So many of us take over-the-counter remedies for the lesser aches and pains of VHL and life in general, we wanted to warn people about possible liver damage from non-aspirin pain relievers when you drink alcohol. -- Editor

A 39-year-old man who normally drank two to four glasses of wine at dinner ran into trouble when he began taking Tylenol, the principal ingredient of which is acetaminophen, a non-aspirin pain-reliever, in the recommended dose for the flu. The man developed liver failure and required an organ transplant to save his life.

He sued the manufacturer and won a multi-million-dollar judgment, which was upheld on appeal. Since then, additional lawsuits have been filed, alleging that the manufacturer did not adequately warn about the potential harm when acetaminophen and alcohol are mixed.

This connection is not new. Case reports have appeared in medical journals since 1977 about liver damage from the mixture of acetaminophen and alcohol. There are 94 known liver damage cases. In September 1995, researchers reported in the liver-specialty journal Hepatology, 67 more cases of serious liver damage linked to acetaminophen taken in usual therapeutic doses for adults (not overdoses taken in suicide attempts) and alcohol. This brings the total reported cases to 161, including 32 deaths.

Sixty-four percent of the new cases were considered alcoholic; however, 35 percent drank less than the equivalent of four glasses of wine, or three mixed drinks containing hard liquor per day.

While the U.S. Food & Drug Administration (FDA) has proposed rules requiring an alcohol warning on all non-prescription pain relievers, not just those containing acetaminophen, it now appears that these rules will not be promulgated before mid-1996. Some manufacturers have already voluntarily added the warning: If you generally consume three or more alcohol-containing drinks per day, you should consult your physician for when and how you should take Tylenol and other pain relievers.

Public Citizen Health Research Group finds this warning totally inadequate. It does not inform consumers that the potential problem is liver toxicity, or that liver toxicity is potentially life-threatening.

What You Can Do

If you drink alcohol, but less than four glasses of wine or three mixed drinks a day, use acetaminophen in the lowest possible dose to relieve your symptoms -- in no event more than four extra-strength or six regular-strength tablets daily -- and stop taking the drug as soon as your symptoms subside.

If you are using acetaminophen to treat cold or flu symptoms and regularly use alcohol, stop the alcohol until you are over the cold or flu, as it can aggravate cold and flu symptoms. Remember that many liquid cold remedies contain alcohol and count as shots of whiskey.

If you use acetaminophen regularly to control pain and use alcohol, keep your dose of acetaminophen as low as possible and moderate your alcohol intake.

The most common complaints reported by those experiencing the acetaminophen-alcohol interaction were nausea, vomiting, abdominal distress or pain. These are very non-specific complaints and are symptoms common to many mild disorders. The only sure way to detect liver toxicity is with a blood test ordered by your doctor.

Heavy drinkers should consult a physician before taking any pain reliever on a regular basis.

Combining heavy drinking with aspirin or ibuprofen (such as Advil) may promote gastrointestinal bleeding. Acetaminophen (such as Tylenol) and heavy drinking may promote liver disease.

Sidney M. Wolfe, Editor, Worst Pills/Best Pills News, 2:3, March 1996, Public Citizen Health Research Group, Washington, D.C.

What is Moderation?

Moderation is defined as no more than one drink per day for women and no more than two drinks per day for men.

Count as a drink--

12 ounces of regular beer (150 calories)
5 ounces of wine (100 calories)
1.5 ounces of 80-proof distilled spirits (100 calories)

-- Nutrition and Your Health: Dietary Guidelines, 4th edition, 1995, U.S. Department of Agriculture, Home & Garden Bulletin #232.

As published in the VHL Family Forum, 4:2, June 1996. For permission to reprint, please contact the VHL Family Alliance, editor@vhl.org. Further information is available from the VHL Family Alliance, info@vhl.org.