Tylenol And Alcohol: Potentially Deadly Combination For Your Kidneys

Wesley suffered peculiar complications when he pulled a muscle in his groin.

Just taking Tylenol relieved the pain, but after a day or so he began to feel incredibly itchy. His whole body seemed to itch all the time. Wesley could move and feel his feet, but they felt heavy. Then they began to swell. And soon Wesley noticed swelling in his fingers and arms and eyelids, too, and made it to an emergency room just before he collapsed.

Like 56,000 people per year in the United States alone, Wesley had suffered acute acetaminophen poisoning. And like 26,000 Americans every year, Wesley had to be hospitalized to deal with the symptoms of acetaminophen toxicity. 

What Is Acetaminophen?

Acetaminophen, known as paracetamol in the United Kingdom and most countries in the British Commonwealth, is a popular, inexpensive, and effective non-steroidal anti-inflammatory medication for relief of pain and fever. Acetaminophen is sold under dozens of brand names. The most common brand of acetaminophen in the United States is Tylenol, but the medication is also available over the counter in tablets, gel caps, and liquid form branded as: 

• Actifed®
• Alka-Seltzer Plus Liquid Gels®
• Anacin®
• Cepacol®
• Contac®
• Coricidin®
• Dayquil®
• Dimetapp®
• Dristan®
• Excedrin®
• Feverall®
• Formula 44®
• Goody’s® Powders
• Liquiprin®
• Midol®
• Nyquil®
• Panadol®
• Robitussin®
• Saint Joseph® Aspirin-Free
• Singlet®
• Sinutab®
• Sudafed®
• Theraflu®
• Triaminic®
• TYLENOL® Brand Products
• Vanquish®
• Vicks®
• Zicam®

Acetaminophen is also sold under various house brands, and appears as part of prescription pain relievers such as oxycodone, hydrocodone, Endocet, Percocet, and Tramadol.

The effects of acetaminophen on the liver are well known. Acetaminophen poisoning necessitates more liver transplants and kills more people than hepatitis B or hepatitis C. But the effects of acetaminophen on the kidneys are not as well known either by doctors or by the public.

What Does Acetaminophen Do to the Kidneys?

Acetaminophen is converted into a non-toxic compound by the liver. Detoxifying acetaminophen requires the use of enzymes which are only available in limited amounts. If these enzymes are busy detoxifying other substances, such as alcohol, they are not available to detoxify the pain reliever.

See Also: FDA Issues Warning Of Potentially Fatal Skin Reaction To Tylenol

In its toxic form, acetaminophen can use up almost all of the glutathione present in the kidneys, leaving very little glutathione to protect the kidneys from inflammation. Kidney cells can become inflamed from the inside out, and die. When enough kidney cells die, the organ ceases to function--and dying cells themselves emit more inflammatory compounds which damage still more healthy cells around them. 

Young children who consume as little as 75 mg of acetaminophen (one pill) can suffer kidney damage. Adults often can tolerate 100 times as much of the medication, but consuming alcohol with an acetaminophen-based drug such as Tylenol increases the risk of kidney damage by as much as 400%. Having a good workout, popping a Tylenol or a Vanquish or an Anacin for sore muscles, and popping the top on a cold beer sometimes is a deadly combination.

How To Avoid Problems With Acetaminophen

Kidney damage from the combination of alcohol and acetaminophen, researchers tell us, is greatest in older adults, males, Hispanics, Blacks, and people who have conditions that affect the kidneys, such as diabetes or high blood pressure. The simplest way to avoid problems with acetaminophen poisoning, of course, is not to take it. Aspirin, after all, is an even more inexpensive and approximately equally effective pain reliever.

Certain prescription anticoagulants (blood thinners) such as the relatively new product Brilinta (ticagrelor) are incompatible with Aspirin. And sometimes acetaminophen is all that is available.

As a general rule:

• If you are an alcoholic, just don't take acetaminophen (Anacin, Tylenol, Robitussin, and many other products listed above).
• If you take more than one extra-strength Tylenol, don't drink alcohol for 24 hours. The greatest danger comes from drinking alcohol after taking acetaminophen, rather from drinking alcohol before taking acetaminophen.
• And if you drink every day, don't take pain relievers that contain acetaminophen. The combination may not cause acute kidney or liver failure, but it can contribute to the slow development of kidney or liver disease.

If you are going to take acetaminophen, back off on the alcohol. Don't give your liver too much to do, so it does not send unprocessed acetaminophen to your kidneys. And give your kidneys extra protection with the over the counter product N-acetyl-cysteine.

N-acetyl-cysteine is a treatment doctors use for kidney damage caused by Tylenol and similar acetaminophen containing medications. It's never a good idea to try to treat what you believe may be kidney damage on your own. If you experience:

• Nausea, vomiting, and loss of appetite 30 minutes to 24 hours after taking acetaminophen.
• Fatigue, pale skin, and sweating in the first 24 hours after taking acetaminophen.
• Racing heart beat, dizziness when moving from a seated position to standing, and pain or tenderness on the right side of the abdomen any time after taking acetaminophen, and especially,
• Decreased urination the day after taking acetaminophen.

See Also: Tylenol Found Unsafe for Women During Pregnancy

However, if you have not yet experienced these symptoms, and you are using acetaminophen, consider adding 500 to 1000 mg of N-acetylcysteine to your daily supplement routine is a good idea. This over the counter antioxidant protects both kidney and nerve tissue from the effects of acetaminophen and other toxins that the liver may fail to process.

Don't use N-acetylcysteine without consulting your doctor if you take nitrates (you wear a nitroglycerin patch, or you take the medications isosorbide mononitrate, Imso, or Imdur). The combination of N-acetyl-cysteine and the medication for your coronary artery disease may result in unusually low blood pressure.