Not to chastise you or your wife, there is an actual "Liver Warning" on Tylenol Product labels. They warn against 4000mg/day or with alcohol consumption. It's not an on/off switch, the damage occurs on a ramp that achieves a critical point after so much consumption.

Saying this to encourage label reading and to refute those who might try to characterize your wife's experience as anecdotal. And for those who stop reading a page like this one, after the first paragraph that touts "no evidence": https://www.tylenolprofessional.com/safety-and-efficacy/safe... when at the bottom it reveals the Liver Warning.

It appears his wife took under that threshold and only for a few days. 4000mg is roughly 8-10 otc painkillers in a day (depending on the brand).

That said, everyone's physical ability to metabolise drugs is different. I might worry something else was wrong, or at least get a followup test done later, if her liver tox screen showed that, just to rule out another cause.

You're right: metabolisms vary. This is why I don't dance with the 4 gram limit, even though (insanely) post-op instructions regularly advise you to.

Out of context on the /comments page, one might think you are talking about completely different substances, heh.

Everyone's ability to metabolize drugs being different has a lot to do with why the labels end up advising less than is effective for many people. Dextromethorphan surely is NOT ineffective, but at 2 tsp, yea, it aint gonna do much of anything (unless you're CYP2D6 deficient -- then, it may still do a LOT depending on how deficient).

>or with alcohol consumption

This part is what a lot of people miss IME

People take alcohol and tylenol???

People need to read and think... I begin to wonder if I am some elite IQ intellect?

Here's one list of medicines containing alcohol: https://www.hpspmonitoring.com/Content/Oregon/Resources/Medi...

You don't have to be a special kind of dumbass to take, let's see, NyQuil when you're sick.

1. NyQuil is not sold here. Not allowed. Probably for that reason! Us northern EUs must be smart, huh?

2. NyQuil is medication. Not what I nor the poster mean. They mean drinking for fun. hmmm whatever to say... Drinking wine, sprit, beer? For the effect of ethanol?

You understand how there is a difference? :)

It doesn’t have to be concurrent to be harmful. You need decent spacing between the two. How do you think many people ride out hangovers?

Meanwhile, an actual doctor has chimed in above…

Alcohol can actually be protective in a paracetamol overdose. Paracetamol itself isn't relatively dangerous, the metabolic product created by the liver is.

Alcohol use acutely reduces the levels of these enzymes which convert paracetamol into it's toxic byproduct as ethanol preferentially binds to the same enzyme for it's own metabolism. Therefore, acute alcohol consumption can reduce the harmful effects of paracetamol.

The reverse is true for overdose in the context of chronic alcohol use, when the liver adapts to long-term alcohol exposure by increasing the levels of enzymes, therefore rapidly metabolising paracetamol into it's toxic byproduct and worsening harm.

Source: doctor

As a side comment, the lack of medical knowledge displayed in HN threads paired with the absolute confidence some verdicts are delivered with is worrying, and something I thought this forum would be better at than other sites (looking at you, reddit). Paracetamol and NSAIDs (including ibuprofens) are safe drugs if taken to the package directions. Some of the ideas shared in this thread about taking one over the other, or not taking one ever etc, are not rational. Please consult your doctor if you are worried about your particular situation, but generally OTC medicines are not dangerous if taken to the package instructions.

Accidental overdoses of paracetamol are exceeding rare, but intentional ones are common.

Expert fallacy: I know a lot about X, so I'm also an expert on adjoining topics V, W, Y, and Z. Also on topic "ecks". And "x-rays". And "excerpts" and "excommunication". Ah, hell: I'm smarter than most, so I'm usually right. Especially about things I'm sure I right about.

Its obviosly more dangerous with medicine but I see the same thing with other non-tech topics here like agriculture and construction trades so I always take non-tech topic comments with a grain of salt on here. There is a good diversity of experts on here but of course they can't be expected to correct everybody all the time.

Yup, did some digging on Tylenol/acetaminophen before I had some surgery, and it's a real danger. Oddly enough, it seems downing a whole bottle won't (usually) end your life as it gets mostly directly eliminated rather than metabolized, but taking just around 2-3X the high-strength dose sustained over 3-4 days can destroy your liver — at that point, you have about six weeks unless they find a new liver for you (obviously, there's wide variance in actual dosages and reactions, but that was the general median). For someone with serious acute pain, who doesn't know this hazard, it'd be pretty easy to self-medicate and load up and lose track...

OTOH Ibuprofein, doesn't have anything like that deadly profile, but enough gut and other issues.

Common advice where i am from is to alternate between acetaminaphen/paracetamol and ibuprofen based otc painkillers. One, it reduces your opporunity to overdose, but also some evidence they work better together.