Health Education

Is it safe to take over-the-counter painkillers with alcohol?

Dawn Weinberger headshot By | June 21, 2019

Have you ever taken an over-the-counter painkiller (such as Tylenol or Advil) after a night of drinking in order to avoid or treat an alcohol-induced headache? You might want to reconsider that practice. Otherwise, you could find yourself dealing with side effects much more serious than the typical hangover—problems like ulcers, liver damage, renal issues, and more.

“People need to be aware that alcohol is a drug,” says Dr. Anna Lembke, MD, director of addiction medicine at Stanford University School of Medicine in Palo Alto, California. “And using alcohol in combination with any other drugs, including OTC painkillers, can exacerbate side effects or lead to drug-drug interactions.”

Acetaminophen (aka Tylenol), for example, is well-known for its potential to cause liver damage. So is alcohol. And according to the Food and Drug Administration, the risk of damage increases when the two are mixed.

“Alcohol and Tylenol in combination tax the liver—and the combination can be cumulative and synergistic, in a bad way, over time,” Dr. Lembke says.

NSAIDS (like ibuprofen and naproxen) aren’t any better, says Dr. Heather Free, Pharm.D., a pharmacist in Columbus, Ohio, and spokesperson for the American Pharmacists Association. NSAIDS alone can damage the stomach and increase your chances of bleeding and/or getting an ulcer. Adding alcohol amplifies the danger, she says. Furthermore, if you are already at risk for kidney problems (because of diabetes or family history), the mixture is even more precarious, she says.

Medicine and alcohol interactions chart

So does all of this mean that you should never, ever take a painkiller for a headache after having a drink or two? Not exactly. The problems occur when alcohol is consumed alongside painkillers regularly, Dr. Lembke explains. “If it is a small amount of alcohol and [you are] taking the painkiller as indicated on the bottle, it is generally not a problem,” she says.

However, because of the potential for long-term consequences, it is still prudent to avoid mixing the two, Drs. Lembke and Free both emphasize.

“Repeated use will just progress the damage, making it difficult for the body to rebound back,” Dr. Free says. Instead, she advises rehydrating your body with water and plenty of electrolytes.

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And Dr. Lembke says it is better to just avoid drinking to the point of needing a painkiller altogether. “If you are drinking so much that you have a hangover, you might want to look at your drinking habits,” she says. “Because if you have had enough that you have a hangover, you have had too much.”

The general rule of thumb, she says, is no more than seven drinks per week and definitely no more than three drinks on any one occasion.

“Anything above that is considered risky drinking and is associated with all sorts of adverse health outcomes,” she says.

And while Dr. Lembke says it would be very surprising for a related medical emergency to occur if you are following these guidelines and don’t have any other risk factors, she also urges people to see a doctor right away for scary symptoms like abdominal pain, altered consciousness, or jaundice. All are signs of a potentially dangerous drug-drug interaction.