What Pain Relievers Are Safe With Alcohol?

Acetaminophen may not be safe for those with impaired livers.

By Leslie Kernisan, M.D., Caring.com

Q: What pain relievers are safe with alcohol?

A: It depends on how much the person drinks and whether his or her liver is functioning normally. In general, the safest pain reliever for older adults is acetaminophen, or Tylenol. However, acetaminophen carries a warning against taking it while drinking more than three alcoholic drinks a day. This is because excessive alcohol consumption damages the liver, and acetaminophen may not be safe for those whose livers are impaired.

Alcohol abuse can cause two different kinds of liver problems:

• Elevated liver enzymes
• Cirrhosis of the liver

If you or a family member is a heavy drinker, it's important to level with the doctor about the alcohol consumption and also to monitor liver function. A rise in liver enzymes can be detected with a blood test. However, once cirrhosis occurs and the liver becomes scarred, liver enzyme levels may not be elevated. Cirrhosis is usually detected with a liver ultrasound scan.

Even so, medical research has shown acetaminophen to be a safe and effective pain reliever even for heavy drinkers and those with chronic liver disease, if they take a maximum of 2 grams a day, half the usual allowable dose. For heavy drinkers who don't have liver disease, it may be safe to take up to 3 grams a day, although it's wisest to do so under careful medical supervision.

Unfortunately, aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are not necessarily any safer. People who drink a lot also tend to have gastritis (inflammation of the stomach's lining), since alcohol irritates the digestive tract. Alcoholics are hence at risk for ulcers and internal bleeding, which aspirin and ibuprofen can make much worse. A safer choice can be opiate medications such as oxycodone or morphine, although there is a very real risk of addiction in people who have a history of abusing alcohol. For people with a history of problem drinking, it's best to get opiates through special pain clinics that have experience monitoring for addiction.

In short, there's no easy way to treat liver patients—or heavy drinkers—for pain. Patients with liver disease need careful supervision when using any pain medication, including over-the-counter pain medications.