Not a Cure for a Hangover

Written By: admin - Dec• 14•11

Well we are coming into winter time and the holidays.  One thing that can end up leading to is people drinking more than they should.  So the first piece of advice is don’t drink too much over the holidays.  But with people relaxing and enjoying themselves with friends and family this is a very common happenstance, though that may not be much comfort if one is suffering the hangover effects of the night before.  So in this post I want to pass along information to make sure a painful nuisance in a hangover does not set one up for something far more serious or tragic.  I’m never quite certain on this blog what is common knowledge and what is new.  Sometimes I will mention something I found ground breaking and stunning and the response is along the lines of, “hmmm- everyone knows that”.  Other times I will mention something in passing that I figure everyone is aware of and it gets quite the response.  So I would think most people must be aware of what I am going to mention, especially people who visit this blog, then again large numbers of people continue to get hurt from doing this so who knows.

Alright, the first and foremost point is, never, ever, ever, take Tylenol(TM) (generic name: acetaminophen or paracetamol) to treat a hangover.  The reasons for this are pretty straight forward.  First on the alcohol side, a common sequelae of chronic alcohol consumption is alcoholic liver disease, which can proceed to cirrhosis of the liver, which can proceed to liver failure and death.  Even with a successful liver transplant one is faced with attempting to forestall immune rejection of the foreign organ and left with a decreased quality of life and expected lifespan.  Alcoholic liver disease is the most common cause of liver failure in western societies.  The CDC estimates some 14,406 deaths per year from alcoholic liver disease, while Johns Hopkin’s puts the figure at around 20,000 deaths per year.

Let’s turn now to Tylenol.  With an estimated 2,000 cases per year, acute liver failure is much less common then chronic liver failure.  However, just as alcohol is the number one cause of chronic liver failure, Tylenol is the number one cause of acute liver failure in Western societies and accounts for nearly half of all acute liver failure diagnoses.  As the authors of a recent study on this commented, “acetaminophen hepatotoxicity far exceeds other causes of acute liver failure in the United States.”  So we have in alcohol and Tylenol the number one causes of chronic and acute liver failure respectively.  “Hey you got chocolate on my peanut butter, you got peanut butter on my chocolate.”  You can begin to see why it is never a good idea to mix these two drugs, it is a recipe for disaster.

Before going further it should be noted that acetaminophen is the most widely used analgesic in the United States.  Why is this drug still on the market, much less sold like tic tacs over the counter?   I don’t have an answer for that.  The U.S. Food and Drug Administration has recently made some weak and half hearted efforts to limit the individual dose size of size of acetaminophen, but despite all the sound and fury over looking into the issue that is all they have done, this is quite clearly an inadequate response.  One could eliminate without any cost the number one cause of acute liver failure in the United States.  This drug should be pulled from the shelves immediately and at best be available as a prescription drug with a black box warning concerning its dangerous hepatotoxicity.  Considering its rather unimpressive anti-inflammatory effects, the availability of similar less toxic alternatives and the thousands of people it has killed already it likely should not even be available with a prescription.  The negligence and turpitude of the FDA in this matter is responsible for the lingering deaths by liver failure of somewhere in the ball park of 500-1,000 people in the United States every year.  I suppose they are too busy trying to limit access to vitamins and harassing walnut growers and Amish farmers.

A study out of England was released just this past November that confirms the danger, known for decades now, of using acetaminophen in conjunction with alcohol.  This research extends previous findings by documenting a synergistic toxicity between alcohol and tylenol.  The researchers found that staggered doses over a period of a few days of even slightly too much acetaminophen could potentially cause liver failure.  Even more concerning, while the total dose was less in the staggered use, than that seen from liver failure caused by a single Tylenol overdose, the mortality was higher from repeatedly taking a little too much Tylenol in conjunction with alcohol.  Often times, these patients had no idea, nor sometimes even their doctors as the blood levels of Tylenol would be only slightly elevated, that they had overdosed on acetaminophen and were facing the prospect of liver failure.  Lastly, as with alcohol, there are known genetic variations in how individuals process acetaminophen.  While they would not be aware of it, some individuals would be far more sensitive to the toxicity of this hepatotoxic drug.

Alright, that’s it, my first Health for the Holidays tip, don’t take Tylenol for a hangover!  You also don’t want to take aspirin, though in that case you are facing a synergistic effect that can lead to a greatly increased risk of a potentially fatal gastrointestinal bleed.  Not a very cheery holiday post, but then again as I said, I’m not really aware of what is common knowledge and what I picked up along the way.  Will try and do the next post on what you actually could do that would be healthy for a holiday hangover.

Paul

 

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3 Comments

  1. Dan says:

    I’m sure you’re already aware of it, but n-acetylcysteine is a pretty effective prophylactic measure for hangovers for me. It also has pretty good results in rat trials.

    I would also love to hear any thoughts you might have on its medical applications. I was reading about alcoholic lung disease, and it seems pretty clear that alcoholics, even if not experiencing acute liver damage, suffer from poor glutathione status. I would assume people regularly taking acetominophen would have similar problems. Maybe also smokers?. Wouldn’t n-acetylcysteine be a pretty good treatment for some of these people?

    • admin says:

      I was going to mention it in the upcoming “What can you do for a hangover” part. I am not an ER doc but I am fairly certain N-acetylcysteine is also the first line treatment for acetaminophen overdose, along with activated charcoal. You often find in these deadly situations where there isn’t so much money to be made, the non-patentable “natural” products used as frontline therapies. So we see magnesium used commonly in ventricular tachycardia but it has hardly been looked at in the much more common Afib. Haven’t talked much, at all actually I think, about glutathoine yet on the blog, there is always so much to cover. Appreciate the link on gluathione levels and smoking, was not aware of that.

  2. Dan says:

    Screwed up my link tag there, I meant to just have it be a numbered link after the question mark, rather than the entire next sentence…