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from https://x.com/PuppyGirlRiot/status/1929501446820560989
Acetaminophen + 10% alcohol
mmm liver-hurting juice
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this post was submitted on 03 Jun 2025
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For posting all the anonymous reactionary bullshit that you can't post anywhere else.
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This is stupid and you shouldn't take it, especially because you might be taking tylenol with something else, but it's probably safe if this is your only tylenol and alcohol in the day. Tylenol is weird because you could (but you shouldn't) take a full day's dose of tylenol all at once and it will probably not harm you, but if you take one extra dose over the course of a day it might destroy your liver and kill you. And the toxic metabolite from tylenol and the toxic metabolite from alcohol are neutralized by the same enzyme in your liver, so if you're at the limit of what your liver can handle on one, adding the other can damage your liver. So if you're taking a bunch of different cold medicines that have tylenol in them and not paying attention, you might be consuming an unsafe amount of tylenol. Anyway ibuprofen is better for pain and safer to take large doses of, but it can make your tummy upset. You can also combine tylenol and ibuprofen safely because they're processed differently, unlike tylenol and alcohol
The 10% alcohol in this is less concerning than the absolute quantity of acetaminophen in the bottle. Acute co-ingestion of APAP and alcohol isn't especially dangerous. Alcohol and APAP both deplete liver stores of glutathione, which one's body uses to neutralize toxic metabolites of both substances as you mentioned. Chronic co-ingestion can cause fulminant liver failure pretty suddenly, as can acute co-ingestion of both substances in large enough quantities.
Some people are able to take what should be lethal doses of acetaminophen for prolonged periods of time with no issues, other people are uniquely susceptible to the toxic effects. The only way to find out which camp you're in is if you end up with liver damage!
Ibuprofen has its own risks and is not nearly as benign as it's made out to be. It won't cause acute liver failure but taken at usual doses for long enough will give you an ulcer and utterly shred your kidneys. People who are hypocoagulable (on blood thinners/various psych meds or have an inborn or acquired bleeding disorder) shouldn't or can't take NSAIDs. They're contraindicated in kidney failure, too.
All that to say the ease with which one can acquire lethal amounts of OTC painkillers in North America is a problem! If this were a saner country this wouldn't be on the market, APAP wouldn't be available in any combination products, and there would be quantity limits on how much you could buy at a time.
I've had the displeasure of almost needing a liver transplant from acetaminophen poisoning. Two weeks in the ICU in indescribable pain, then my liver decided it was fine, actually. I recovered with my factory liver intact and no sequelae but it's not worth risking, ever.