Paracetamol is a widely-used over-the-counter medicine that’s effective for the treatment of fever and mild to moderate pain. Given its ubiquity, it’s common for it to be thought of as unreservedly safe. However, as with any medicine, paracetamol needs to be used as directed by medical professionals for individuals who don’t have compounding risk factors. For example, you may be wondering whether combining alcohol with paracetamol may run the risk of any negative and even serious side effects?
Can you take paracetamol with alcohol in your system?
As with most medicines, it’s not advised to use paracetamol in conjunction with alcohol. The simple reason is that both substances individually, especially in high concentrations, can put the liver under tremendous strain.1 In combination, the effect of both will also be amplified and possibly even debilitating. But while a single recommended dose of paracetamol in combination with a moderate amount of alcohol, not exceeding a guideline daily allowance, is most likely not harmful in healthy people. However, the line between safe and dangerous can quickly be crossed, resulting in liver damage.2
The role that paracetamol often plays in dealing with the side effects of heavy drinking can also be harmful if not administered properly. This is because paracetamol is often used as a painkiller for headaches, which are part and parcel of a hangover cure regimen. It’s most common use is to deal with a headache the next day, but it’s also occasionally used as a prophylactic headache prevention strategy before bedtime. Both scenarios are potentially harmful. To understand why, it’s necessary to explain how the liver deals with paracetamol and alcohol, respectively.
What happens when you take paracetamol with alcohol?
The liver produces an antioxidant called glutathione, which helps to remove toxins from the liver. When paracetamol is digested, some of it is converted into a toxin called N-acetyl-p-benzoquinone imine, or NAPQI. This needs to be neutralised by glutathione. However, high concentrations of paracetamol can rapidly deplete or even overwhelm the available glutathione. In this scenario, liver damage can be caused by the excess NAPQI.
Similarly, alcohol digestion creates toxins that need to be removed from the liver by glutathione. Thus, high alcohol consumption can also create a situation where glutathione is depleted. Clearly, then, introducing one substance into a body where the liver’s glutathione has already been depleted creates the ideal circumstances for liver damage to occur.3
What are the side effects of ingesting alcohol & paracetamol together?
Liver damage is the most severe symptom of using paracetamol in conjunction with alcohol. People with alcohol-use dependencies, like alcoholism, are at an increased risk of suffering liver damage when taking paracetamol. Other side effects can include an upset stomach, internal bleeding.4
Liver damage or liver failure will seriously reduce the body’s ability to filter out toxins. Perhaps the most common symptom of liver damage is jaundice, which presents as a yellow pigmentation of the skin and the whites of the eyes. This is often accompanied by very dark urine. Other symptoms can include nausea, vomiting, and fatigue.5
It’s always better to be safe than sorry!
How long would one have to wait after taking paracetamol before the liver’s stores of glutathione have recovered sufficiently for alcohol use to be safe? That largely depends on the dose of paracetamol that was taken, but also on the amount taken in a 24-hour period, and factors such as the weight and age of the person. But as a general rule of thumb, it’s safest to wait a few hours before consuming alcohol. Do not hesitate to speak to your healthcare provider prior to proceeding with these recommendations.
- Ansorge, R. Alcohol Interactions With Medications: Effects and Guidelines. WebMD (2022). [online] Available at: <https://www.webmd.com/mental-health/addiction/alcohol-interactions-with-medications> (22/01/2022).
- NHS. (n.d.). NHS choices. Can I drink alcohol if I’m taking painkillers? [online] Available at: <https://www.nhs.uk/common-health-questions/medicines/can-i-drink-alcohol-if-i-am-taking-painkillers> (11/01/2020).
- Hines MD, R. L. Napqi. NAPQI – an overview | ScienceDirect Topics. [online] Available at: <https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/napqi> (2018).
- Graham, G., Scott, K. & Day, R. Alcohol and paracetamol. researchgate [online] Available<https://www.researchgate.net/publication/228827801_Alcohol_and_paracetamol>.
- Rotundo, L., Pyrsopoulos, N. ). Liver injury induced by paracetamol and challenges associated with intentional and unintentional use. World journal of hepatology. [online] Available <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336293/> (27/04/2020).