There’s no clear answer because no one really knows “what constitutes the minimum threshold for alcohol consumption” in people who take Tylenol, said Dr. Ray Chung, medical director of liver transplantation at Massachusetts General Hospital.
A small woman, for instance, could be at risk of liver damage if she regularly consumes as few as 2 to 3 drinks a day plus eight Extra Strength pills of 500 milligrams each of Tylenol (acetaminophen), said Dr. Rudrajit Rai, medical director of liver transplantation at Johns Hopkins Medicine. A healthy man probably can get away with a little more alcohol and the same dose of Tylenol.
It’s not difficult to reach these levels if you’re in constant pain and often have a couple of glasses of wine with dinner. It’s also not difficult given that acetaminophen comes in many medications besides Tylenol, including cold and sinus remedies.
Combining alcohol and acetaminophen is dangerous because of basic liver biochemistry. Chronic alcohol use causes an enzyme to break down acetaminophen into more toxic metabolites.
The label on Tylenol bottles may be overly reassuring. It states: “If you consume three or more alcoholic drinks every day, ask your doctor whether you should take acetaminophen or other pain relievers/fever reducers. Acetaminophen may cause liver damage.”
“This may leave readers with the sense that they can get away with three drinks a day or less” and still take Tylenol safely, which may not be true, Chung said.
Even without alcohol, acetaminophen can cause acute liver failure at doses higher than 24 extra-strength (500 milligram) pills or more within 24 hours. A prescription drug called Mucomyst can reverse liver damage if taken soon enough.
Bottom line? If you’re taking Tylenol, Chung said, stick to one drink a day or less.