Why we should not take paracetamol to combat a hangover (and what alternative is better)

Hangover, for most of you, must be a common ailment after a night of festivities.

However, not everyone is affected by alcohol intake. The answer varies greatly depending on each individual, environmental and temporal factors.

All of them can significantly affect when suffering this inevitable feeling of indisposition (and, sometimes, regret for not having avoided it) or whether it is of greater or lesser intensity.

Although we know what your triggers usually are, the specific cause that causes us to suffer from a hangover is still unknown. Nor do we know what are the reasons behind all the effects associated with it.

Where is the cause of the hangover?

If we do some research in the scientific literature, hangover symptoms have been tried to justify for different reasons. The first one is the dehydration.

But it also appeals to the alteration of the concentration of endogenous substances (which are produced in the body naturally) such as glucose or some hormones. This could happen due to the ingestion of large amounts of alcohol, which results in high concentrations of ethanol and its breakdown products in the blood.

However, it is not very clear that the discomfort associated with hangovers is due to these disorders and its origin is still being investigated.

In recent years, some researchers have linked the discomfort and symptoms to an immunological origin that triggers the release of endogenous substances related to pain and inflammatory processes. These would be the cause of headache and general bodily discomfort.

While we leave it to researchers to identify the true causes of hangovers, we will evaluate what drugs we have at our disposal to manage these symptoms in the best possible way. To do this, we must first understand how alcohol works in our body.

This is how alcohol flows through your body

When we drink an alcoholic drink, the ethanol it contains is absorbed very quickly in the gastrointestinal tract and later reaches the liver. This organ is responsible for metabolism through enzymes called alcohol dehydrogenase (ADH).

If you keep drinking alcohol for long periods, the intense liver enzyme activity It can affect the health of the liver itself. This can suffer alterations due to the accumulation of ethanol metabolites that can damage liver cells.

In addition, these breakdown products can cause inflammation and lead to the development of an alcoholic fatty liver, which is the initial and earliest stage of the alterations that the liver can undergo and that can trigger a alcoholic hepatitis or cirrhosis in the most serious cases.

That said, and knowing the serious consequences of alcohol abuse, let’s see if the most used treatments to overcome that bad drink (pun intended) are doing more harm than good.

After nights of debauchery, ibuprofen, not paracetamol

If you have already gone through one of these stages you will have resorted to paracetamol or ibuprofen hoping for miraculous results to mitigate the symptoms. But do you know how these drugs work?

First of all, paracetamol is a drug with analgesic and antipyretic properties, very effective to control fever or treat pain. That is why it is one of the drugs of choice to treat processes that cause pain.

However, these molecules do not have anti-inflammatory activity, so if the pain is associated with inflammatory processes it is less effective.

This medicine, at therapeutic doses, is safe and has no toxic effects. Once absorbed and in the bloodstream, it is metabolized in the liver and the intact molecule and its metabolites are mainly eliminated through the kidney.

For its part, ibuprofen belongs to the group of non-steroidal anti-inflammatory drugs and it has antipyretic, analgesic and anti-inflammatory activity. It is normally prescribed for pain caused by inflammatory processes such as arthritis, tooth or toothache pain, muscle injury or menstrual pain.

Unlike acetaminophen, ibuprofen does not damage the liverAlthough due to its own anti-inflammatory action mechanism, it can affect the gastric mucosa and damage this protective barrier of the stomach. But it will do so to a lesser extent than other drugs in the group of anti-inflammatory drugs.

Paracetamol will make our liver work more if we have consumed alcohol

The problem of taking paracetamol after excessive alcohol intake is related to the metabolism mechanism of both.

Remember the enzyme ADH? Well, this enzyme metabolizes alcohol in the gastric mucosa and liver to transform it into a molecule that is easier to eliminate from the body. But when we drink excessively, this enzyme becomes saturated and you must ask for help from another: the CYP2E1 enzyme. And it will do so in large quantities because alcohol works as an inducer on this enzyme system.

For its part, paracetamol is also metabolized in the liver through two processes: 80% by conjugation with glucuronic acid and 20% by the CYP2E1 enzyme.

As you can see, this enzyme participates both in the process of metabolizing alcohol and paracetamol. Here comes the problem.

That small part of the paracetamol that is metabolized by the CYP2E1 enzyme is transformed into a highly reactive metabolite, NAPQI, which can lead to oxidative stress and cell death. Under normal conditions, we can eliminate it thanks to glutathione, but when we have drunk a lot of alcohol, the process is complicated.

Why? Because our body will have very high levels of the CYP2E1 enzyme (to be able to metabolize alcohol), so paracetamol tends to use its secondary metabolism pathway (by CYP2E1).

In this way, much more NAPQI will be generated and, if the body cannot eliminate it (because glutathione is limited), it could cause liver damage.

At this point, we ask ourselves, what should our choice be? Analyzing the two molecules, it is advisable to use ibuprofen.

Additionally, if, as described, the hangover is associated with an inflammatory process, ibuprofen, in addition to its analgesic action, will act on the inflammation and, therefore, will be more effective.

Either way, you have to be careful as ibuprofen can enhance the irritant activity of alcohol at the gastric level, by altering the stomach barrier. But this does not usually happen after ingesting a single adequate dose of this anti-inflammatory, but after taking it continuously when very high doses are used.

However, let’s remember that the best remedy for a hangover is not to consume alcohol. Or, at least, not in large quantities.

* This article was published in The Conversation, whose original version you can read here.

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