Does Tylenol Interact with Other Drugs?

Tylenol is one of the most widely taken over the counter (OTC) pain medications, and questions often come up about what other drugs it interacts with. Taking Tylenol while also taking either aspirin or ibuprofen carries risks, but the combination of the drugs is usually not a problem.

Interactions with Common Drugs

Drug interactions sometimes change how well your medications work and can increase the possibility of negative side effects. It’s important to maintain a list of all the drugs and supplements you take, along with dosage amounts and schedule.

Your list should include all prescription and non-prescription medications, herbal supplements and products, as well as vitamins and ointments. Keep your list current and share it regularly with all of your doctors and pharmacists.

Some of the common drug interactions include:

• Tylenol and Phenytoin
• 
  Tylenol and Valsartan
• 
  Tylenol and Warfarin

Taking acetaminophen while taking the blood thinner Warfarin has the potential to cause serious issues. N-acetyl-p-benzoquinone, a metabolite in acetaminophen, interferes with the synthesis of coagulation factors and vitamin K metabolism, potentially negating Warfarin’s ability to thin the blood sufficiently.

Acetaminophen may also have anti-aggregatory effects, meaning it prevents blood platelets from binding. Research the Canadian Medical Association Journal published shows that concurrent use of Warfarin and acetaminophen can lead to a higher  internalized normalized ratio (INR) lab result, and may also lead to  bleeding.

A study published in the Journal of Pharmaceutics about paracetamol, the name for acetaminophen in the United Kingdom, notes that the drug-drug interaction between Warfarin and paracetamol can lead to bleeding and anemia. 

The interactions of phenytoin and paracetamol can lead to reduced efficacy of paracetamol and an increased risk of hepatotoxicity. The study showed the risk of this interaction had both a suspicion of hepatotoxicity and an episode of pain breakout. A mix of valsartan and paracetamol can lead to hypertension and tachycardia.

Can You Take Tylenol with Ibuprofen?

Available data shows that alternating use of or taking Tylenol and ibuprofen in combination is well tolerated. And there’s growing research that suggests there are benefits to doctor-managed treatment regimens combining ibuprofen and acetaminophen.

While combining Tylenol and ibuprofen or taking them in alternating fashion appears to reduce fevers in children compared to using them alone, there are concerns about potential dosing errors that can lead to unintentional overdose with this more complicated regimen.

Tylenol and ibuprofen each have potential health risks before being combined with another medication, and these side effects may be contraindicated for some patients. Although Tylenol and ibuprofen make for a well-tolerated combination, their use at the same time still elevates the risk of a negative effect.

Even without noticeable negative side effects, you should not take either medication long term. If you experience any side effects from Tylenol or ibuprofen, or from the combination of the two, speak to your doctor immediately.

Can You Take Tylenol with Aspirin?

Tylenol and aspirin each have potential health risks and may be contraindicated for some people. Although they are well-tolerated in combination, it’s important to note that the combined use of Tylenol and aspirin increases the variables in terms of risks.

The FDA recognized the combination of acetaminophen (250 mg), caffeine (65 mg) and acetylsalicylic acid (250 mg) as safe and effective in treating acute headaches, especially migraines. This finding is also backed up by the American Headache Society (Level A).

The consensus is that the combined use of acetaminophen, caffeine and acetylsalicylic acid is well-tolerated in episodic tension-type headaches and is better than using acetaminophen alone. All components of this combination are safe and can be taken orally for acute migraine attacks, even when breastfeeding.

Although the combined use of Tylenol and aspirin is well tolerated, neither medication should be taken long term. Reach out to your doctor immediately if you experience any side effects from either one or the combined use of these two medications.

Can Tylenol Interact With Food?

Besides potential drug-drug interactions (pDDI) and drug-supplement interactions, Tylenol can also interact with foods and beverages.

Foods that are high in pectin (including jellies), carbohydrates and cruciferous vegetables like cabbage, broccoli and Brussels sprouts, can affect the amount and rate of acetaminophen absorption. Research into how much effect the interactions have on acetaminophen efficacy shows no definite answers.

