Also indexed as: APAP, Paracetamol, Tylenol
Combination drugs: Alka-Seltzer Plus, Co-Proxamol, Darvocet N, Endocet,
Excedrin PM, Fioricet, Lortab,
Midrin, Nyquil, Nyquil Hot Therapy Powder, Percocet,
Phrenilin, Propacet 100, Roxicet,
Theraflu, Tylenol Allergy Sinus, Tylenol Cold, Tylenol Flu NightTime Maximum Strength Powder, Tylenol Multi-Symptom Hot Medication, Tylenol PM, Tylenol Sinus, Wygesic
Acetaminophen is used to reduce pain and fever. Unlike NSAIDs (nonsteroidal anti-inflammatory drugs), it
lacks anti-inflammatory activity. Acetaminophen is available by itself or in nonprescription
and prescription-only combination products used to relieve pain and the symptoms associated
with colds and flu.
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
| May Be Beneficial: Side effect
reduction/prevention—Taking these supplements may help reduce the likelihood and/or
severity of a potential side effect caused by the medication.
| May Be Beneficial: Supportive
interaction—Taking these supplements may support or otherwise help your medication
Avoid: Reduced drug absorption/bioavailability—Avoid these supplements
when taking this medication since the supplement may decrease the absorption and/or activity
of the medication in the body.
Check: Other—Before taking any of these supplements or eating any of
these foods with your medication, read this article in full for details.
|Depletion or interference
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
Interactions with Dietary Supplements
Hospitals use oral and intravenous N-acetyl cysteine (NAC) to treat liver damage induced by
acetaminophen overdose poisoning.1 NAC is often administered intravenously by
emergency room doctors. Oral NAC appears to be effective for acetaminophen toxicity.
An uncontrolled trial compared intravenous NAC with oral NAC in children with acetaminophen
poisoning and found that both methods were equally effective in reversing
acetaminophen-induced liver toxicity.2 However, acetaminophen toxicity is a
potential medical emergency, and should only be managed by qualified healthcare
Taking 3 grams vitamin C with acetaminophen has been shown to prolong the amount of time
acetaminophen stays in the body.3 This theoretically might allow people to use less
acetaminophen, thereby reducing the risk of side effects. Consult with a doctor about this
potential before reducing the amount of acetaminophen.
Interactions with Herbs
One small study found that hibiscus could decrease levels of acetaminophen if the drug was
taken after the tea was consumed though it was not entirely clear if the decreases were
thistle (Silybum marianum)
Silymarin is a collection of complex flavonoids found in milk thistle that has been shown to
elevate liver glutathione levels in rats.5 Acetaminophen can cause liver damage,
which is believed to involve glutathione depletion.6 In one study involving rats,
silymarin protected against acetaminophen-induced glutathione depletion.7 While
studies to confirm this action in humans have not been conducted, some doctors recommend
silymarin supplementation with 200 mg milk thistle extract, containing 70–80% silymarin,
three times per day for people taking acetaminophen in large amounts for more than one year
and/or with other risk factors for liver problems.
Schisandra (Schisandra chinensis)
Gomisin A is a constituent found in the Chinese herb schisandra. In a study of rats given
liver-damaging amounts of acetaminophen, gomisin A appeared to protect against some liver
damage but did not prevent glutathione depletion8 (unlike milk thistle, as reported
above). Studies have not yet confirmed this action in humans.
Interactions with Foods and Other Compounds
Food, especially foods high in pectin (including jellies), carbohydrates, and large amounts of
cruciferous vegetables (broccoli, Brussels
sprouts, cabbage, and others) can interfere with acetaminophen absorption.9 It is
unclear how much effect this interaction has on acetaminophen activity.
Moderate to high amounts of acetaminophen have caused liver damage in people with
alcoholism.10 To prevent problems, people taking acetaminophen should avoid
1. Vale JA, Proudfoot AT. Paracetamol (acetaminophen) poisoning.
2. Perry HE, Shannon MW. J Pediatr 1998;132:149–52.
3. Houston JB, Levy G. Drug biotransformation interactions in man. VI:
Acetaminophen and ascorbic acid. J Pharm Sci 1976;65:1218–21.
4. Kolawole JA, Maduenyi A. Effect of zobo drink (Hibiscus
sabdariffa water extract) on the pharmacokinetics of acetaminophen in human volunteers.
Eur J Drug Metab Pharmacokinet 2004;29:25–9.
5. Valenzuela A, Aspillaga M, Vial S, Guerra R. Selectivity of silymarin
on the increase of the glutathione content in different tissues of the rat. Planta
6. Threlkeld DS, ed. Central Nervous System Drugs, Acetaminophen. In
Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1997,
7. Campos R, Garrido A, Guerra R, Valenzuela A. Silybin dihemisuccinate
protects against glutathione depletion and lipid peroxidation induced by acetaminophen on rat
liver. Planta Med 1989;55:417–9.
8. Yamada S, Murawaki Y, Kawasaki H. Preventive effect of gomisin A, a
lignan component of schizandra fruits, on acetaminophen-induced hepatotoxicity in rats.
Biochem Pharmacol 1993;46:1081–5.
9. Holt GA. Food & Drug Interactions. Chicago: Precept
Press, 1998, 2.
10. Threlkeld DS, ed. Central Nervous System Drugs, Acetaminophen. In
Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar