Let’s say I had a 400mg Ibuprophen tablet earlier today, and now I’m going out to a party. At what point is it safe to have a few drinks? How long should I wait? What are the potential consequences? Like, I saw issues about problems with the stomach lining, but that seemed to be with long-term use, and I’ve been on it for a few days now, tops.
I would be interested in this answer, too. I usually avoid mixing acetaminophen (paracetamol) with alcohol, but was under the impression that ibuprofen was safer. I also thought that taking either medication before drinking was preferable to taking them directly after, when the liver is busy working through the alcohol. Can anyone confirm or correct?
I hate to fight the hypothetical, but if you’ve got something injured such that you need to take ibuprofen for it, the alcohol’s probably going to mess you up whether you’ve taken ibuprofen or not… if you give your body a choice between repairing muscle damage or eliminating toxins from your bloodstream, it’s going to go with clearing out the toxins and you’ll still be hurt in the morning.
IANAD, but my understanding is that ibuprofen and alcohol are compatible in moderate doses for most people - generally, nothing to worry about unless you have liver or other problems.
Naproxen sodium, though (Aleve) has such scary alcohol warnings that I threw away a large bottle of it rather than risk take any by mistake when I’d had a couple.
And, of course, acetaminophen is outright toxic in relatively small excess dosage. I have always been shocked it ended up next to aspirin as a general NSAID. Yeah, yeah, Reye’s syndrome and all. Great marketing spin on that one.
When I was rear ended, and was worried about getting whiplash, I talked to both a doctor and a workers’ comp nurse. Both recommended that I take ibuprofin and have a couple of drinks before I went to bed, to reduce inflammation and as a muscle relaxant, to prevent the muscles from tensing overnight.
(I’ve had whiplash, it didn’t manifest until the next day.)
I asked them about the interaction between ibuprofin and alcohol, and both said it wasn’t something I needed to worry about from moderate amounts of the drugs used together rarely. Maybe if I were older, or had a pre-existing liver or kidney problem it would have been more of a concern. I was in my 40s at the time.
So I wouldn’t worry about a couple of drinks at a party after taking some ibuprofen earlier in the day. I would avoid alcohol if you’ve recently had acetaminophen. I probably wouldn’t worry about naproxen, either. But I don’t have any authorities to cite on that one.
fwiw, I take a lot of NSAIDs now, enough that I get blood tests to look for possible damage from them at my annual physical exam. My doctor encouraged me to switch from ibuprofen to naproxen, and didn’t say anything about drinking. I don’t drink much, but I do sometimes have a couple glasses of wine, and he knows that.
All NSAIDS (Ibuprofen, Naproxen, as well as the rx ones) share the same warning with alcohol: that consuming them with alcohol may increase GI bleeding risk. This is believed to be a combination of irritating the stomach lining and because both NSAIDS and alcohol lower the production of prostaglandins, which your body uses to keep membranes strong. This is realistically mostly a risk for chronic alcoholic use and/or chronic NSAID use, but the warning is there without caveat to the public. Amongst medical professionals, it’s generally accepted that men can tolerate 3-4 drinks a day, and women 2-3 drinks, when they’re taking NSAIDS.
Ibuprofen takes about 2 hours to be halfway gone from your system, and in 24 hours, it’s totally eliminated. Naproxen stays in your system much longer, with a half life of 12-17 hours.
Tylenol, which is not an NSAID, has completely different and much more severe, life threatening and potentially irreversible interactions with alcohol, having to do with how the liver makes toxins out of acetaminophen too quickly in the presence of alcohol. It’s recommended that men have no more than two drinks, women no more than one, in any day when they consume acetaminophen.
But is that a choice the body has to make? Eliminating toxins from the bloodstream is done by the liver, right? While repairing muscle damage happens in the muscles. What are the resources the two are competing for, and are they in short supply?
Well, the liver is responsible for the production of albumin (needed to move everything in the body to get repair and clean up done) and for detoxifying many damaged cell proteins, including bilirubin. If one had a really horrible crushing injury, then yeah, it might take a bit longer if the liver was also trying to metabolize a whole bunch of alcohol at the same time. The liver is quite the multi-tasker, but it does have its limits.
