (GI) bleeding associated with
nonsteroidal anti-inflammatory drug (NSAID) use. An
alcohol-acetaminophen hypothesis contends that alcohol enhances
acetaminophen toxicity. Because 22% of adults use acetaminophen each
week and 5% to 10% of the population is alcoholic, the healthcare
implications of serious adverse interactions are considerable.
However, such interactions are rare when NSAID doses remain in the
therapeutic range. Although clinical studies fail to support anecdotal
case reports of liver damage associated with consumption of
therapeutic doses of acetaminophen by alcohol users, such reports are
probably inaccurate because of the uncritical acceptance of patient
history by the clinician and a lack of well-designed prospective
trials. Over-the-counter (OTC) NSAIDs, such as aspirin, naproxen, and
ketoprofen, are other analgesic options, but each carries the risk of
GI bleeding. Unanswered questions about the newer 'second-generation'
NSAIDs, such as celecoxib and rofecoxib, make them less desirable than
acetaminophen and OTC NSAIDs. Because the risk of GI bleeding or
ulceration may be higher in alcoholic patients, the optimal strategy
in prescribing pain relievers to those who consume alcohol is to use 1
drug at a time and to clearly communicate its generic name.
Acetaminophen is the safest OTC analgesic."
PubMed: The use and effect of analgesics in patients who regularly drink alcohol
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11776482&dopt=Abstract
Google search strategy:
Google Web Search: tylenol OR acetaminophen OR paracetemol alcohol hours
://www.google.com/search?hl=en&q=acetaminophen+OR+paracetemol+OR+tylenol+alcohol+hours
Please keep in mind that Google Answers is not a source for
authoritative medical advice; the material I've posted above is for
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substitute for the services of a medical professional.
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