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Acetaminophen/pseudoephedrine Disease Interactions

There are 9 disease interactions with acetaminophen / pseudoephedrine.

Major

Acetaminophen (applies to acetaminophen/pseudoephedrine) alcoholism

Major Potential Hazard, High plausibility.

Chronic alcohol abusers may be at increased risk of hepatotoxicity during treatment with acetaminophen (APAP). Severe liver injury, including cases of acute liver failure resulting in liver transplant and death, has been reported in patients using acetaminophen. Therapy with acetaminophen should be administered cautiously, if at all, in patients who consume three or more alcoholic drinks a day. In general, patients should avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure. They should also be advised to seek medical attention if they experience signs and symptoms of liver injury such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice.

References

  1. Kaysen GA, Pond SM, Roper MH, Menke DJ, Marrama MA "Combined hepatic and renal injury in alcoholics during therapeutic use of acetaminophen." Arch Intern Med 145 (1985): 2019-23
  2. O'Dell JR, Zetterman RK, Burnett DA "Centrilobular hepatic fibrosis following acetaminophen-induced hepatic necrosis in an alcoholic." JAMA 255 (1986): 2636-7
  3. Seeff LB, Cuccherini BA, Zimmerman HJ, Adler E, Benjamin SB "Acetaminophen hepatotoxicity in alcoholics." Ann Intern Med 104 (1986): 399-404
  4. McClain CJ, Kromhout JP, Peterson FJ, Holtzman JL "Potentiation of acetaminophen hepatotoxicity by alcohol." JAMA 244 (1980): 251-3
  5. Kartsonis A, Reddy KR, Schiff ER "Alcohol, acetaminophen, and hepatic necrosis." Ann Intern Med 105 (1986): 138-9
  6. Prescott LF, Critchley JA "Drug interactions affecting analgesic toxicity." Am J Med 75 (1983): 113-6
  7. "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical PROD (2002):
  8. Whitcomb DC, Block GD "Association of acetaminopphen hepatotoxicity with fasting and ethanol use." JAMA 272 (1994): 1845-50
  9. Bonkovsky HL "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA 274 (1995): 301
  10. Nelson EB, Temple AR "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA 274 (1995): 301
  11. Zimmerman HJ, Maddrey WC "Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: analysis of instances of therapeutic misadventure." Hepatology 22 (1995): 767-73
View all 11 references
Major

Acetaminophen (applies to acetaminophen/pseudoephedrine) liver disease

Major Potential Hazard, Moderate plausibility. Applicable conditions: Malnourished, Dehydration

Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease. Patients with hepatic impairment may be at increased risk of toxicity. Severe liver injury, including cases of acute liver failure and death, have been reported in patients using this drug. Clinical monitoring of hepatic function is recommended. Caution is advised if using acetaminophen in patients with chronic malnutrition or severe hypovolemia. Instruct patients to avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure.

References

  1. "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical PROD (2002):
  2. "Product Information. Acetaminophen (acetaminophen)." Hikma Pharmaceuticals USA Inc. ORIG-1 (2022):
Major

Sympathomimetics (applies to acetaminophen/pseudoephedrine) cardiovascular disease

Major Potential Hazard, High plausibility. Applicable conditions: Cerebrovascular Insufficiency, Hyperthyroidism, Pheochromocytoma

Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.

