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Acetaminophen

Also indexed as: APAP, Paracetamol, Tylenol®

Combination drugs: Alka-Seltzer Plus®, Coalgesic®, Co-Proxamol, Darvocet® N, Distalgesic®, 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, Tylenol® with Codeine, Vicodin®, 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 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 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

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.4 Acetaminophen can cause liver damage, which is believed to involve glutathione depletion.5 In one study involving rats, silymarin protected against acetaminophen-induced glutathione depletion.6 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 depletion7 (unlike milk thistle, as reported above). Studies have not yet confirmed this action in humans.

Interactions with Foods and Other Compounds

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.8 It is unclear how much effect this interaction has on acetaminophen activity.

Alcohol
Moderate to high amounts of acetaminophen have caused liver damage in people with alcoholism.9 To prevent problems, people taking acetaminophen should avoid alcohol.

Summary of Interactions for Acetaminophen

Depletion or interference None known
Adverse interaction None known
Side effect reduction/prevention Milk thistle*
N-acetyl cysteine
Supportive interaction Vitamin C*
Reduced drug absorption/bioavailability None known
Other (see text) Schisandra

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

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. 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.

5. Threlkeld DS, ed. Central Nervous System Drugs, Acetaminophen. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1997, 247–f.

6. 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.

7. 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.

8. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 2.

9. Threlkeld DS, ed. Central Nervous System Drugs, Acetaminophen. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1997, 247–f.