People’s Pharmacy: Can you have a drink when you take Tylenol?

Q. A few years ago, my primary physician said that you don’t have to worry about consuming alcohol and taking acetaminophen together unless you are an alcoholic. What are your feelings on this? Am I damaging my liver if I have one drink while taking Tylenol?

A. In 2011, the Food and Drug Administration asked manufacturers to limit the amount of acetaminophen in prescription products to 325 milligrams per pill. In addition, the agency advised patients, “Do not drink alcohol when taking medicines that contain acetaminophen.”

The makers of Tylenol are far more lenient, though. They warn: “Severe liver damage may occur if you take 3 or more alcoholic drinks every day while using this product.”

The FDA also warns against taking more than 4,000 milligrams of acetaminophen in a day. A high dose of acetaminophen can harm the liver even if alcohol is not a factor.

Perhaps the best way to tell if your own liver is holding up is to ask your doctor to run a liver function test. This blood test measures liver enzymes to assess liver health.

Q. My husband has been on Zyrtec every other night for years and years. He will not consider coming off it, because when he tries, his skin itches. Can you give me any advice that I could share with him? He’s extremely healthy otherwise but won’t even discuss this anymore.

A. Many readers have reported problems stopping the antihistamines cetirizine (Zyrtec) or levocetirizine (Xyzal). If they have been taking one of these medicines for an extended period, as your husband has, they may experience unbearable itching when they stop.

We found two reports in the medical literature regarding this problem. One was a series of a dozen case reports (Drug Safety Case Reports, December 2016). The other covers nearly 150 cases reported to the Food and Drug Administration (Therapeutic Advances in Drug Safety, July 5, 2019).

Side effects of cetirizine may include drowsiness, stomachache, fatigue, dry mouth, sore throat, diarrhea and nausea.

If your husband decides to wean himself off this allergy medicine despite the itching, he will need patience. Readers who have been through this challenge tell us it can take several weeks for the itching to subside.

Q. I just returned from New Zealand a few days ago and I’m still not able to poop. I’m using stool softeners and laxatives as well as walking and drinking water. I’m getting worried about using over-the-counter drugs. They are starting to get things moving but not enough. Is this a common consequence of jet lag?

A. Many people find that traveling disrupts their digestive systems. You don’t have to travel internationally to suffer, though.

The experts usually blame this problem on changes in your normal schedule, although we suspect there isn’t much evidence for this hypothesis. The ordinary recommendations include consuming plenty of water (as you are), avoiding long sedentary periods (as you are) and consuming a fiber-rich diet with lots of fruits and vegetables (are you?).

There are many other approaches that can be effective, such as chewing sugarless gum or taking psyllium. Prunes, alone or as part of a bran/applesauce/prune juice mixture, can often help.

Our “eGuide to Overcoming Digestive Disorders” has details, along with our 10 tips on avoiding constipation and a list of drugs that can make constipation worse. You’ll find this online resource under the Health eGuides tab at www.PeoplesPharmacy.com.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla., 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”