Should 2 grams of acetaminophen plus 1 - 2 ounces of alcohol within a 6 hour period be cause for worry? SWIM recently took 4 tabs of Tylenol PM, but would like to have a few drinks as well. Will SWIM be pushing the limits of his liver? SWIM doesn't take Tylenol regularly, but /has/ had a total of 5 grams of acetaminophen within the last 24 hours.
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No, but its very unhealthy and could cause serious liver damage if done repeatedly.
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4 grams is the recommended dosage, however we all know that most recommended dosages vary by many factors from the LD/50 of a substance. The LD/50 for Acetaminophen / Paracetamol isn't given in the PDR.
But the PDR states:
Acetaminophen in massive OD may cause hepatic toxicity in some patients. In adults/adolescents, hepatic toxicity has rarely been reported following ingestion of acute ODs of less than 10g. With the proper supportive measures, fatalities are infrequent & have rarely been reported w/ ODs of less than 15g. In children, an acute OD of less than 150 mg/kg has not been associated with hepatic toxicity.
According to the UK health department:
A hospital will start an acetylcysteine drip if the dose of paracetamol is over 12g (24 x 500mg), but doses less than that will damage your liver to some degree (doses over 4g)
And according to the drug database of Canada:
Oral, mouse: LD50 = 338 mg/kg; Oral, rat: LD50 = 1944 mg/kg. Acetaminophen is metabolized primarily in the liver, where most of it is converted to inactive compounds by conjugation with glucuronic acid and, to a lesser extent, sulfuric acid. Conjugates are then excreted by the kidneys. Only a small portion is excreted in unchanged in urine or oxidized via the hepatic cytochrome P450 enzyme system (CYP2E1). Metabolism via CYP2E1 produces a toxic metabolite, N-acetyl-p-benzoquinoneimine (NAPQI). The toxic effects of acetaminophen are due to NAPQI, not acetaminophen itself nor any of the major metabolites. At therapeutic doses, NAPQI reacts with the sulfhydryl group of glutathione to produce a non-toxic conjugate that is excreted by the kidneys. High doses of acetaminophen may cause glutathione depletion, accumulation of NAPQI and hepatic necrosis. The maximum daily dose of acetaminophen is 4 g. Liver failure has been observed at doses as low as 6 g per day. As such, the maximum daily and single dose of acetaminophen is currently being reviewed in some countries. N-acetyl-cysteine, a precursor of glutathione, may be administered in the event of acetaminophen toxicity.
My personal opinion based on the above information would be to ease into the alcohol if you're going to drink. I say this only because you could weigh 50 kilograms and have a bad liver or kidneys already; so I'll always err on the side of caution when I don't know all the details to a situation, which makes Y!Answers hard as far as answering questions like this.
Regardless, I wouldn't want you to come to harm, but if you're going to drink, I'd say take it very slow and easy. Alcohol's effects should be enhanced as your hepatic system will already be under considerable load from the APAP. Hope I've helped. <3
But the PDR states:
Acetaminophen in massive OD may cause hepatic toxicity in some patients. In adults/adolescents, hepatic toxicity has rarely been reported following ingestion of acute ODs of less than 10g. With the proper supportive measures, fatalities are infrequent & have rarely been reported w/ ODs of less than 15g. In children, an acute OD of less than 150 mg/kg has not been associated with hepatic toxicity.
According to the UK health department:
A hospital will start an acetylcysteine drip if the dose of paracetamol is over 12g (24 x 500mg), but doses less than that will damage your liver to some degree (doses over 4g)
And according to the drug database of Canada:
Oral, mouse: LD50 = 338 mg/kg; Oral, rat: LD50 = 1944 mg/kg. Acetaminophen is metabolized primarily in the liver, where most of it is converted to inactive compounds by conjugation with glucuronic acid and, to a lesser extent, sulfuric acid. Conjugates are then excreted by the kidneys. Only a small portion is excreted in unchanged in urine or oxidized via the hepatic cytochrome P450 enzyme system (CYP2E1). Metabolism via CYP2E1 produces a toxic metabolite, N-acetyl-p-benzoquinoneimine (NAPQI). The toxic effects of acetaminophen are due to NAPQI, not acetaminophen itself nor any of the major metabolites. At therapeutic doses, NAPQI reacts with the sulfhydryl group of glutathione to produce a non-toxic conjugate that is excreted by the kidneys. High doses of acetaminophen may cause glutathione depletion, accumulation of NAPQI and hepatic necrosis. The maximum daily dose of acetaminophen is 4 g. Liver failure has been observed at doses as low as 6 g per day. As such, the maximum daily and single dose of acetaminophen is currently being reviewed in some countries. N-acetyl-cysteine, a precursor of glutathione, may be administered in the event of acetaminophen toxicity.
My personal opinion based on the above information would be to ease into the alcohol if you're going to drink. I say this only because you could weigh 50 kilograms and have a bad liver or kidneys already; so I'll always err on the side of caution when I don't know all the details to a situation, which makes Y!Answers hard as far as answering questions like this.
Regardless, I wouldn't want you to come to harm, but if you're going to drink, I'd say take it very slow and easy. Alcohol's effects should be enhanced as your hepatic system will already be under considerable load from the APAP. Hope I've helped. <3
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4000 milligrams is the most you are to have in 1 day. Of acetaminophen. I take 1500 per day.