As for beverages, one study found that hibiscus could decrease acetaminophen levels in the bloodstream if Tylenol was taken after consuming tea containing the flowers or leaves. It’s also not clear if the decrease is clinically significant to change the efficacy of the medication.

Lawsuit Information

ADHD and autism spectrum disorder are among the injuries being named in Tylenol lawsuits.

View Lawsuits

Does Tylenol Raise Your Blood Pressure?

Observational and interventional studies examining the effect of Tylenol on hypertension (blood pressure) have produced conflicting results. Acetaminophen, the active ingredient in Tylenol, was shown in some studies to cause a mild increase in blood pressure, although the elevation was not associated with heart attack or stroke.

Findings from one 2022 clinical research trial suggested that regular daily intake of 4 g acetaminophen increased systolic blood pressure in individuals with hypertension by about 5 mm Hg compared with a placebo. The study concluded that this increase in cardiovascular risk calls into question the safety of regular acetaminophen use in similar situations.

People with any cardiovascular risk factors — obesity, high cholesterol, high blood pressure, family history of heart problems — should talk to their doctor before taking Tylenol. Doctors will likely want a full list of the other medications you take for possible negative interactions.

Can You Take Tylenol While Pregnant?

Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDS) are an appropriate combination for someone to take for mild to moderate pain. In fact, acetaminophen is a first-line symptomatic treatment during pregnancy.

However, you should avoid NSAIDs in the third trimester because of their established risks. As an active ingredient in more than 600 medications used to relieve mild to moderate pain and reduce fever, acetaminophen is much more appropriate for pregnant women.

Government agencies that include the U.S. Food and Drug Administration (FDA) recommend acetaminophen as a safe and effective medication for use during pregnancy particularly when used as directed.

Increasing experimental and epidemiological research suggests that prenatal exposure to acetaminophen might alter fetal development. This could increase the risk of some neuro-developmental, urogenital and reproductive disorders. There is a need for precautionary action by increasing awareness among pregnant women and health professionals as well as through focused research.

Tylenol and Autism

A study the National Institutes of Health and the Agency for Healthcare Research and Quality funded suggests prenatal exposure to acetaminophen may increase a child’s risk for attention deficit/hyperactivity disorder and autism spectrum disorder.

Researchers believe that their findings show enough to raise concerns about potential development of risks associated with prenatal exposure to acetaminophen and therefore call for precautionary action.

Epidemiological studies consistently suggest that prenatal exposure to acetaminophen might increase the risk of adverse neurodevelopmental and behavioral outcomes, such as:

• Attention deficit hyperactivity disorder (ADHD)
• 
  Autism spectrum disorder
• 
  Decreased intelligence quotient
• 
  Language delay (in girls)

The consensus is that the timing and duration of maternal use of acetaminophen is a determining factor in its safety for the newborn.

In a cohort study of 996 mother-infant pairs from the Boston Birth Cohort, cold plasma biomarkers of prenatal acetaminophen exposure were associated with significantly increased risk of autism spectrum disorder and childhood attention deficit/hyperactivity disorder.

A Scandinavian Journal of Pain study showed that prenatal exposure to acetaminophen is associated with:

• Asthma
• 
  Attention deficit/hyperactivity disorder
• 
  Autism spectrum disorder
• 
  Behavioral problems during childhood
• 
  Lower performance intelligence quotient
• 
  Neurodevelopmental problems (communication and gross motor development)
• 
  Poor attention and executive function
• 
  Shorter male infant anogenital distance (predicts a male reproductive potential)

A meta-analysis of available studies and research shows a strong correlation between prenatal exposure to acetaminophen and its potential adverse effects, although no conclusive studies exist.

Please seek the advice of a medical professional before making health care decisions.

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Drug interactions with paracetamol – PubMed

Review

. 2005 Jan-Feb;12(1):56-66.

doi: 10.1097/00045391-200501000-00009.

Maurice J Toes 
¹
, Alison L Jones, Laurie Prescott

Affiliations

Affiliation

• ¹ National Poisons Information Service, Guy’s and St. Thomas’ NHS Trust, Medical Toxicology Unit, Avonley Road, London SE14 5ER, United Kingdom.