References

  1. Humberstone PM "Hypertension from cold remedies." Br Med J 1 (1969): 846
  2. Mariani PJ "Pseudoephedrine-induced hypertensive emergency: treatment with labetalol." Am J Emerg Med 4 (1986): 141-2
  3. Rosen RA "Angina associated with pseudoephedrine ." Ann Emerg Med 10 (1981): 230-1
  4. Wiener I, Tilkian AG, Palazzolo M "Coronary artery spasm and myocardial infarction in a patient with normal coronary arteries: temporal relationship to pseudoephedrine ingestion." Cathet Cardiovasc Diagn 20 (1990): 51-3
  5. Gordon RD, Ballantine DM, Bachmann AW "Effects of repeated doses of pseudoephedrine on blood pressure and plasma catecholamines in normal subjects and in patients with phaeochromocytoma." Clin Exp Pharmacol Physiol 19 (1992): 287-90
  6. Loizou LA, Hamilton JG, Tsementzis SA "Intracranial haemorrhage in association with pseudoephedrine overdose." J Neurol Neurosurg Psychiatry 45 (1982): 471-2
  7. Dickerson J, Perrier D, Mayersohn M, Bressler R "Dose tolerance and pharmacokinetic studies of L (+) pseudoephedrine capsules in man." Eur J Clin Pharmacol 14 (1978): 253-9
  8. Wooten MR, Khangure MS, Murphy MJ "Intracerebral hemorrhage and vasculitis related to ephedrine abuse." Ann Neurol 13 (1983): 337-40
  9. To LB, Sangster JF, Rampling D, Cammens I "Ephedrine-induced cardiomyopathy." Med J Aust 2 (1980): 35-6
  10. Bruno A, Nolte KB, Chapin J "Stroke associated with ephedrine use." Neurology 43 (1993): 1313-6
  11. Stoessl AJ, Young GB, Feasby TE "Intracerebral haemorrhage and angiographic beading following ingestion of catecholaminergics." Stroke 16 (1985): 734-6
  12. Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
  13. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome PROD (2001):
  14. Kizer KW "Intracranial hemorrhage associated with overdose of decongestant containing phenylpropanolamine" Am J Emerg Med 2 (1984): 180-1
  15. Edwards M, Russo L, Harwood-Nuss A "Cerebral infarction with a single oral dose of phenylpropanolamine." Am J Emerg Med 5 (1987): 163-4
  16. Lake CR, Gallant S, Masson E, Miller P "Adverse drug effects attributed to phenylpropanolamine: a review of 142 case reports." Am J Med 89 (1990): 195-208
  17. Lake CR, Zaloga G, Bray J, Rosenberg D, Chernow B "Transient hypertension after two phenylpropanolamine diet aids and the effects of caffeine: a placebo-controlled follow-up study." Am J Med 86 (1989): 427-32
  18. Lake CR, Zaloga G, Clymer R, Quirk RM, Chernow B "A double dose of phenylpropanolamine causes transient hypertension." Am J Med 85 (1988): 339-43
  19. Bernstein E, Diskant BM "Phenylpropanolamine: a potentially hazardous drug." Ann Emerg Med 11 (1982): 311-5
  20. Kroenke K, Omori DM, Simmons JO, Wood DR, Meier NJ "The safety of phenylpropanolamine in patients with stable hypertension." Ann Intern Med 111 (1989): 1043-4
  21. Pentel PR, Mikell FL, Zavoral JH "Myocardial injury after phenylpropanolamine ingestion." Br Heart J 47 (1982): 51-4
  22. Howrie DL, Wolfson JH "Phenylpropanolamine-induced hypertensive seizures." J Pediatr 102 (1983): 143-5
  23. Horowitz JD, Lang WJ, Howes LG, Fennessy MR, Christophidis N, Rand MJ, Louis WJ "Hypertensive responses induced by phenylpropanolamine in anorectic and decongestant preparations." Lancet 1 (1980): 60-1
  24. Johnson DA, Etter HS, Reeves DM "Stroke and phenylpropanolamine use" Lancet 2 (1983): 970
  25. McEwen J "Phenylpropanolamine-associated hypertension after the use of "over- the-counter" appetite-suppressant products." Med J Aust 2 (1983): 71-3
  26. Elliott CF, Whyte JC "Phenylpropanolamine and hypertension." Med J Aust 1 (1981): 715
  27. Maher LM, Peterson PL, Dela-Cruz C "Postpartum intracranial hemorrhage and phenylpropanolamine use" Neurology 37 (1987): 1686
  28. Kase CS, Foster TE, Reed JE, Spatz EL, Girgis GN "Intracerebral hemorrhage and phenylpropanolamine use." Neurology 37 (1987): 399-404
