Acetaminophen is the generic name for the brand drug Tylenol. While more than 130 drugs are known to have some interaction with acetaminophen, many of these are minor effects. In addition, some of these drugs are no longer commonly prescribed. However, some drugs, or drug categories, can have serious side effects if combined with acetaminophen.
Alcohol
In large quantities, alcohol acts as a drug in the body. Many cough and cold medicines also contain alcohol. If consumed in high volume or chronic amounts, alcohol and acetaminophen will increase the risk that a patient will develop liver damage. In extreme cases, liver failure can occur.
Cholestyramine
Cholestyramine (brand name Questran) is prescribed as a cholesterol-lowering drug. Cholestyramine decreases the body's absorption of acetaminophen in the gastrointestinal tract. Clinically, this means a patient shouldn't take acetaminophen and cholestyramine at the same time. Ideally, he should take the two drugs at least two hours apart.
Isoniazid
Isoniazid (brand name INH), is a drug prescribed to patients to prevent tuberculosis. Concurrent consumption of isoniazid and acetaminophen can cause nausea, vomiting, abdominal discomfort or fatigue. In severe cases, the combination can cause liver damage.
Warfarin
Warfarin (brand name Coumadin) is the most commonly prescribed anticoagulant, or blood thinner, in the U.S. If a patient is taking both acetaminophen and warfarin, the blood-thinning effect is likely to be magnified. Therefore, she should have frequent lab monitoring of her anticoagulant levels. Not doing so may lead to stroke or gastrointestinal bleeding.
Diflunisal
Diflunisal (brand name Dolobid) is a non-steroidal anti-inflammatory (NSAID) drug that is used to treat patients with chronic pain, including those with osteoarthritis or rheumatism. It has been noted to increase blood levels of acetaminophen by as much as 50 percent. This means that any patient on acetaminophen and diflunisal should be monitored closely for signs of "acetaminophen overdose."
Another option would be for the doctor to switch the patient from diflunisal to another NSAID medication. Acetaminophen overdose, also known as "Tylenol poisoning," is a serious medical condition in which the afflicted patient may develop kidney or liver failure or even die.
Acetaminophen-Containing Narcotics
Numerous narcotic pain medications contain some combination of acetaminophen and hydrocodone (a semi-synthetic opioid derived from codeine). Some of the more common brand names include Vicodin, Norco, Lortab, Lorcet, Hycet and Co-Gesic. Regularly taking acetaminophen and an acetaminophen-containing narcotic painkiller together can lead to acetaminophen overdose.
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