• PMID:

  15662293

• DOI:

  10.1097/00045391-200501000-00009

Review

Maurice J Toes et al.

Am J Ther.

2005 Jan-Feb.

. 2005 Jan-Feb;12(1):56-66.

doi: 10.1097/00045391-200501000-00009.

Authors

Maurice J Toes 
¹
, Alison L Jones, Laurie Prescott

Affiliation

• ¹ National Poisons Information Service, Guy’s and St. Thomas’ NHS Trust, Medical Toxicology Unit, Avonley Road, London SE14 5ER, United Kingdom.

• PMID:

  15662293

• DOI:

  10.1097/00045391-200501000-00009

Abstract

Paracetamol (acetaminophen) is one of the most commonly used analgesic antipyretic drugs worldwide, and it is widely available by prescription and over the counter (OTC). Fortunately, few clinically significant drug interactions have been documented. There is probable potentiation of hepatotoxicity following an overdose from the paracetamol metabolite NAPQI by enzyme-inducing drugs. There is considerable controversy regarding the possible interaction with warfarin in its potential to increase its anticoagulant effects because of discrepancies between observational studies and those in healthy volunteers. Otherwise, no serious adverse drug interactions with therapeutic doses of paracetamol have been confirmed in humans. Because the absorption of paracetamol is so dependent on gastric emptying, other drugs that alter gastric emptying can change its pharmacokinetics; but this would not cause serious adverse effects. Although animal experiments have demonstrated that many compounds can modify paracetamol hepatotoxicity, these are unlikely to be important at therapeutic doses.

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Acetaminophen: Pediatric Medication | Memorial Sloan Kettering Cancer Center

Pediatric Medicine

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Provided by Lexicomp ^® , this document contains all the information you need to know about this medicine, including indications, directions for use, side effects, and when your healthcare provider should be contacted.

Trade names: USA

7T Gummy ES [DSC]; 8 Hour Pain Reliever [OTC]; Acetaminophen 8 Hour [OTC]; Acetaminophen Extra Strength [OTC]; Aminofen [OTC] [DSC]; Apra [OTC]; Arthritis Pain Relief [OTC]; Aurophen Childrens [OTC] [DSC]; BetaTemp Childrens [OTC]; Children’s Acetaminophen [OTC]; Children’s APAP [OTC]; Children’s Non-Aspirin [OTC]; Children’s Silapap [OTC]; Children’s Tactinal [OTC] [DSC]; Ed-APAP [OTC]; ElixSure Fever/Pain [OTC]; FeverAll Adults [OTC]; FeverAll Childrens [OTC]; FeverAll Infants [OTC]; FeverAll Junior Strength [OTC]; GoodSense Pain & Fever Child [OTC]; GoodSense Pain & Fever Infants [OTC]; GoodSense Pain Relief Extra St [OTC]; GoodSense Pain Relief [OTC] [DSC]; Healthy Mama Shake That Ache [OTC]; Liquid Pain Relief [OTC]; M-PAP [OTC]; Mapap Acetaminophen Extra Str [OTC]; Mapap Arthritis Pain [OTC]; Mapap Childrens [OTC]; Mapap [OTC]; Max Relief Junior [OTC]; Non-Aspirin Extra Strength [OTC]; Non-Aspirin Pain Reliever [OTC] [DSC]; Non-Aspirin [OTC]; Nortemp Infants [OTC] [DSC]; Nortemp [OTC] [DSC]; Firmev[DSC]; Pain & Fever Childrens [OTC] [DSC]; Pain & Fever Extra Strength [OTC] [DSC]; Pain & Fever [OTC] [DSC]; Pain Relief Childrens [OTC]; Pain Relief Extra Strength [OTC]; Pain Relief Regular Strength [OTC]; Pain Relief [OTC]; Panadol Childrens [OTC]; Panadol Extra Strength [OTC]; Panadol Infants [OTC]; Pharbetol Extra Strength [OTC]; Pharbetol [OTC]; Tactinal Extra Strength [OTC] [DSC]; Tactinal [OTC] [DSC]; Triaminic Fever Reducer [OTC]; Tylenol 8 Hour Arthritis Pain [OTC]; Tylenol 8 Hour [OTC]; Tylenol Children’s Chewables [OTC]; Tylenol Children’s Pain + Fever [OTC]; Tylenol Childrens [OTC]; Tylenol Dissolve Packs [OTC]; Tylenol Extra Strength [OTC]; Tylenol for Children + Adults [OTC]; Tylenol Infants Pain+Fever [OTC]; Tylenol [OTC]

