Acetaminophen with Codeine
Also indexed as: Codeine with Acetaminophen, Tylenol with
Codeine
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.
Codeine is a narcotic analgesic (pain reliever) derived from opium. It is used alone and in
combination products to treat mild to moderate pain and as a cough suppressant.
Summary of
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
interactions.
 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. |
Milk thistle*
N-acetyl cysteine
|
| May Be Beneficial: Supportive
interaction—Taking these supplements may support or otherwise help your medication
work better. |
Vitamin C*
|
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. |
Hibiscus
Tannin-containing herbs* such as green tea, black tea, uva ursi,
black walnut, red raspberry, oak, and witch hazel
|
Check: Other—Before taking any of these supplements or eating any of
these foods with your medication, read this article in full for details. |
Schisandra
|
| Depletion or interference |
None known
|
| Adverse interaction |
None known
|
| The interactions listed in this table may
apply to one or more ingredient of this medication. |
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
evidence.
Interactions with Dietary Supplements
N-acetyl cysteine
(NAC)
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
professionals.
Vitamin
C
Taking 3 grams of 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
Hibiscus
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 clinically
significant.4
Milk
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.
Tannin-containing herbs
Tannins are a group of unrelated chemicals that give plants an astringent taste. Herbs with
large amounts of tannins may interfere with the absorption of codeine and should not be taken together with codeine
or codeine-containing products.9 Herbs containing high levels of tannins include green tea (Camellia sinensis), black
tea, uva ursi (Arctostaphylos
uva-ursi), black walnut (Juglans nigra),red raspberry (Rubus idaeus),oak (Quercus spp.), and witch hazel (Hamamelis virginiana).
Interactions with Foods and Other Compounds
Alcohol
Moderate to high amounts of acetaminophen have
caused liver damage in people with alcoholism.10 To prevent problems, people taking
acetaminophen should avoid alcohol.
Alcohol causes a loss of coordination, impaired judgment, decreased alertness, drowsiness,
and other actions. Narcotic analgesics, including
codeine, cause similar loss of control. Combining codeine and alcohol increases the risk
of accidental injury. People taking codeine-containing products should avoid alcohol.
Food
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.11 However, this interference is probably not of great
significance, and it is generally accepted that acetaminophen can be taken with or without
food.
Codeine commonly causes gastrointestinal
(GI) upset. Codeine and codeine-containing products may be taken with food to reduce or
prevent GI upset.12 A common side effect of narcotic analgesics, including codeine,
is constipation. Increasing dietary fiber (fruits,
vegetables, beans, whole-grain foods, and others) and water intake can
ease constipation.
References:1. Vale JA, Proudfoot AT. Paracetamol (acetaminophen) poisoning.
Lancet 1995;346:547–52.
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
Med 1989;55:420–2.
6. Threlkeld DS, ed. Central Nervous System Drugs, Acetaminophen. In
Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1997,
247–f.
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. Brinker F. Interactions of pharmaceutical and botanical medicines.
J Naturopathic Med 1997;7(2):14–20.
10. Threlkeld DS, ed. Central Nervous System Drugs, Acetaminophen. In
Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar
1997, 247–f.
11. Holt GA. Food & Drug Interactions. Chicago: Precept
Press, 1998, 2.
12. Threlkeld DS, ed. Central Nervous System Drugs, Narcotic Agonist
Analgesics. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and
Comparisons, Feb 1990, 243d.