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Tylenol Common Questions & Drug Interactions

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.

Last Modified: June 6, 2022
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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 medication, herbal supplements and products, as well as vitamins and ointments. Keep your list current and share it regularly with all your doctors and pharmacists.

Besides potential drug-drug interactions (pDDI) and drug-supplement interactions, acetaminophen medications like 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.

Some of the common drug interactions include:
  • Tylenol and Warfarin
  • Tylenol and Phenytoin
  • Tylenol and Valsartan

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 causes blood platelets to not bind. Research published by the Canadian Medical Association Journal shows that concurrent use of warfarin and acetaminophen can cause a pharmacodynamic (high-powered) effect — one that leads to a supratherapeutic internalized normalized ratio (INR) and consequent bleeding.

A study published in the Journal of Pharmaceutics about paracetamol, the name for acetaminophen in the United Kingdom, notes that the drug-drug mix of 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. A study published by the Journal of Pharmaceutics 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.

Given the differential mechanisms of metabolism, action and end-organ toxicities, combining Tylenol and ibuprofen or taking them in alternating fashion appears to reduce fevers in children compared to using them alone. However, 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 combination, it is important to note that the combined use of Tylenol and aspirin increases the variable to consider 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 headache and is in fact superior to using acetaminophen only. 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.

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.

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 funded by the National Institutes of Health and the Agency for Healthcare Research and Quality 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:
  • Autism spectrum disorder
  • Attention deficit hyperactivity disorder (ADHD)
  • 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 dyads 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.

Another study published by the Scandinavian Journal of Pain showed that prenatal exposure to acetaminophen is associated with:
  • Lower performance intelligence quotient
  • Asthma
  • Autism spectrum disorder
  • Shorter male infant anogenital distance (predicts a male reproductive potential)
  • Neurodevelopmental problems (communication and gross motor development)
  • Poor attention and executive function
  • Attention deficit/hyperactivity disorder
  • Behavioral problems during childhood

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.