Warning

• This medicine contains acetaminophen. During the use of acetaminophen, liver disorders were recorded. In some cases, these disorders have required liver transplantation or have resulted in death. In most cases, liver disorders occurred in patients who exceeded the allowable daily dose of acetaminophen. It was not uncommon for patients to use not just one, but several acetaminophen-containing medicines at the same time. If you have any questions, check with your child’s doctor.

What is this drug used for?

• It is used to relieve pain and reduce high fever.

What do I need to tell the doctor BEFORE my child takes this drug?

• If your child has an allergy to this drug, any of its ingredients, other drugs, foods, or substances. Tell the doctor about the allergy and how it manifested itself in the child.
• If your child has liver disease.

This list of drugs and conditions that may interact with this drug is not exhaustive.

Talk to your doctor or pharmacist about all medicines your child is taking (prescription and over-the-counter, natural, and vitamins) and any health problems. You need to make sure that this drug is safe to use for your child’s illnesses and in combination with other drugs he or she is already taking. Do not start, stop taking, or change the dosage of any drug your child is taking without the doctor’s approval.

What do I need to know or do while my child is taking this drug?

• Tell all health care providers who care for your child that your child is taking this drug. These are your child’s doctors, nurses, pharmacists and dentists.
• It is not recommended to give your child other medicines containing acetaminophen. Carefully study the instructions for medicines. Taking acetaminophen in excessive amounts can lead to liver problems.
• Follow the instructions exactly. Do not exceed your child’s daily dose of acetaminophen. If you don’t know what your child’s daily dose of acetaminophen is, ask your doctor or pharmacist. If you have exceeded your child’s daily dose of acetaminophen, contact their healthcare provider immediately, even if the child’s condition does not worsen.
• Alcohol can interact with this drug. Make sure your child does not drink alcohol.
• This drug may affect the results of some lab tests. Tell all health care workers and laboratory workers who provide your child’s health care that your child is taking this drug.
• If your child has phenylketonuria, talk to your doctor. Some foods contain phenylalanine.
• Doses of this drug indicated for use in children may vary by brand. Talk to your doctor before giving this drug to a child.

If your daughter is pregnant or breastfeeding:

• Consult physician if your daughter is pregnant, pregnant, or breastfeeding. The benefits and risks for your daughter and her baby will need to be discussed.

What side effects should I report to my child’s doctor right away?

WARNING/CAUTION: Although rare, some people may have very serious and sometimes deadly side effects of this drug. Call your child’s doctor right away or get medical help if your child has any of the following signs or symptoms that could be associated with a very bad side effect:

• Signs of an allergic reaction such as rash, hives, itching, red and swollen skin with blisters or peeling with or without fever, wheezing, tightness in the chest or throat, trouble breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue or throat. Some allergic reactions in rare cases have become life-threatening.
• Signs of liver problems such as dark urine, fatigue, lack of appetite, nausea or abdominal pain, light-colored stools, vomiting, yellowing of the skin or eyes.
• Difficulty urinating or a change in the amount of urine produced.
• Possible severe skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis). This can lead to severe health problems, which can be permanent, and sometimes death. Seek immediate medical attention if your child has symptoms such as redness, swelling of the skin with blistering or peeling (with or without fever), redness or irritation of the eyes, painful sores in the mouth, throat, nose or eyes .

What are some other side effects of this drug?

Any drug can cause side effects. However, for many people, side effects are either minor or non-existent. Contact your child’s doctor or seek medical attention if any of these or other side effects bother your child or if they persist:

• Nausea or vomiting.
• Sleep disorders.
• Headache.
• Constipation.

