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Which medical conditions and medications are contraindicated for acetaminophen?

Jun 25, 2019 • 3 comments

Acetaminophen is a widely used drug. Used under normal conditions, it is safe and effective, but are you aware of the common drug interactions and diseases for which it is contraindicated?

Read our guide to learn more.

Which medical conditions and medications are contraindicated for acetaminophen?

What is acetaminophen?

Acetaminophen (aka paracetamol) is the most widely sold drug in the UK. Acetaminophen is the active substance of a number of analgesic drugs, i.e. mild to moderate pain relieve. It can also be used for fevers.

Acetaminophen is a safe and effective drug when used under normal conditions and, therefore, can be used in children, pregnant women, or breastfeeding women.

When and how to take acetaminophen?

For an adult over 110 lbs, the maximum recommended dose of acetaminophen is 3 grams per 24 hours. This corresponds to 3, 1000 mg tablets per day (1000 mg = 1 g). In cases of more severe pain and with the advice of a doctor, the maximum dose may be 4 grams per day, not for a prolonged duration of time.

In both cases, acetaminophen doses should be at least 4 hours apart, with idealy 6 hours between doses. Be careful, in some cases, the maximum dose and duration between doses may change. These cases are explained below in the article. The most effective dose of acetaminophen remains, as with many drugs, the lowest dose for the shortest period of time.

If acetaminophen is used for acute pain and the pain persists after 5 days of treatment, it is recommended to seek medical advice. In the case of a fever, if after 3 days of treatment with acetaminophen there is no improvement in symptoms or there is an increase in symptoms, a consultation with a doctor is recommend.

What medications contain acetaminophen?

There are many medication brands that contain acetaminophen. In some cases, it is combined with other medications.
It is recommended to avoid combining two drugs that contain acetaminophen or, if that is not possible, not to exceed the maximum dose of 3 grams per 24 hours.

Here is a list of the main drugs containing paracetamol:

Over the counter drugs (OTC) containing only acetaminophen
- Tylenol®
- Feverall®
- Panadol®

OTC medications containing acetaminophen in combination with other medications:
- Midol®
- Excedrin®
- Cepacol®
- DayQuil®
- NyQuil®
- Goody's® Powders
- Mucinex®
- Theraflu®
- Vicks®

Prescription drugs containing acetaminophen in combination with other medications 
- Percocet®
- Vicodin®
- Tylenol® with Codeine
- Endocet®

What conditions may be contraindicated for acetaminophen ?

Renal insufficiency

In the case of renal failure, it is recommended to leave an interval of 8 hours between doses of acetaminophen and not exceed 3g per 24 hours.

Hepatic insufficiency

Severe liver failure is an absolute contraindication to the use of acetaminophen. Indeed, its elimination depends on the liver, so when the liver does not function effeciently, acetaminophen cannot be eliminated properly.

In cases of mild to moderate hepatic insufficiency, it is advisable to limit the consumption of acetaminophen to 2 to 3 grams per 24 hours and to use it only for short periods of time, while always remaining cautious. Consult your doctor if you have any doubts!

>> Read our article on the benefits of teleconsultation

What drugs may be contraindicated for acetaminophen?

Anticoagulants (aka blood thinners, aka vitamin K antagonists): Coumadine®, Heparin®, Eliquis®, Warfarin

When taking acetaminophen with anticoagulants, caution should be exercised. 4g of acetaminophen per day for at least 4 days, enlarges the risk of an increase in the effect of anticoagulants - an increase in the risk of bleeding.

In this case, biological monitoring by INR measurement should be performed during and at the end of acetaminophen treatment.

Bile acid chelating resins: Questran®, Colestid®, Welchol®, Colesevelam, Cholestyramine

As these medications can cause poor intestinal absorption of acetaminophen, it is advisable to take both drugs at least 2 hours apart.

Liver toxicity

When acetaminophenis eliminated by the liver, a small part is transformed into a toxic product for the liver. In case of acetaminophen overdose, there is a significant increase in toxic metabolites. Acetaminophen overdose is defined as the consumption of more than 6 grams of acetaminophen per day.

An overdose can lead to severe liver toxicity and acute hepatitis. This toxicity may also be increased when certain drugs are taken at the same time as acetaminophen.

Here are some medications that may increase liver toxicity:

Some anti-epileptic drugs:
- Phenobarbital (Luminal®, Solfoton®)
- Gabapentin (Neurontin®)
- Phenytoin (Dilantin®, Phenytek®)
- Carbamazepine (Tegretol®)

Antibiotic Rifampicin (Rifadine®, Rimactane®)

If you regularly take acetaminophen without a prescription to relieve pain, do not hesitate to discuss it with your doctor, who may be able to offer you other or more appropriate solutions for pain relief.
 

How often do you use acetaminophen? Did you know about these contraindications?

avatar Lee Ruiz

Author: Lee Ruiz, Community Manager USA

Comments

on 7/4/19

Thank you for sharing! I seldom take it, but when I do it is for joint pain, which I find I respond better to Tylenol than NSAIDs, which is not wht everyone would think.

on 7/5/19

I know this about Tylenol but I can't take asprin due to bleeding of the stomach and Ibprophion is not recommended for your kidneys and I'm in stage 3 of renal failure

on 7/11/19

This article is really helpful and informative regarding tylenol (acetaminophen). I have a medical app on my phone, MedScape, and any time a doctor adds a new medication to the list of what I'm already taking or I take an OTC (over-the-counter) medicine or vitamin, I always cross check for interactions. With the tylenol, I find myself taking between 3000-3500mgs a day. I'm on Plaquenil and prednisone for lupus and CellCept for the interstitial lung disease. The two meds for the lupus are supposed to help with the pains, however, I'm still in a good amount of daily pain. I loathe taking prescription meds and for sure do not like taking prescription pain meds.  Some days I take 4000mgs when it's really bad and I have a migraine. I try not to do that. Guess I really need to talk to my pain control specialist and see what they can do to help. 

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