Common brand names:Excedrin PM, Sominex 2 Pain Relief, Tylenol PM, Bayer Select Night Time Pain Relief, Midol PM
Summary of Interactions with Vitamins, Herbs, & Foods
Replenish Depleted Nutrients
Reduce Side Effects
Silymarin is a collection of complex flavonoids found in milk thistle (Silybum marianum) that has been shown to elevate liver glutathione levels in rats. Acetaminophen can cause liver damage, which is believed to involve glutathione depletion. In one study involving rats, silymarin protected against acetaminophen-induced glutathione depletion. 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.The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Food, especially foods high in pectin (including jellies), carbohydrates, and many types of cruciferous vegetables (broccoli, Brussels sprouts, cabbage, and others) can interfere with acetaminophen absorption. It is unclear how much effect this interaction has on acetaminophen activity.
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.
Food, especially foods high in pectin (including jellies), carbohydrates, and many types of cruciferous vegetables (broccoli, Brussels sprouts, cabbage, and others) can interfere with acetaminophen absorption. It is unclear how much effect this interaction has on acetaminophen activity.The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Potential Negative Interaction
Hospitals use oral and intravenous NAC to treat liver damage induced by acetaminophen overdose poisoning. 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. However, acetaminophen toxicity is a potential medical emergency, and should only be managed by qualified healthcare professionals.
Antihistamines, including diphenhydramine, can cause “anticholinergic” side effects such as dryness of mouth and heart palpitations. Henbane (Hyoscyamus niger) also has anticholinergic activity and side effects. Therefore, use with diphenhydramine could increase the risk of anticholinergic side effects, though apparently no interactions have yet been reported with diphenhydramine and henbane. Henbane should not be taken except by prescription from a physician trained in its use, as it is extremely toxic.The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Gomisin A is a constituent found in the Chinese herb schisandra (Schisandra chinensis). 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 depletion (unlike milk thistle, as reported above). Studies have not yet confirmed this action in humans.
Taking 3 grams vitamin C with acetaminophen has been shown to prolong the amount of time acetaminophen stays in the body. 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. However, increasing the time acetaminophen is in the body might also theoretically increase its toxicity. Consult with a doctor before taking vitamin C along with acetaminophen.
Last Review: 03-24-2015
Copyright © 2023 TraceGains, Inc. All rights reserved.
Please read the disclaimer about the limitations of the information provided here. Do NOT rely solely on the information in this article. The TraceGains knowledgebase does not contain every possible interaction.
The information presented by TraceGains is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2023.