This list of possible side effects is not exhaustive. If you have any questions about side effects, ask your child’s doctor. Talk to your child’s doctor about side effects.

You can report side effects to the National Health Board.

What is the best way to give this drug?

Give this drug to your child as directed by your doctor. Read all the information provided to you. Strictly follow all instructions.

All oral preparations:

• Give this drug with or without food.

Chewable:

• Make sure that the child chews the drug thoroughly before swallowing.

Lozenge:

• Put it on your tongue and let it dissolve.

Long-acting tablets:

• Ask your child to swallow whole. Ask your child not to chew, break, or crush the tablet.
• Give this drug with a full glass of water.

All liquid formulations:

• Liquid doses should be measured with caution. Use the dispenser that comes with the medicine. If the dispenser is not provided in the package, ask the pharmacist for a dosing agent for this drug.

Liquid (suspension):

• Shake well before use.

Suppositories:

• Candles are for rectal use only.
• Wash your hands before and after use.
• If the candle is soft, cool it in the refrigerator or hold it under cold water.
• Before using the candle, remove the foil wrapper.
• Moisten the suppository before inserting it into the rectum.
• Gently pressing, insert the candle with the pointed end forward into the rectum. Do not hold in your hands for too long.

Injection:

• For intravenous infusions.

What if my child misses a dose of medication?

Oral preparations and suppositories:

• If the child takes the drug regularly, give him the missed dose as soon as you remember about it.
• If it is time for your child to take the next dose, do not take the missed dose and then go back to your child’s normal schedule.
• Do not give a double dose at the same time or additional doses.
• In most cases, this drug is used as needed. Do not give your child the drug more often than prescribed by the doctor.

Injection:

• Contact your child’s doctor to find out the next steps.

How do I store and/or discard this drug?

All oral preparations:

• Store at room temperature. Do not place in refrigerator or freezer.
• Store in original packaging to protect from light.
• The lid must be tightly closed.
• Store in a dry place. Do not store in the bathroom.

Suppositories:

• Store at room temperature, protected from light. Store in a dry place. Do not store in the bathroom.
• Don’t freeze.
• Some drugs can be stored in the refrigerator. Check with your pharmacist or read the label on the package.

Injection:

• If you need to store this drug at home, check with your child’s doctor, nurse, or pharmacist about how to store it.

All forms:

• Keep all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into a toilet or sewer unless instructed to do so. If you have any questions about disposing of medicines, ask your pharmacist. Drug disposal programs may be in place in your area.

General information about medicines

• If your child’s symptoms or health problems do not improve, or worsen, contact your child’s doctor.
• Do not share your child’s medicine with others and do not give anyone else’s medicine to your child.
• Some medicines may come with other patient information leaflets. If you have questions about this drug, talk with your child’s doctor, nurse, pharmacist, or other health care professional.
• If you think you have overdosed, call a poison control center or get medical help right away. Be prepared to tell or show what drug you took, how much, and when it happened.

Consumer Use of Information and Limitation of Liability

This summary information includes a summary of the diagnosis, treatment, and/or drug product. It is not intended to be a comprehensive source of data and should be used as a tool to help the user understand and/or evaluate potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a particular patient. It should not be considered medical advice or a substitute for medical advice, diagnosis or treatment provided by a physician based on a medical examination and assessment of the patient’s specific and unique circumstances. Patients should consult with their physician for full information about their health, medical issues, and treatment options, including any risks or benefits regarding the use of medications. This information is not a guarantee that a treatment or drug is safe, effective, or approved for a particular patient. UpToDate, Inc. and its subsidiaries disclaim any warranties or liabilities related to this information or its use. The use of this information is subject to the Terms of Use found at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms.

Last revision date

2023-02-01

Copyright

© UpToDate, Inc. and its affiliates and/or licensors, 2023. All rights reserved.

