Whether you’re sipping from a fancy glass or gulping straight through the bottle, alcohol can make it tempting to keep drinking more. The reason: On your first few glasses, alcohol causes dopamine—a feel-good hormone—to flood the brain’s reward center, eliciting a pleasurable buzz you can only keep up by having another drink.
And we know what that leads to: a hangover the next morning. You might be tempted to take Tylenol to calm your symptoms. After all, it’s the most readily available over-the-counter painkiller. But given that your liver processes Tylenol and it’s already working overtime because of the alcohol, doctors warn against taking Tylenol (also known as acetaminophen or paracetamol) for a hangover because it can be hard on your liver, especially at high doses or with frequent use.
A 2021 study published in the Journal of Theoretical Biology suggests that taking Tylenol with alcohol may increase your risk of acetaminophen-induced acute liver injury—a condition that occurs when alcohol and Tylenol cause a build-up of toxins in the liver.
“Alcohol consumption causes extra stress on your liver, so combining the two in a short time can potentially lead to liver damage in the long run,” says Stacia Woodcock, PharmD, a pharmacist and clinical editor at the GoodRx. “Better options are aspirin or ibuprofen, which get processed through the kidneys.”
What happens when you take Tylenol for a hangover?
According to Tanya Dall, MD, emergency medicine specialist with Providence Mission Hospital in Orange County, California, your body first processes acetaminophen by absorbing it through the small intestine. Once in the bloodstream, the liver enzymes metabolize it into smaller molecules—most of which won’t do you any harm.
“However, one of these substances, N-acetyl-p-benzoquinone imine (NAPQI), is a harmful chemical. Luckily, your liver takes care of it through a molecule called glutathione—making it harmless and flushing it out when you pee,” says Dr. Woodcock.
But if you take too much Tylenol, or if your liver is already stressed out by processing alcohol, “it can’t make enough glutathione to keep up with the excesses, and toxic NAPQI can build up in the liver,” she says.
For a person with a healthy liver, the maximum daily recommended acetaminophen allowance is 3000 milligrams. Adding excess alcohol to the picture, however, makes it easier to trigger liver toxicity.
Medical experts warn that Tylenol toxicity is the most common cause of acute liver failure in the U.S., accounting for 56,000 emergency room visits, 2,600 hospitalizations, and 500 deaths per year.
Tylenol toxicity is the most common cause of acute liver failure in the U.S.
“By drinking too much alcohol, your liver is already working overdrive, increasing the production of toxic and damaging substances. And long-term alcohol use can weaken your liver and make it less able to process Tylenol safely,” Dr. Woodcock explains.
What are the possible complications?
The Centers for Disease Control and Prevention notes that using Tylenol together or within a couple of hours of drinking alcohol can cause difficulty breathing, liver failure, apnea, or liver damage.
“Early signs of liver damage include feeling nauseous, tired, and less hungry than usual. At this point, if you avoid substances that are hard on the liver, your liver cells may recover quickly, and these symptoms will usually resolve on their own,” says Dr. Woodcock.
Your chances of experiencing lasting liver damage depend on how much alcohol and Tylenol you consume, and how often you combine them. Dr. Dall and Dr. Woodcock agree that if you’ve had a drink or two and taken a standard dose of Tylenol, there’s probably no need to worry. But if you’ve consumed several drinks, or taken more Tylenol than recommended, then you need to pay attention to how you’re feeling.
“Seek urgent medical attention if you’re experiencing any red flags, such as bleeding and bruising, dark urine, weakness, confusion, abdominal pain or swelling and yellowing of the eyes or skin,” Dr. Woodcock adds.
And, if you’re feeling nauseated, “resist the urge to trigger your gag reflex and induce vomiting—this can lead to choking,” Dr. Dall warns.
What treatments can work instead?
If you’re looking for a hangover treatment that won’t increase your risk of liver damage, you have a couple of options.
Dr. Woodcock says hydration is key, since dehydration contributes to many common hangover symptoms. Sipping on water or an electrolyte-rich drink like coconut water or Gatorade can help you feel better quickly.
“For stomach issues, medications like Pepcid or Zantac may help. NSAIDs, like ibuprofen or naproxen, are better options for pain and headache since they don’t affect the liver. But they can be hard on the stomach, so taking them with food is a good idea, and you should only take them if other remedies have yet to work,” she says.
And remember, prevention is key. “Consuming alcohol modestly and responsibly is the best approach to protecting your body from harm,” Dr. Woodcock says.