But for minor injuries, alcohol is a rather useful nonprescription muscle relaxant, if used responsibly. 
I used to think this was the case, but then I read some stuff which suggested it’s the amount of you drink regularly that matters, not just how much you have had to drink that particular day.
(Pasting my post from a previous thread)
The trouble with paracetamol is that the therapeutic dose is close to the harmful dose. The current recommendations are to take no more than 4 g per day, while toxicity might commonly start around 10 g per day (depending on body weight and other factors). So if you’re taking near (or more than) the maximum daily recommended dose, you’re already skating on sort of thin ice, and anything that hurts your ability to safely metabolize it can make things a lot worse quickly.
Basically, when you drink moderately for several days, your liver ups the production of an enzyme that helps break down alcohol,but also breaks down paracetamol into a toxic byproduct (NAPQI). Usually only around 10% of paracetamol is converted to NAPQI, but if you’ve been drinking moderately for several days, that fraction will increase.
So, say you have a drink with dinner, then get a headache. You’re probably fine popping a couple Tylenol pills, because these are probably the first ones you’ve had today, and you probably won’t be having a ton more before bed. The problem is not really the immediate proximity of alcohol and paracetamol, it’s the combination of a large amount of paracetamol after a several day period of drinking.
In fact, say you’ve been drinking 4 drinks a day for the last week, you get a headache, decide to take some Tylenol. If you keep drinking like you have, you’re probably still OK, because the alcohol competes with paracetamol for the liver enzyme (though I wouldn’t recommend trying it). The trouble comes when someone who usually drinks moderately comes down with the flu, feels awful, so both stops drinking and starts taking the maximum dose (or more) or Tylenol every day for a couple days.
No, it’s not a choice the body has to make, save in extremis, after much chronic illness, malnutrition, and general metabolic collapse. 99.999% of the time, the body can easily handle both at once. Along with about a million other metabolic tasks.
Combining NSAIDs with alcohol increases the risk of GI bleeding as was well-explained previously, that’s the fact. So be careful when mixing them. Ethanol’s a crap analgesic anyway (small therapeutic window, not much room between ‘not enough’ and ‘oops, I’m unconscious’), and most pain isn’t related to muscle spasm, so its muscle-relaxing properties do’t come into play often.
Right. Well that, and the fact that alcohol consumption can deplete the antioxidant glutathione, which helps to inactivate NAPQI (along with a great many other reactive molecules, in both plant and animal tissues).
I drink probably an average of 2 units/day (though mostly on weekends, not every day), and I take an over the counter glutathione precursor, but I still stay away from acetaminophen entirely (including cold medicines that contain it), for entirely that reason.
So you just can’t have an alcohol-free evening and allow your body to heal from whatever is ailing you?
Well, in my case, I was specifically advised to take both, by two medical professionals.
I don’t drink often, but these days I take NSAIDs often enough that if I never drank on days when I’d taken some, I’d probably never drink. I suppose that wouldn’t be tragic, but it is nice to accept a glass of home-made wine from time to time.
Ethanol is medically necessary in only very rare circumstances, such as; a significant complication in premature labor, with no access to modern medical care or better tocolytics (labor-halting meds); methanol or ethylene glycol poisoning, without access to better antidotes; and a need to prevent/abort acute alcohol withdrawal and its potentially fatal seizures, where once again there is lack of access to more appropriate medications.
I can’t immediately think of any other circumstances where ethanol would be medically necessary. Other than as a topical disinfectant for a wound where there’s no better agent.
So, the prescribing of alcohol as a true pharmacologic agent is vanishingly rare, and any medical professional doing so in their capacity as a medical professional should set off a few alarm bells.
If they’re saying, ‘yeah, go ahead, take some motrin and a nice glass of white wine to help you relax’, that’s a different story, and not automatically terrible advice. But the alcohol part is almost always optional.
Heck, so’s the motrin part.
Your expertise is much appreciated, Dr. Qadgop.
Regards,
Shodan
Thanks to both WhyNot and Qadgop. I guess I was right to be leery of mixing acetaminophen and alcohol.
buddy also covered the acetaminophen angle quite nicely.
I probably could have. Just didn’t want to. When *this *friend throws a party, you go.