Warning about Norvir and Tylenol

[sfnoepaul]

Tylenol (acetaminophen) has a very complex metabolism in the body. One of the pathways use CYP3A4 as an intermediate metabolizing enzyme. The problem is that Norvir blocks the action of CYP3A4 and thus interferes with the metabolism of acetaminophen. The use of Norvir and acetaminophen or products containing
acetaminophen can cause the creation of intermediate metabolites that are very toxic to the liver. When I took vicodin (which contains acetaminophen) while taking Norvir, my alt (liver test) results over a period of 3 months increased by a factor of 10, showing liver toxicity. When I switched to hydrocodone without acetaminophen my alt went back to normal.

Acetaminophen or medications that contain acetaminophen should not be used by anyone taking Norvir

see http://www.genego.com/map_2377.php and
http://www.medscape.com/viewarticle/459187_2

[buginme2]

I personally believe that Tylenol (acetaminophen) is taken way too much anyway.  It has long been known to affect liver function.  Being that all HIV positive people are at risk for liver disease (and have a higher rate of death attributed to liver disease) I try and avoid taking Tylenol anyway and I do not take Norvir.  This is just my personal opinion its not backed up by any study.

[tednlou2]

I take Tylenol by itself and sometimes in hydrocodone, due to chronic back pain following back surgery to "fix" my L4, L5, and S1 discs.  When picking out the regimen I would start with--Truvada, Reyetaz, and Norvir, I was told there would be no problem with Tylenol.  So, this is interesting.  Since you didn't link to a study, I'm assuming this is just your personal experience?

Modified:  I just noticed the links you provided.  Guess I'm half asleep tonight.  I will take a look at those to see what they are. 

[Matty the Damned]

I take Tylenol by itself and sometimes in hydrocodone, due to chronic back pain following back surgery to "fix" my L4, L5, and S1 discs.  When picking out the regimen I would start with--Truvada, Reyetaz, and Norvir, I was told there would be no problem with Tylenol.  So, this is interesting.  Since you didn't link to a study, I'm assuming this is just your personal experience?

Well he has provided two links in his OP, one of which is paywalled.

On that basis I think you're ok to have one of your usual little panic attacks, babe.

MtD

[tednlou2]

Panic attack that I will have to give up my pain pills 

I've tried the hydrocodone that doesn't contain Tylenol.  I found it didn't nearly work as well.  There's the kind that contains aspirin or ibuprophen, but then you can run into issues with that.  While on the topic, I thought the FDA ruled drugs like hydrocodone containing acetaminophen would have to be changed to not contain more than 325mg of acetaminophen.  Was this just a recommendation?  So far, I haven't seen a change and haven't been able to find a good answer online.  I thought if this change was made, many people would just take over-the-counter Tylenol to replace the missing dose--which would probably lead to actually taking more than they were before.         

[LiveWithIt]

Tylenol (acetaminophen) has a very complex metabolism in the body. One of the pathways use CYP3A4 as an intermediate metabolizing enzyme. The problem is that Norvir blocks the action of CYP3A4 and thus interferes with the metabolism of acetaminophen. The use of Norvir and acetaminophen or products containing
acetaminophen can cause the creation of intermediate metabolites that are very toxic to the liver. When I took vicodin (which contains acetaminophen) while taking Norvir, my alt (liver test) results over a period of 3 months increased by a factor of 10, showing liver toxicity. When I switched to hydrocodone without acetaminophen my alt went back to normal.

Acetaminophen or medications that contain acetaminophen should not be used by anyone taking Norvir

see http://www.genego.com/map_2377.php and
http://www.medscape.com/viewarticle/459187_2

Cool, thanks for the info.  I almost never take pain killers, but when I do I will take ibuprofen. 