Date last updated

Monday, December 12, 2022

Grippex (Grippex). Oral tablets Directory of drugs. Tomsk

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Packaging

Oral tablets

Pharmacological action

Each Gripex tablet contains three safe and effective ingredients. Acetaminophen (paracetamol) has analgesic and antipyretic effects, eliminates mild to moderate pain, including headache, reduces fever. Pseudoephedrine reduces swelling of the nasal mucosa, stops the secretion of mucus from the nose and improves the patency of the paranasal sinuses. Dextromethorphan, due to its antitussive action, reduces cough caused by mild irritations of the throat and bronchi. All of the above symptoms can accompany colds.

Indications for use

Gripex is used to relieve symptoms of colds and flu: mild to moderate pain (sore throat, general and muscle pain), fever, swelling of the mucous membrane of the nasal cavity and paranasal sinuses, runny nose, cough

Formulation

tablets; blister pack 12, cardboard pack 1;

pills; blister pack 12, carton pack 2;

Pharmacodynamics

Each Gripex tablet contains three safe and effective ingredients. Acetaminophen (paracetamol) has analgesic and antipyretic effects, eliminates mild to moderate pain, including headache, reduces fever. Pseudoephedrine reduces swelling of the nasal mucosa, stops the secretion of mucus from the nose and improves the patency of the paranasal sinuses. Dextromethorphan, due to its antitussive action, reduces cough caused by mild irritations of the throat and bronchi. All of the above symptoms can accompany colds.

Pharmacokinetics

The pharmacokinetics of the drug depends on the pharmacokinetics of the active substances.

Acetaminophen is absorbed from the gastrointestinal tract quickly and almost completely. The maximum plasma concentration is reached within 30-40 minutes after ingestion. The half-life of acetaminophen is 2-4 hours. The analgesic effect of acetaminophen is observed within 4–6 hours, and the antipyretic effect is observed within 6–8 hours. Metabolism of acetaminophen is carried out by microsomal liver enzymes. 24 hours after taking a therapeutic dose, 90 – 100% of the drug, mainly after combination in the liver with glucuronic, sulfuric acids, cysteine ​​and in unprocessed form.

Pseudoephedrine is absorbed from the gastrointestinal tract quickly and almost completely. Peak plasma concentration is reached after approximately 2 hours. The vasoconstrictive effect of pseudoephedrine hydrochloride in the form of tablets is detected within 15 to 30 minutes after ingestion and lasts 3 to 4 hours.

Pseudoephedrine is partially metabolized in the liver by N-demethyl to form an inactive metabolite. The drug and its metabolite are excreted in the urine. The half-life of pseudoephedrine varies from 3-6 hours to 9-16 hours at urine pH levels of 5 and 8, respectively.

Dextromethorphan is rapidly absorbed from the gastrointestinal tract. Antitussive action is detected within 15-30 minutes and lasts 4-6 hours. The maximum plasma concentration is reached within 2-3 hours. The metabolism of dextromethorphan is carried out in the liver by cytochrome P450IID6 and ends with the formation of active and inactive metabolites. Dextromethorphan is excreted unprocessed or as demethylated metabolites after combination with glucuronic and sulfuric acids. The plasma half-life of dextromethorphan is 3-4 hours.

Use during pregnancy

The use of Gripex during pregnancy and lactation is possible only in this case, when the potential benefit from the use of the drug outweighs the possible risk.

Contraindications for use

Gripex is not indicated for patients with hypersensitivity to any of the components of the drug, as well as during treatment with alternative drugs that contain aceminophen, dextromethorphan or pseudoephedrine. Acute renal or hepatic failure. Severe hypertension. Severe coronary heart disease. Alcohol abuse. Do not use together with monoamine oxidase (MAO) inhibitors and within 2 weeks after the suspension of MAO inhibitors. Do not administer to children younger than 6 years.

Side effects

Some patients may feel tired, drowsy and dizzy. Possible disorders of the gastrointestinal tract, accompanied by nausea, vomiting. Rarely, allergic skin reactions may occur. In persons with hypersensitivity to the drug, there may be a slight increase in blood pressure and tachycardia.

Dosage and Administration

Adults and children 12 years of age and older: two tablets of Gripex 3-4 times a day. The daily dose should not exceed 8 tablets.

Children 6 to 12 years of age: One tablet 3-4 times daily.