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Alcohol tylenol pm: Is It Safe To Mix Alcohol and Tylenol (Acetaminophen)?

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Is It Safe To Mix Alcohol and Tylenol (Acetaminophen)?

Article at a Glance:

  • It can be harmful to mix alcohol and Tylenol.
  • The biggest risk tends to be to the liver, but this combination can also increase the risk of kidney disease.
  • You should never drink more than three alcoholic beverages in a day, and you should always make sure you’re not combining Tylenol with any other medicine that contains acetaminophen.
  • You should never take more than 3,000 mg of acetaminophen in a day, and you shouldn’t take it for longer than ten days in a row.

Can You Mix Alcohol and Tylenol?

To put it simply, if you’re asking “can you mix alcohol and Tylenol,” the answer is no.

The standard guideline is that if you’re taking acetaminophen, you should have no more than three drinks in a day, but many physicians and pharmacists will recommend avoiding alcohol altogether. This is because the risks are so high.

For example, a standard serving size of alcohol tends to be much smaller than what most people would think. With wine as an example, a standard drink is only five ounces. It’s very easy to go over what’s meant as the guideline for moderate drinking and put yourself at risk as a result.

The Risks of Mixing Alcohol and Tylenol

There are enzymes found in your liver that are responsible for breaking down substances that enter the body. If you drink, it can make it more difficult for your liver to break down and process the Tylenol. When this happens, you’re at risk for severe liver damage. This risk goes up as you take more of the pain reliever or drink more alcohol.

When your body uses acetaminophen for fever or pain relief, it produces a toxic substance called NAPQI. NAPQI is metabolized by a substance called glutathione. By taking too much acetaminophen, the body’s glutathione is depleted, so it is unable to metabolize and process other harmful substances. This leads to a toxic buildup of NAPQI. When toxic substances build in the body, it can lead to liver damage.

When you experience liver damage, it can reduce the functionality of this vital organ and it can also lead to pressure in the brain, and abnormal bleeding or swelling.

What is Tylenol?

Tylenol is the brand name for acetaminophen, an over-the-counter (OTC) pain and fever reducer. It’s one of the most commonly used pain medicines in the world and can be used to treat everything from headaches to arthritis. Acetaminophen is also an ingredient in other combination products available as prescriptions and over-the-counter.

There are many different forms of Tylenol on the market including Tylenol Children’s, Tylenol Extra Strength, Tylenol Cold and Flu, Tylenol Allergy, Tylenol PM, and others.

Some of the brand name medications that contain acetaminophen include Theraflu and DayQuil, which are used to treat colds and the flu. Prescription drugs with acetaminophen include Norco and Percocet, among others. When acetaminophen is included in prescription pain relievers, it’s combined with another active ingredient, often opioid painkillers.

How Does Acetaminophen Work? Is it Safe?

Acetaminophen is classified as a non-opioid analgesic. It blocks an enzyme that produces prostaglandins, which create pain and inflammation. It’s different from NSAIDs, like aspirin, because it doesn’t reduce swelling and inflammation. It can also be used for the treatment of migraines, and it’s often combined with aspirin and caffeine in the drug Excedrine.

Despite how widely used Tylenol is, and the fact that it’s considered relatively safe, there is the potential for an acetaminophen overdose. People who take more than the maximum dosage of Tylenol, which is usually 3,000 milligrams in a day, may experience severe side effects including liver damage, acute liver failure, or death. The dose should never exceed 3,000 mg per day unless advised by a physician.

For the most part, acetaminophen overdoses are accidental. People simply don’t realize how much they’re taking and how severe the side effects can be.

Signs of Liver Damage

Symptoms of liver damage can include yellowing of your skin or the whites of your eyes, pain in the upper right portion of your abdomen, swelling of the abdomen, loss of appetite, nausea, vomiting, tiredness, and sweating.

Liver damage from the combination of alcohol and Tylenol is called acute liver damage, and this condition can occur very quickly. For many people, it’s possible to recover from liver damage resulting from mixing alcohol and Tylenol, but for some people, the damage can be pervasive or can lead to death.

Some people are at a higher risk of liver damage than others. For example, people with existing liver damage should not use or combine the two substances. Also, binge drinkers or heavy drinkers should avoid Tylenol.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Is Mixing Alcohol and Tylenol Dangerous?

What Are the Risks?

The risks of mixing alcohol and Tylenol vary significantly based on how much of both are used, as well as how frequently and heavily someone uses alcohol. Someone who drinks two or more standard drinks a day may have a greater risk of having problems when the two are mixed.

A “standard drink” refers to a drink that contains about 14 grams of pure alcohol. The idea of a standard drink helps people to understand how much alcohol they have had. A standard drink for different alcoholic beverages would generally be:

  • 12 oz of regular beer
  • 8–9 oz of malt liquor
  • 5 oz of wine
  • 1.5 oz of distilled spirits (gin, rum, whisky, vodka, etc.)

