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Tylenol with Caffeine Increases the Risk of Liver Damage

Posted: Thursday, October 18, 2007

A mix of acetaminophen and caffeine may cause liver damage, especially in heavy caffeine drinkers, according to a study at the University of Washington in Seattle.

Although previous studies have linked alcohol consumption and use of acetaminophen to liver damage, this is the first study to link caffeine to the danger.

Scientists at the University of Washington found that consuming acetaminophen, one of the main ingredients in many over-the-counter pain-relief medications like Tylenol, and caffeine can eventually scar the tissue in the liver. The study also found a link between liver damage and over-the-counter and prescribed medications that include caffeine and acetaminophen together, like some Anacin and Excedrin products, often used to treat migraines, arthritis and other painful conditions.

Consumers may want to limit their intake of caffeine, included in coffee and many popular energy drinks, such as Red Bull, while taking acetaminophen, according to researchers.

Researchers have found that caffeine can triple the amount of a toxic byproduct, N-acetyl-p-benzoquinone imine (NAPQI), an enzyme produced while breaking down acetaminophen, which is also responsible for liver damage and failure in most toxic alcohol-acetaminophen interactions.

Some patients may be more susceptible to the toxic interaction than others, according to Nelson, including patients who take certain anti-epileptic medications, including carbamazepine and Phenobarbital, or those who take the herbal supplement St. John’s Wort. These products, often used to boost levels of the enzymes that produce the toxic enzyme NAPQI, may be exaggerated if someone is ingesting acetaminophen and caffeine.

Dr. Steven Lidofsky, director of hepatology and director of gastrointestinal research at the University of Vermont Medical Center and the Fletcher Allen Medical Center in Burlington, Vt. said he doesn’t know if there’s a real link between caffeine and acetaminophen consumption and liver damage since caffeine is often used to slow liver scarring in patients with chronic liver disease. He said the answer may be found in the actual mechanism or initial development of these toxic enzymes and how they affect the liver.

“Off the top of my head, it’s hard to imagine how caffeine might do it,” said Lidofsky. “I have to speculate. Caffeine reduces antioxidants in the liver, somehow affecting levels of CYP2e1, which converts the NAPQI enzyme into a toxin. I’m surprised that caffeine would induce this. In terms of how acetaminophen causes damage and being a toxic metabolite, the things that would promote acetaminophen toxicity are things that inhibit antioxidants in the liver.”

Researchers at the University of Washington are considering using human volunteers for future studies, including one that will study the mechanism of how the toxic interaction occurs between acetaminophen and caffeine.

Source: Diabetes In Control: University of Washington News Release