  29. Kikta DG, Devereaux MW, Chandar K "Intracranial hemorrhages due to phenylpropanolamine." Stroke 16 (1985): 510-2
  30. Clark JE, Simon WA "Cardiac arrhythmias after phenylpropanolamine ingestion." Drug Intell Clin Pharm 17 (1983): 737-8
  31. Noble R "A controlled clinical trial of the cardiovascular and psychological effects of phenylpropanolamine and caffeine." Drug Intell Clin Pharm 22 (1988): 296-9
  32. O'Connell MB, Gross CR "The effect of multiple doses of phenylpropanolamine on the blood pressure of patients whose hypertension was controlled with beta blockers." Pharmacotherapy 11 (1991): 376-81
  33. O'Connell MB, Gross CR "The effect of single-dose phenylpropanolamine on blood pressure in patients with hypertension controlled by beta blockers." Pharmacotherapy 10 (1990): 85-91
  34. Chin C, Choy M "Cardiomyopathy induced by phenylpropanolamine." J Pediatr 123 (1993): 825-7
  35. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  36. Lee KY, Beilin LJ, Vandongen R "Severe hypertension after ingestion of an appetite suppressant (phenylpropanolamine) with indomethacin." Lancet 1 (1979): 1110-1
  37. Gibson GJ, Warrell DA "Hypertensive crises and phenylpropanolamine." Lancet 2 (1972): 492-3
  38. Frewin DB "Phenylpropanolamine. How safe is it?" Med J Aust 2 (1983): 54-5
  39. Lee KY, Beilin LJ, Vandongen R "Severe hypertension after administration of phenylpropanolamine" Med J Aust 1 (1979): 525-6
  40. Horowitz JD, McNeil JJ, Sweet B, Mendelsohn FA, Louis WJ "Hypertension and postural hypotension induced by phenylpropanolamine (Trimolets)." Med J Aust 1 (1979): 175-6
  41. Frewin DB, Leonello PP, Frewin ME "Hypertension after ingestion of Trimolets." Med J Aust 2 (1978): 497-8
  42. Teh AY "Phenylpropanolamine and hypertension" Med J Aust 2 (1979): 425-6
  43. Shapiro SR "Hypertension due to anorectic agent." N Engl J Med 280 (1969): 1363
  44. Maher LM, Peterson PL, Dela-Cruz C "Postpartum intracranial hemorrhage and phenylpropanolamine use." Neurology 37 (1987): 1886,1890
  45. Fallis RJ, Fisher M "Cerebral vasculitis and hemorrhage associated with phenylpropanolamine." Neurology 35 (1985): 405-7
  46. Caperton E "Raynaud's phenomenon. Role of diet pills and cold remedies." Postgrad Med 73 (1983): 291-2
  47. McDowell JR, LeBlanc HJ "Phenylpropanolamine and cerebral hemorrhage." West J Med 142 (1985): 688-91
  48. Williams DM "Phenylpropanolamine hydrochloride" Am Pharm NS30 (1990): 47-50
  49. Dowse R, Scherzinger SS, Kanfer I "Serum concentrations of phenylpropanolamine and associated effects on blood pressure in normotensive subjects: a pilot-study." Int J Clin Pharmacol Ther Toxicol 28 (1990): 205-10
  50. Pentel PR, Aaron C, Paya C "Therapeutic doses of phenylpropanolamine increase supine systolic blood pressure." Int J Obes 9 (1985): 115-9
  51. Finton CK, Barton M, Chernow B "Possible adverse effects of phenylpropanolamine (diet pills) on sympathetic nervous system function--caveat emptor!" Mil Med 147 (1982): 1072
  52. "Product Information. Adrenalin (EPINEPHrine)." Apothecon Inc (2022):
  53. Leo PJ, Hollander JE, Shih RD, Marcus SM "Phenylpropanolamine and associated myocardial injury." Ann Emerg Med 28 (1996): 359-62
  54. Gill ND, Shield A, Blazevich AJ, Zhou S, Weatherby RP "Muscular and cardiorespiratory effects of pseudoephedrine in human athletes." Br J Clin Pharmacol 50 (2000): 205-13
  55. Haller CA, Benowitz NL "Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids." N Engl J Med 343 (2000): 1833-8
  56. Mansoor GA "Herbs and alternative therapies in the hypertension clinic." Am J Hypertens 14(9 Pt 1) (2001): 971-5
  57. Samenuk D, Link MS, Homoud MK, et al. "Adverse cardiovascular events temporally associated with ma huang, an herbal source of ephedrine." Mayo Clin Proc 77 (2002): 12-6
  58. "Product Information. Akovaz (ephedrine)." Eclat Pharmaceuticals (2016):
View all 58 references
Moderate

