What Pain Relievers Are Safe for Problem Drinkers or Those Who Drink Large Quantities of Alcohol?

A fellow caregiver asked...

What pain relievers are safe for problem drinkers or those who drink large quantities of alcohol?

Expert Answer

Dr. Leslie Kernisan is the author of a popular blog and podcast at BetterHealthWhileAging.net. She is also a clinical instructor in the University of California, San Francisco, Division of Geriatrics.

No pain reliever is 100 percent safe for heavy drinkers. Which pain reliever a doctor recommends should depend on how much the person drinks and whether his or her liver is functioning normally. In general, for mild pain, the safest pain reliever for older adults is acetaminophen, or Tylenol. However, acetaminophen carries a warning against taking it while drinking more than three alcoholic drinks a day. This is because excessive alcohol consumption damages the liver, and acetaminophen may not be safe for those whose livers are impaired.

Alcohol abuse can cause two different kinds of liver problems:

  • Elevated liver enzymes

  • Cirrhosis of the liver

If you or a family member is a heavy drinker, it's important to level with the doctor about alcohol consumption, and it's also important to monitor liver function. A rise in liver enzymes can be detected with a blood test. However, once cirrhosis occurs and the liver becomes scarred, liver enzyme levels may not be elevated. Cirrhosis is usually detected with a liver ultrasound scan.

Still, medical research has shown acetaminophen can be a safe and effective pain reliever even for those with chronic liver disease, as long as the person taking it doesn't take more than 2 grams a day, half the usual allowable dose. Of course it's wisest to do so under medical supervision.

Unfortunately, aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are not necessarily any safer. People who drink a lot also tend to have gastritis (inflammation of the stomach's lining), since alcohol irritates the digestive tract. Heavy drinkers are hence at risk for ulcers and internal bleeding, which aspirin and ibuprofen can make much worse.

For drinkers with chronic pain (from bad arthritis or cancer, for example), it's sometimes necessary to use opiate medications such as oxycodone or morphine, but this should only be in the context of close medical and home supervision, and the drugs should be kept by a responsible family member who can make sure they aren't used during binges. Because people who have a history of problem drinking run a very real risk of addiction when using these drugs, it's best to get opiates through special pain clinics that have experience monitoring for addiction.

In short, there's no easy way to treat liver patients -- or heavy drinkers -- for pain. Still, their pain needs to be taken seriously (uncontrolled pain has been linked to worse drinking, as well as to depression). These people will need careful supervision when using any pain medication. For heavy drinkers, an occasional tablet of acetaminophen for a headache or an achy back should be safe, but I'd recommend a doctor's supervision before giving acetaminophen, aspirin, or NSAIDs on a daily basis to someone who drinks more than one to two drinks every day. For more substantial pain, doctors and family will have to work together closely to figure out an individualized plan and to monitor the safety issues.