South Florida Sun-Sentinel (Sunday)
Be aware of your daily alcohol intake while using Tylenol
Q: I do a lot of outside work. To control the aches and pains, I take Extra-Strength Tylenol. Sometimes, I drink a glass of wine with dinner. I understand that alcohol can increase the risk for liver damage if you take acetaminophen. How much alcohol would it take to cause problems? I have also read that the supplement NAC can help protect you. Is it safe to take NAC on a daily basis?
A: The maker of Tylenol states that “Severe liver damage may occur if you take three or more alcoholic drinks every day while using this product.” It seems like you are well under that level, but we would still be cautious.
NAC is N-acetylcysteine and is considered an antidote to acetaminophen overdose. It enhances levels of the natural compound glutathione, an antioxidant that is valuable for detoxification.
A mouse study did find that NAC “may be a useful tool for combating the enhanced acetaminophen toxicity associated with alcohol ingestion (Alcohol, January-February 1987). A review in the journal American Family Physician (Aug. 1, 2009) concludes that NAC “is a safe, inexpensive, and well-tolerated antioxidant with a well-defined mechanism of action.”
Q: I was prescribed lisinopril for high blood pressure over 10 years ago. It worked great with no side effects until recently. At first, I just noticed a little swelling in my face. Then my lips started swelling, too. When my tongue swelled up, I was transferred to the ER by ambulance. They treated me with an epinephrine injection and kept me overnight for observation. I was surprised that I could develop such a bad reaction after 10 years. You would think that such a serious side effect would have showed up much earlier. The ER doctor said it can happen after one day or after 20 years. Do people know this?
A: Angioedema (swelling of the mouth, tongue or throat) can be a life-threatening reaction to “-pril”type blood pressure drugs. This category includes benazepril, captopril, enalapril, lisinopril and quinapril. Swelling of the tongue or throat requires emergency medical treatment.
There is another kind of angioedema that can occur in the digestive tract. The same blood pressure medications can cause abdominal obstruction. This kind of swelling can lead to bloating and severe stomach pain and cramping. Such an adverse drug reaction can be hard to diagnose and is also life threatening.
We fear that patients are not always warned about angioedema. People should be warned that it can occur unexpectedly, after many years of treatment.
Q: What is it in Ozempic that makes you so exhausted?
A: Doctors prescribe semaglutide (Ozempic) to control blood glucose for people with Type 2 diabetes. The most common side effects are stomachache, nausea, vomiting, diarrhea or constipation. Some people also report feeling tired, though it is considered an uncommon complication. We do not have an explanation for this adverse reaction, though you should monitor your blood sugar levels to make sure they don’t fall too low. If that were to happen, symptoms might include dizziness, shakiness, fatigue, headache and difficulty concentrating.