In hangover hell

I drank too much last night and don't know what to do -- pop Tylenol or Advil?

By Cynthia Kuhn - Wilkie Wilson

Published June 28, 2000 7:00PM (EDT)

Dear Buzzed,

I'm extremely hung over. I want to know how come Tylenol bottles have a warning on them stating that Tylenol can harm your liver if you have more than three drinks a day. What is this based on? Is it still safe to take Tylenol/Advil after a night of pounding too many tequila shots?

Hung Over

Dear Hung Over,

Buzzed is very, very sympathetic. If we really had the cure for hangovers, we'd be more than buzzed -- we'd be rich and, on occasion, we'd feel a bit better ourselves.

Hangovers are believed to occur as a result of three different processes. Everyone knows you sweat and urinate a lot when you drink, possibly leading to dehydration. Your brain also quickly adapts to the presence of the ethanol, and when you stop drinking, parts of your brain and heart become excitable (giving you that jittery feeling). Add to that the metabolism of ethanol -- which produces a chemical called acetaldehyde -- and you've arrived to that hellish, miserable state we refer to as being hung over.

While Tylenol (acetaminophen) is normally a very safe drug -- hospitals use it all the time because it doesn't have the problems of most other painkillers -- if you take it when you're drunk, the alcohol interferes with the acetaminophen's metabolism, and you risk damaging your liver.

Normally, if you take too much acetaminophen, the metabolic breakdown process gets overloaded and your body activates a backup system to help. Unfortunately, as this backup system metabolizes the acetaminophen, it produces a substance that is very toxic to your liver. A big overdose of acetaminophen alone can damage the liver permanently, and even kill you.

In the presence of ethanol, this backup system is activated with a lot less of the drug. So even taking a few tablets after drinking could damage your liver.

On the other hand, Advil (ibuprofen) and similar drugs (aspirin, Nuprin, Aleve, Vioxx, Celebrex), known as non-steroidal anti-inflammatory drugs (NSAIDs), are OK to take (as directed). They not only reduce pain but actually suppress the inflammatory processes in the body. Plus, they do not cause liver injury the way the acetaminophen does.

However, they are not without their own side effects. When you take high doses or use them for a long time, they may damage the stomach and promote bleeding from the gastrointestinal tract, as ethanol does.

If you want to avoid pharmaceuticals, there are a wealth of other cures that have been tried, including primrose oil, peppermint tea, honey with soda crackers, aromatherapy cocktails, raw owl's eggs and sheep lungs (favored by the early Romans), tangerine juice, orange juice, strawberries and Gatorade. Although there is no research supporting the claims, all these are said to help metabolize alcohol and restore the vitamins lost during dehydration -- or to "flush toxins." Crackers may help settle an uneasy stomach, and any noncaffeinated fluids may help if you have really lost a lot of water.

Our recommendation? The obvious: Try to drink less. But if that doesn't fit with your Saturday night plans, drink some fluids, take a small dose of the headache remedy of your choice and just give yourself a little time to recover -- perhaps, depending on how much you drank, all of Sunday.

Cynthia Kuhn

Cynthia Kuhn, Ph.D., is a professor of pharmacology at Duke University Medical School and heads the Pharmacological Sciences Training Program at Duke. She is coauthor of "Buzzed: The Straight Facts About the Most Used and Abused Drugs From Alcohol to Ecstasy" and of the forthcoming book "Pumped: Straight Facts for Athletes About Drugs, Supplements and Training."

MORE FROM Cynthia Kuhn

Wilkie Wilson

Wilkie Wilson, Ph.D., is a professor of pharmacology at Duke University Medical School. He studies how drugs affect the brain, particularly the processes of learning and memory. He is also coauthor of "Buzzed" and of the forthcoming book "Pumped."

MORE FROM Wilkie Wilson

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