Acetaminophen (applies to acetaminophen/pseudoephedrine) PKU

Moderate Potential Hazard, High plausibility. Applicable conditions: Phenylketonuria

Several oral acetaminophen and acetaminophen-combination products, particularly flavored chewable tablets, contain the artificial sweetener, aspartame (NutraSweet). Aspartame is converted to phenylalanine in the gastrointestinal tract following ingestion. Chewable and effervescent formulations of acetaminophen products may also contain phenylalanine. The aspartame/phenylalanine content should be considered when these products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).

References

  1. "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical PROD (2002):
Moderate

Pseudoephedrine (applies to acetaminophen/pseudoephedrine) GI narrowing

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Gastrointestinal Obstruction

The extended-release formulation of pseudoephedrine (Sudafed 24 Hour) contains a non-deformable material. There have been rare reports of obstructive symptoms in patients with known strictures following the ingestion of similar sustained-release products. Therapy with the extended-release formulation of pseudoephedrine should be administered cautiously in patients with preexisting severe gastrointestinal narrowing or obstruction, whether pathologic or iatrogenic.

References

  1. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome PROD (2001):
Moderate

Pseudoephedrine (applies to acetaminophen/pseudoephedrine) PKU

Moderate Potential Hazard, High plausibility. Applicable conditions: Phenylketonuria

Chewable products frequently may contain aspartame, which is metabolized in the gastrointestinal tract to phenylalanine. Sudafed (brand of pseudoephedrine) chewable 15 mg tablets provide the equivalent of 0.78 mg of phenylalanine per each tablet. The aspartame/phenylalanine content should be considered when this and similar products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).

References

  1. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome PROD (2001):
Moderate

Sympathomimetics (applies to acetaminophen/pseudoephedrine) BPH

Moderate Potential Hazard, High plausibility. Applicable conditions: Benign Prostatic Hyperplasia, Prostate Tumor

Sympathomimetic agents may cause or worsen urinary difficulty in patients with prostate enlargement due to smooth muscle contraction in the bladder neck via stimulation of alpha-1 adrenergic receptors. Therapy with sympathomimetic agents should be administered cautiously in patients with hypertrophy or neoplasm of the prostate.

References

  1. Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
  2. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome PROD (2001):
  3. Williams DM "Phenylpropanolamine hydrochloride" Am Pharm NS30 (1990): 47-50
  4. "Product Information. Akovaz (ephedrine)." Eclat Pharmaceuticals (2016):
View all 4 references
Moderate

Sympathomimetics (applies to acetaminophen/pseudoephedrine) diabetes

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus

Sympathomimetic agents may cause increases in blood glucose concentrations. These effects are usually transient and slight but may be significant with dosages higher than those normally recommended. Therapy with sympathomimetic agents should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate.

References

  1. Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
  2. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome PROD (2001):
  3. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  4. Williams DM "Phenylpropanolamine hydrochloride" Am Pharm NS30 (1990): 47-50
  5. "Product Information. Adrenalin (EPINEPHrine)." Apothecon Inc (2022):
  6. "Product Information. Akovaz (ephedrine)." Eclat Pharmaceuticals (2016):
View all 6 references
Moderate

Sympathomimetics (applies to acetaminophen/pseudoephedrine) glaucoma

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension

Sympathomimetic agents can induce transient mydriasis via stimulation of alpha-1 adrenergic receptors. In patients with anatomically narrow angles or narrow-angle glaucoma, pupillary dilation can provoke an acute attack. In patients with other forms of glaucoma, mydriasis may occasionally increase intraocular pressure. Therapy with sympathomimetic agents should be administered cautiously in patients with or predisposed to glaucoma, particularly narrow-angle glaucoma.

References

  1. Covington TR, eds., Lawson LC, Young LL "Handbook of Nonprescription Drugs." Washington, DC: American Pharmaceutical Association (1993):
  2. "Product Information. Sudafed (pseudoephedrine)." Glaxo Wellcome PROD (2001):
  3. Fraunfelder FT, Fraunfelder FW; Randall JA "Drug-Induced Ocular Side Effects" Boston, MA: Butterworth-Heinemann (2001):

Acetaminophen/pseudoephedrine drug interactions

There are 304 drug interactions with acetaminophen / pseudoephedrine.

Acetaminophen/pseudoephedrine alcohol/food interactions

There are 2 alcohol/food interactions with acetaminophen / pseudoephedrine.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.