“font-size: 10.0pt; font-family: Verdana; text-transform: uppercase;”> Your health questions matter
“font-size: 10.0pt; font-family: Verdana; color: windowtext;”>How do painkillers react with alcohol?
“font-size: 10.0pt; font-family: Verdana; color: windowtext; mso-bidi-font-weight: bold;”> Medical toxicologist Dr. Michael E. Mullins responds “font-size: 10.0pt; font-family: Verdana; color: windowtext;”>
“font-size: 10.0pt; font-family: Verdana; color: windowtext; mso-bidi-font-weight: bold;”> “I have heard various reports on how the most popular painkillers have reactions with alcohol that are very bad for your stomach and/or liver. What are the facts on how the most common over-the-counter painkillers (aspirin, ibuprofen and acetaminophen) interact with alcohol in your system?”
“mso-bidi-font-style: normal;”>– C.S. “font-family: Verdana; font-size: 13px;”>
“font-size: 10.0pt; font-family: Verdana; color: windowtext; mso-bidi-font-weight: bold;”> The answer comes from Dr. Michael E. Mullins, a medical toxicologist and assistant professor and research director of Emergency Medicine at Washington University School of Medicine, St. Louis. “font-family: Verdana; font-size: 13px;”>
“font-size: 10.0pt; font-family: Verdana;”>First, aspirin, ibuprofen and acetaminophen are all very safe and effective when used as directed in the normal doses.
“font-size: 10.0pt; font-family: Verdana;”>The extent to which there may be a problem related to alcohol use depends largely on how heavily one drinks alcohol. For someone who occasionally enjoys one or two drinks / beers / glasses of wine, there is no additional risk when using any of these three over-the-counter pain relievers.
“font-size: 10.0pt; font-family: Verdana;”>On the other hand, for someone who is an alcoholic (drinking two or more drinks per day every day or nearly every day), the risks start to increase.
“font-size: 10.0pt; font-family: Verdana;”>If the alcoholism leads to liver disease (cirrhosis) and varicose veins in the esophagus (esophageal varices), taking aspirin or ibuprofen may increase the likelihood of bleeding from the varices or may increase the severity of the bleeding because both (especially aspirin) make the platelets (clotting cells in the blood) work less effectively.
“font-size: 10.0pt; font-family: Verdana;”>Also, if the alcoholism leads to stomach irritation (gastritis) or stomach ulcers, both ibuprofen and aspirin can increase the irritation and bleeding because both ibuprofen and aspirin interfere with making a natural chemical (prostaglandin) that protects the lining of the stomach from its own acids.
“font-size: 10.0pt; font-family: Verdana;”>Acetaminophen, in normal doses, is the least risky. It does not increase bleeding or irritate the stomach.
“font-size: 10.0pt; font-family: Verdana;”>In overdose, acetaminophen can cause serious liver damage that can be fatal in some people. Because heavy alcohol use damages the liver, many people – including many doctors – assume that acetaminophen and alcohol together cause more liver damage or that a person with alcoholic liver damage cannot take acetaminophen. This is an area of some controversy among liver specialists and toxicologists.
“font-size: 10.0pt; font-family: Verdana;”>There are case reports and case series of alcoholics who get liver damage that gets blamed on acetaminophen. Usually the patient claims to have taken only the normal dose, with no medical proof to confirm this.
“font-size: 10.0pt; font-family: Verdana;”>We know, however, that heavy drinkers consistently say that they drink less than they really do. If I had a dollar for every patient I had in the ED who got into trouble after “just two beers,” I would be a rich man today. The flaw in all of these reports is that the doctors believe the patient tells the truth about the dose of acetaminophen even though they assume that the patient lies about their alcohol use.
“font-size: 10.0pt; font-family: Verdana;”>It turns out that this may not be true. Alcohol and acetaminophen affect the liver in different ways. Scientific studies of alcoholic people taking normal doses of acetaminophen do not cause liver damage.
“font-size: 10.0pt; font-family: Verdana;”>No matter how much you drink, you should never take more than eight tablets of all acetaminophen-containing medicines in one day. This includes over-the-counter medicines such as Tylenol, Tylenol PM, Excedrin and generic acetaminophen. This also includes prescription pain relievers such as Percocet, Vicodin, Lorcet, Norco or almost any medicine with a name ending in “cet.”
“font-size: 10.0pt; font-family: Verdana;”>If you are a light or occasional drinker, then normal doses of acetaminophen, aspirin or ibuprofen are safe.
“font-size: 10.0pt; font-family: Verdana;”>If you are a heavy drinker, normal doses of acetaminophen, aspirin, or ibuprofen are still usually safe unless you have alcoholic liver disease.
“font-size: 10.0pt; font-family: Verdana;”>As Paracelsus, the father of modern toxicology, wrote five centuries ago, “In all things there is poison. There is none which is not poison. Only the dose determines the poison.”
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“font-size: 10.0pt; font-family: Verdana;”>Let us hear from you. Do you have a health-related question? Email it to
“mso-bidi-font-weight: normal;”>yourhealthmatters@stlamerican.com Rather than a personal reply, a health professional will provide an answer that we will share with all readers in a future issue of Your Health Matters. Your privacy will be respected.
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