If you drink two or more standard drinks a day or drink several standard drinks in one sitting (called binge drinking), then you may be at greater risk when using Tylenol.

Liver Damage

Alcohol is a toxin, and the liver processes alcohol to help the body get rid of it. Alcohol use can cause liver damage, especially when larger amounts of alcohol are used. Tylenol is also processed in the liver. While the liver does not typically struggle to process normal doses of Tylenol, taking too much or using it chronically can lead to liver problems.

While alcohol and Tylenol can both cause liver damage on their own, the effects can multiply when both substances are used together. The liver has a finite ability to process chemicals, and when both substances are combined, they multiply the stress on the liver. This can lead to not only a greater buildup of toxins but also permanent liver damage.

Kidney Disease

While Tylenol usually does not significantly affect the kidneys, it can in large doses. Alcohol use is dehydrating, and less hydration being supplied to the kidneys also raises the risk of damage to the kidneys. When these two factors are combined, alcohol can make the kidneys more susceptible to the effects of Tylenol, leading to acute or chronic kidney injury.

Is Drinking On Acetaminophen Safe?

Nowadays, the subject of alcohol and Tylenol (acetaminophen) use is not discussed as much as it should, even though many people drink regularly, especially when socializing. Situations, where a person takes Tylenol together with the spirits, drink to relieve pain or fever are not uncommon. What happens when acetaminophen and alcohol are taken together? Do severe complications occur? What to expect when Tylenol and alcohol are mixed, and what should everyone know about this, especially if someone has done it on multiple occasions? Read on to find out.

Is It Safe To Mix Tylenol And Alcohol?

Most people take this over-the-counter pill at one point or another to relieve fever or pains and aches. Still, the Tylenol-alcohol subject requires more attention to avoid potential complications. Generally speaking, taking Tylenol with liquor is not always safe. Just like with many other medications, the human body metabolizes acetaminophen in the liver. When the recommended dosage is taken, the liver converts most of the drug into a benign substance, then eliminates it from the body via urine. The body converts a small byproduct of metabolized Tylenol into a toxic substance, which can be quite dangerous for liver health. But, glutathione or a secondary substance minimizes the toxic effects of the drug.

Taking too much acetaminophen can cause toxic metabolites to build up and damage the liver. This can also happen when glutathione levels are low. Liquor is also metabolized by the liver and utilizes glutathione to downplay the adverse effects.

Over time, especially with excessive drinking, glutathione levels can deplete, and the liver becomes more sensitive. Mixing alcohol and acetaminophen can be considered relatively safe in small doses, but excessive dosages can cause side effects that range from mild to severe.

Risks Of Mixing Tylenol And Alcohol

As seen above, mixing liquor and this common pill is not always safe. How long after taking Tylenol can one drink alcohol? The answer is not quite simple and depends on a few factors, including how big the person is, Tylenol dosage, duration of use, and drinking habits.

Speaking of Complications, Common Risks, and Side Effects that Happen When These Two Substances are Mixed Include:

The risk of the symptoms mentioned above increases when mixing acetaminophen and alcohol in higher doses. For example, mixing Tylenol 3 and alcohol can cause severe side effects, including death.

AUD And Acetaminophen Overdose

Acetaminophen overdose occurs when a person intentionally or accidentally takes more than the medicine’s recommended or average amount. Acetaminophen overdose is one of the most common poisonings, and it is a crucial point to address, especially when it is related to AUD. Alcoholism weakens the liver and increases the risk of many diseases, such as cirrhosis and fatty liver disease.

Bearing in mind that liver functions decrease due to excessive drinking, the risk of acetaminophen overdose increases.

Can one drink alcohol after taking Tylenol? Most people don’t wonder about AUD cases and consequences that happen later. People who are battling AUD or have successfully beaten the addiction should bear in mind their liver is sensitive and probably damaged, so consulting a doctor about Tylenol effects could be practical. This is yet another reason why mixing Tylenol with alcohol is not a good idea.

The good news is that people with AUD who take recommended amounts of medicine are not at a higher risk of liver damage.

As long as dosages are appropriate, Tylenol can be tolerated, but this is not a green light to go ahead and drink when taking pills, particularly in people with AUD. In fact, the negative consequences of combining Tylenol extra strength and alcohol should be highlighted to discourage people. Still, they should also elucidate what would happen if people with AUD whose liver is damaged take this particular medicine. At this point, not enough attention is paid in public to the habit of taking Tylenol with alcohol.

