Tylenol and Alcohol

If you are taking Tylenol, alcohol should generally be avoided. Studies show that people who drink alcohol regularly are at an increased risk for Tylenol poisoning even if they are taking a normal dosage. However, consuming a large amount of alcohol in a single dose is typically less likely to cause damage.

What Is the Risk in Combining Tylenol and Alcohol?

It may be dangerous for people who drink alcohol to take Tylenol® (acetaminophen). For most people, the medication is extremely safe when taken appropriately. However, people who drink often may be at risk for Tylenol poisoning even when taking a normal Tylenol dosage.
In fact, the manufacturer recommends that people who consume three or more alcoholic beverages per day not take the drug without consulting their healthcare providers.

How Alcohol Affects Tylenol

The body metabolizes Tylenol via several different mechanisms. In one mechanism, enzymes in the liver oxidize the drug, creating a toxic by-product called N-acetyl-benzoquinoneimine (NAPQI). Normally, only a small amount of Tylenol is oxidized, and the liver quickly gets rid of the toxic by-product using an antioxidant called glutathione.
Chronic alcohol intake affects this process in a couple of ways. First, chronic drinking increases the activity of the enzymes that oxidize Tylenol into NAPQI, causing more to be produced when Tylenol is taken. Second, alcohol depletes the body's store of glutathione, decreasing the ability to handle NAPQI.
This combination of effects lowers that safe dose of Tylenol. Even a normal amount can cause significant liver damage or even death (see Tylenol Overdose).
Consuming a large amount of alcohol in a single dose is typically less likely to cause damage, compared to chronic alcohol use. Alcohol competes with the enzymes that oxidize Tylenol into NAPQI, which means that if the enzymes are busy oxidizing alcohol, they are less likely to oxidize Tylenol.
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