[Matty the Damned]

Panic attack that I will have to give up my pain pills 

I've tried the hydrocodone that doesn't contain Tylenol.  I found it didn't nearly work as well.  There's the kind that contains aspirin or ibuprophen, but then you can run into issues with that.  While on the topic, I thought the FDA ruled drugs like hydrocodone containing acetaminophen would have to be changed to not contain more than 325mg of acetaminophen.  Was this just a recommendation?  So far, I haven't seen a change and haven't been able to find a good answer online.  I thought if this change was made, many people would just take over-the-counter Tylenol to replace the missing dose--which would probably lead to actually taking more than they were before.       

Yup, that's the way.

MtD

[Miss Philicia]

You'll find when you have surgery twice in four months you can't really be picky with your pills.

[LiveWithIt]

Drugs.com tells me that Tylenol (acetaminophen) will not interfere with Norvir, Truvada or Lexiva, which I am on, but Advil (Ibuprofen)  will.  I have to take something for my herniated disk so I will take Tylenol for now and find out if anything is up when I get my blood work next week.  I only take one maybe 4 times a day.  I took the Vicodin with Tylenol for 3 weeks, but stopped when I felt better for fear of getting hooked on it. 

[Miss Philicia]

Before making this decision based on "internet" information I recommend calling your pharmacy and asking their opinion, or better yet your doctor.

[LiveWithIt]

Before making this decision based on "internet" information I recommend calling your pharmacy and asking their opinion, or better yet your doctor.

The Norvir and Tylenol thing is "internet info" too.  I asked my doctor last visit and she said Tylenol was fine with Norvir.  If not Tylenol there is no pain killer that is over the counter that I can take.  Aspirin, Advil and Aleve all have  specific adverse reactions on drugs.com to my drug cocktail. 

[newt]

drugs.com is not a reliable source of information for drug interactions.

Try http://www.hiv-druginteractions.org/

Acetominophen does not interact with HIV meds, and is safe to use on all combinations. Need to watch your liver full stop with acetominophen and stick to the dosing and timing recommended.

Ibuprofen may be affected by ritonavir (norvir) but probably not as a rule. It's hard on the kidneys so perhaps not the best choice for more than the odd dose if you are on tenofovir + atazanavir (or even just tenofovir).

I am on 1,500mg a day acetominophen and 1,200mg a day ibuprofen plus 12.5mg codeine at night for 2 broken ribs and a broken wrist right now. Pain doesn't go with my darunavir/norvir/Truvada combo. So needs must I guess.

Oh, here's an answer on the Body about this topic:

http://www.thebody.com/Forums/AIDS/Meds/Q199376.html

and another:

http://www.thebody.com/Forums/AIDS/Meds/Q204272.html

Clearly, some people can't or shouldn't take these painkillers cos they are allergic, have damaged livers etc. Acetominophen is hard on your liver, but then so is a glass of wine or two. And pain hurts and disables. << go away pain

- matt

[LiveWithIt]

drugs.com is not a reliable source of information for drug interactions.

Try http://www.hiv-druginteractions.org/

Acetominophen does not interact with HIV meds, and is safe to use on all combinations. Need to watch your liver full stop with acetominophen and stick to the dosing and timing recommended.

Okay cool.  The thing I don't like about that site is that it lists the generic name of the meds after you pick them, and the way it's alphabetized in rows is confusing, I couldn't even find Aspirin on the list.  From what I did see there were no red flags, so that's good.

[weasel]

   I was told by a knowledgeable I.D. Doctor Not to EVER take Tylenol  EVER !

   Something  about  the meds & the fact it is deadly by itself !


   As for  ADVIL ....

   I used Advil  for YEARS !    , Not anymore ! 
     IT WAS THE CAUSE OF MY  E.D. 

    Bayer  aspirin   Is all I take if i need a pain pill  .   

                                           That is all ,  Weasel   
 

[weasel]

   I was told by a knowledgeable I.D. Doctor Not to EVER take Tylenol  EVER !

   Something  about  the meds & the fact it is deadly by itself !


   As for  ADVIL ....

   I used Advil  for YEARS !    , Not anymore ! 
     IT WAS THE CAUSE OF MY  E.D. 

    Bayer  aspirin   Is all I take if i need a pain pill  .   

                                           That is all ,  Weasel