People With Increased Risk Factors

Generally speaking, everyone who mixes paracetamol and alcohol is at risk of developing side effects. But, some people, including those who mix Tylenol 3 with alcohol, are at a higher risk than others.

These Risk Factors Include:

  • AUD
  • Liver disease
  • Low levels of glutathione
  • Infection
  • Having some illness which damaged the liver
  • Taking more Tylenol than necessary

In order to different weigh-in perspectives to determine if one can the two simultaneously, consider the above-mentioned risk factors.

To avoid Tylenol and alcohol interaction, people in the high-risk groups shouldn’t take medicine without consulting a pharmacist or their healthcare provider, just to be on the safe side.

Safe Dose Of Alcohol To Take With Tylenol

To understand the wait time, the important fact to bear in mind is that the half-life of the drug is four hours, after which blood levels of the drug start decreasing. Eight hours after taking the pill, the blood levels of acetaminophen lower by 75%, and in 12 hours, they reduce by 88%. Although combining drugs such as Tylenol PM and alcohol is not always the wisest idea of light drinking after six hours from the last dosage is generally tolerated by the body. Make sure to consult a healthcare provider and ask him if it is safe to take Tylenol with alcohol in order to avoid potential complications. This is particularly the case for stronger instances such as hydrocodone-acetaminophen alcohol.

Some people drink alcohol every day, but aches and pains can pop up, and this medicine can help eliminate them. Is there any possibility where drinking alcohol with Tylenol is okay?

Or in other words, when taking Tylenol before alcohol, is there a limit to avoid crossing in terms of drinking? Generally speaking, as long as Tylenol, after alcohol is taken as directed, drinking in moderation is okay. Here “in moderation” refers to not more than three drinks a day. Taking acetaminophen and alcohol one time can be okay but shouldn’t turn into a habit.

Note that each individual may react to the ethanol-paracetamol combination differently. That’s why it is essential to consult a medical professional before use.

What To Do If Accidentally Took Alcohol With Tylenol

Mixing Tylenol and alcohol doesn’t have to cause panic. If both substances are taken together, the answer is not to drink more alcohol and only take the recommended dose at the frequency mentioned on the label. To avoid complications of taking Tylenol PM with alcohol, the best thing to do is to stop drinking when taking medicine to alleviate pain or fever.

Any regular drinker may be wondering how long after liquor can one take Tylenol? The answer is not easy to find as resources on this subject are scarce. Acetaminophen and alcohol interaction may not occur if a recommended dosage is taken after having a drink in people with a healthy liver. But liquor and acetaminophen can induce various problems in people with a weak liver. Wait a few hours after a drink to take this medicine.

People with liver diseases should always ask for the doctor’s approval to avoid alcohol-acetaminophen syndrome. Its hepatotoxicity occurs from the therapeutic ingestion of paracetamol in moderate or heavy drinkers.

Alternatives To Tylenol Which Are Relatively Safe With Alcohol

Some people want to know whether there are alternatives that are safe with drinking. This is especially the case for people whose alcoholic parents had a bad habit of mixing their drinks with drugs and experienced side effects in return. The good news is that there are alternatives that don’t involve taking Tylenol PM and alcohol together.

Popular alternatives to acetaminophen include non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. NSAIDs work in a slightly different manner than acetaminophen and are usually fine to take with the drink. Of course, this isn’t a recommendation. Only a doctor shall determine whether benefits outweigh the risks for each individual case.

When To See A Doctor If Mixed These Two Substances

People tend to mix different substances such as caffeine and alcohol, drugs and drinks, and so much more, but don’t always think about potentially negative scenarios. For example, mixing hydrocodone acetaminophen and alcohol can cause severe complications, so a person should see or call the doctor right after. Mixing Tylenol with codeine and alcohol, especially in people with a damaged liver, can lead to further damage and serious symptoms. When to see a doctor after combining liquor with Tylenol depends on various factors, including drug dosage, amount of the drink, or whether a person has liver disease or not.

See the doctor if the above-mentioned symptoms associated with medicine side effects occur.

People who notice symptoms of liver disease may also want to see their doctor. These symptoms include jaundice, pain in the abdomen’s upper right side, swelling in the abdomen, loss of appetite, nausea and vomiting, tiredness, sweating, confusion, unusual bruising, or bleeding. Every person should consider the negatives as well to avoid having to see the doctor. If a friend or family member tends to do this without realizing that combining acetaminophen and drinks can lead to liver damage and other problems, referring them to a healthcare provider who will perform a CAGE assessment could help prevent potentially lethal consequences.

Is It Really Safe?

The paracetamol-alcohol relationship is complicated, but generally speaking, moderate drinking and taking pills as directed is relatively safe for a patient’s health. However, in people with liver damage, Tylenol and liquor death can be the most severe scenario that is bound to motivate people to avoid using medicine when drinking and vice versa. Before combining both, it’s useful to consult a healthcare provider or pharmacist.

