Lots of medications come with the warning to avoid alcohol when you’re taking them. Antibiotics are a tough one to accept, especially if you’re not feeling particularly sick from what ails you. But reading the labels on pain relievers like Advil (ibuprofen) and Tylenol (acetaminophen) and learning that severe side effects are more likely when you mix them with booze feels downright torturous—especially when your head is pounding and popping a few pills promises sweet relief.
The warnings aren’t there just to taunt you, though. In fact, ibuprofen, acetaminophen, and even aspirin, come with potential dangers if you make a habit of taking them with alcohol. “All have risks if you take them, period, as do all medications, but the risks for all three increase if you take them when you drink,” Debra E. Brooks, M.D., an urgent care physician at GoHealth Urgent Care. This goes for immediately post-imbibing, too, when you’re trying to preemptively treat the hangover-induced headache you know will hit in the A.M.
Ibuprofen is a NSAID, or non-steroidal anti-inflammatory drug. It works as a pain reducer and, you guessed it, also reduces inflammation. The most concerning side effect is that ibuprofen can cause irritation in the lining of the stomach that can lead to ulcers and bleeding, sometimes without warning. Alcohol on its own is a known irritant to the stomach lining and can cause ulcers in heavy drinkers, so and adding ibuprofen into the mix can compound the effects. Ibuprofen can also be toxic to the liver and kidneys, and though it isn’t a blood thinner, may alter how blood coagulates, either to form clots more easily or to cause easier bleeding, Brooks says.
Your other go-to option is probably acetaminophen, or Tylenol. “It’s completely different, and its analgesic effects have a different mechanism,” Brooks says. It doesn’t affect your blood’s clotting abilities nor does it hurt your stomach lining. But acetaminophen is more toxic to the liver and more often associated with liver failure—often and without warning, Brooks notes—than NSAIDs. When you’re drinking, you’re already sending a toxic substance to your liver and making it work overtime to filter it out. Adding acetaminophen puts additional, overwhelming stress on the organ, increasing the risk of damage.
Aspirin is also a NSAID, and additionally, works as a blood-thinner. “It is an anti-platelet medicine, which means it makes it harder for blood to clot,” Brooks says. That’s why it’s sometimes recommended as preventive medication for those at high risk of heart disease. Its effects on the liver and kidneys are similar to ibuprofen, and it can also cause bleeding in the GI tract. “Alcohol multiplies the blood-thinner effects of aspirin, and heavy drinkers are already at risk of bleeds due to previous damage to the stomach and liver, so they are at far greater risk of bleeding.”
There is some good news: If you’re relatively healthy, and have no existing problems like gastritis or ulcers, or issues with your kidneys or liver, “taking any of these if you are going out to dinner and having one drink is most likely safe,” Brooks reassures. If you have a choice, you probably want to reach for NSAIDs over acetaminophen, which is the worst for your liver. Food also buffers the effects of both alcohol and NSAIDs, so eating something at the same time can help mitigate potential side effects. But if you’re drinking heavily, it might not be so safe. “Again, this depends on the genetic make up and the prior history of the person imbibing. In a certain way, it’s Russian roulette. It’s not a problem, until one day it is,” Brooks says.
When it comes to the morning after, it’s unclear how much of a risk remains because it’s dependent on so many factors including how much the person drinks in general, and how much alcohol is still in their body.
If you have to take pain medication during or after imbibing, curb your drinking to be safe. If you’re popping pills in anticipation of the morning after, it’s best to prevent a hangover the old-fashioned way: by chugging lots of water. Or just don’t drink enough to be hungover in the first place.