Many people drink alcohol, especially when they socialize. Many people have also taken acetaminophen (Tylenol) to relieve minor aches, pains, or fever. These pains often go hand in hand with drinking, so you may have even used alcohol and acetaminophen at the same time. If you were left wondering about your safety, know that the combination isn’t dangerous if you don’t misuse either one and don’t have certain risk factors.

Read on to learn how acetaminophen and alcohol work on your liver, how to stay safe, and what may indicate a more serious problem.

As long as you take acetaminophen as directed, you can drink alcohol in moderation. Drinking in moderation means having no more than three drinks per day.

This guideline may sound pretty straightforward, but not all alcoholic drinks are created equal. A standard alcoholic drink contains 0.6 ounces of alcohol. However, the amount of alcohol in different drinks varies. The following amounts each equal one standard alcoholic drink:

  • 12 ounces of beer
  • 8 ounces of malt liquor
  • 5 ounces of wine
  • 1.5 ounces (one shot) of 80-proof distilled spirits, including vodka, gin, whiskey, rum, and tequila

Drinking in moderation and using acetaminophen as directed can help minimize your risks. However, dismissing these precautions can have severe effects on your liver.

Many enzymes in your body break down acetaminophen and other drugs so your body can use them. Most of these enzymes are in your liver. Alcohol can affect the enzymes that process acetaminophen.

Your risk of severe liver damage from alcohol and acetaminophen increases as the amounts of each substance in your body increase. Liver damage can also occur if you take the right dose of acetaminophen but take it for longer than recommended, even if you drink in moderation. It can happen also if you drink too frequently, even when using recommended doses of acetaminophen for the recommended amount of time.

As your body uses acetaminophen, it converts it into a harmful substance. Your liver then processes this substance and removes it from your body. Drinking alcohol while you take acetaminophen causes your body to make more of the harmful substance, and it becomes more difficult for your body to remove it. So, mixing too much alcohol with any acetaminophen (or too much acetaminophen with any alcohol) can make removal of this substance even more difficult. The excess substance attacks your liver. This can cause severe liver damage.

You must be careful if you use acetaminophen and drink. Talk to your doctor before using acetaminophen if you’re not sure if you drink too frequently to use this drug.

Your liver is a large organ in the upper right side of your abdomen. It helps you digest food. It also helps with blood clotting, and it filters out any toxic or dangerous chemicals in your blood. Damage to your liver can reduce its ability to perform these functions. It can also lead to increased pressure in your brain or abnormal bleeding and swelling.

Symptoms of liver damage include:

  • jaundice (yellowing of your skin or the whites of your eyes)
  • pain in the upper right side of your abdomen
  • swelling of your abdomen
  • loss of appetite
  • nausea or vomiting
  • tiredness
  • sweating
  • confusion
  • unusual bruising or bleeding

The type of liver damage from misuse of alcohol and acetaminophen is called acute liver damage. Symptoms of acute liver damage can be severe and happen within a few hours. Maximum liver damage can happen in as quickly as a few days.

Most cases of liver damage from acetaminophen are reversible. Most people recover in about two weeks. However, for people who take too much of the drug or who have existing liver problems, the damage can be lasting and even cause death.

Certain people are at increased risk of liver damage from drinking when using acetaminophen. For example, people with liver damage or liver failure are at increased risk of causing even more damage. They should not drink alcohol or take acetaminophen.

If you binge drink or frequently drink a lot of alcohol, you’re also at increased risk of liver damage. Talk to your doctor before using acetaminophen. It’s important to be honest with your doctor about the amount of alcohol you drink. They won’t judge you, and they need to know the truth so that they can make the best recommendation for your health.

Read more: Alcohol-related liver disease »

To reduce your risk of liver damage from acetaminophen and alcohol, minimize your use of both. Here are some guidelines:

  • Use less than 3,000 mg of acetaminophen per day.
  • Don’t take acetaminophen for longer than 10 days in a row for pain, or three days in a row for fever, unless recommended by your doctor.
  • Drink fewer than three alcoholic drinks per day.
  • Check all of the medications you take to see if they contain acetaminophen.
  • Take only one product that contains acetaminophen at a time.

Several over-the-counter and prescription products contain acetaminophen. It’s easy to take more than the recommended amount of acetaminophen if you take more than one medication that contains it. If you’re not sure if a drug you take contains acetaminophen, ask your pharmacist or doctor.

For more information, read about acetaminophen overdose.

While liver damage is not likely if you take simple precautions, it’s still important to know the symptoms of liver damage. Call your doctor and stop taking acetaminophen if you have any of the symptoms.

The best way to avoid complications is to take the right amount of acetaminophen for a safe length of time and to drink only moderate amounts of alcohol. If you have liver disease or increased risk factors for liver disease, talk to your doctor about other pain remedies that are safer for you.