It is also necessary to ask for help in the rehabilitation center in case there are any signs of addiction to alcohol. Alcoholism treatment is a way to start a new sober and free life.

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Page Sources

  1. Snider, N. T., Portney, D. A., Willcockson, H. H., Maitra, D., Martin, H. C., Greenson, J. K., & Omary, M. B. (2016). Ethanol and Acetaminophen Synergistically Induce Hepatic Aggregation and TCh446-Insensitive Nuclear Translocation of GAPDH. PloS one, 11(8), e0160982. https://doi.org/10.1371/journal.pone.0160982
  2. Prescott L. F. (2000). Paracetamol, alcohol and the liver. British journal of clinical pharmacology, 49(4), 291–301. https://doi.org/10.1046/j.1365-2125.2000.00167.x
  3. Fruchter, L. L., Alexopoulou, I., & Lau, K. K. (2011). Acute interstitial nephritis with acetaminophen and alcohol intoxication. Italian journal of pediatrics, 37, 17. https://doi.org/10.1186/1824-7288-37-17
  4. Hyman J. Zimmerman, Willis C. Maddrey,(1995). Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: Analysis of instances of therapeutic misadventure, Hepatology, Volume 22, Issue 3, https://doi. org/10.1016/0270-9139(95)90295-3
  5. Emby DJ, Fraser BN. Hepatotoxicity of paracetamol enhanced by ingestion of alcohol: report of two cases. S Afr Med J. 1977 Feb;51(7) 208-209. PMID: 847572.

Published on: December 10th, 2019

Updated on: April 2nd, 2021

Isaak Stotts is an in-house medical writer in AddictionResource. Isaak learned addiction psychology at Aspen University and got a Master’s Degree in Arts in Psychology and Addiction Counseling. After graduation, he became a substance abuse counselor, providing individual, group, and family counseling for those who strive to achieve and maintain sobriety and recovery goals.

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.

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Tylenol PM Extra Strength oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

See also Warning section.

If you are taking this medication under your doctor’s direction, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.

Before using this product, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: antihistamines applied to the skin (such as diphenhydramine cream, ointment, spray), ketoconazole, MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine).

Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or other antihistamines (such as cetirizine, diphenhydramine).

Antihistamines are ingredients found in many nonprescription products and in some combination prescription medications. Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may also contain an antihistamine or other ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

This medication may interfere with certain medical/laboratory tests (such as urine 5-HIAA, allergy skin tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

This document does not contain all possible interactions. Before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

TYLENOL® PM Extra Strength | TYLENOL®

TYLENOL® PM Extra Strength | TYLENOL®
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Relieves minor aches and pains while helping you fall asleep and is non-habit forming when used as directed.

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Snorting Tylenol PM: Dangers And Side Effects

Tylenol PM is an over-the-counter drug that some people may crush and snort for faster effects. It can also be crushed and mixed with heroin. Snorting Tylenol PM can be dangerous, and may have harmful side effects, including overdose and liver damage.

Tylenol PM is a drug that can be bought over-the-counter (OTC) and comes in the form of a tablet. Getting Tylenol PM does not require a prescription.

Uses for Tylenol PM include:

  • pain relief
  • allergy relief
  • reducing fever
  • sleep aid

This drug is intended to be swallowed by mouth. Taking it in any way other than directed, including snorting it, can have harmful side effects and may be a sign of drug abuse.

Learn more about the dangers and effects of snorting drugs

What Makes Tylenol PM Different Than Tylenol?

Regular Tylenol contains the active ingredient acetaminophen. Tylenol PM contains the added ingredient diphenhydramine, an antihistamine that can relieve allergies and cause sleepiness.

What Does Snorting Tylenol PM Do?

Snorting drugs, also known as insufflation, is a common sign of drug misuse. While often done to feel the effects of a drug more quickly, this can also lead to potentially serious side effects.

Side effects of snorting Tylenol PM can include:

  • irritated or runny nose
  • nosebleeds
  • intense drowsiness
  • dizziness
  • upset stomach
  • blurred vision
  • dry mouth
  • dry nose

Snorting a lot of Tylenol PM, or crushing it and mixing it with other drugs, can lead to additional side effects, including changes in mood, behavior, and vital signs.

Why Do People Snort Tylenol PM?

Snorting over-the-counter drugs like Tylenol PM is uncommon. This is typically a sign of drug abuse or addiction.

People may snort Tylenol PM to:

  • get high
  • get rapid pain relief
  • fall asleep
  • stave off withdrawal symptoms

Tylenol PM is sometimes crushed and mixed with heroin. This has been referred to as “cheese” heroin. It is tannish or brown in color.

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