Ibuprofen and tylenol pm

Going Safety of over-the-counter sleeping pills

Safety of over-the-counter sleeping pills

Published: August, 2005

Many people wonder about over-the-counter (OTC) medications like Tylenol PM that combine a pain reliever and a sleep aid. These pills help many get to sleep, but is it a good idea to keep on taking them?

The sleep-inducing ingredient in Tylenol PM is diphenhydramine, an antihistamine. People take antihistamines for hay fever or cold symptoms, but doctors have known for a long time that they also make people drowsy. Other nighttime pain relievers (Alka-Seltzer PM, Excedrin PM) contain diphenhydramine, and it’s the only active ingredient in OTC sleeping pills like Sominex and Simply Sleep. Sominex and the allergy-relief version of Benadryl have exactly the same active ingredient: 25 milligrams of diphenhydramine.

Dr. David White, director of the Sleep Disorders Program at Harvard-affiliated Brigham and Women’s Hospital, is not a fan of the antihistamines. He says they leave many people feeling groggy and tired rather than rested. And true to their anti–hay fever effects, they dry out the nose and mouth.

For people who have a hard time falling asleep, Dr. White prescribes either zolpidem (Ambien) or zaleplon (Sonata). For those who have trouble staying asleep, there are medications that stay in your system longer. The main choices have been trazodone (Desyrel), a sedating antidepressant, or one of the benzodiazepines (Ativan, Restoril, others). But trazodone doesn’t work for many people and hasn’t been well studied. The benzodiazepines cause daytime drowsiness and withdrawal symptoms if they’re taken for a long time.

In December 2004, the FDA approved a new long-acting medication, eszopiclone (Lunesta). You aren’t supposed to take the other sleeping pills for more than a few weeks. The FDA didn’t set any such time restrictions on Lunesta, so it could become the first medication approved as a sleeping pill that people can take indefinitely.

August 2005 Update

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

TYLENOL PM Extra Strength Liquid Pain Reliever And Sleep Aid8.0oz

Liver warning: This product contains acetaminophen. Severe liver damage may occur if you take

  • More than 4,000 mg of acetaminophen in 24 hours
  • With other drugs containing acetaminophen
  • 3 or more alcoholic drinks every day while using this product

Allergy alert: acetaminophen may cause severe skin reactions. Symptoms may include:

  • Skin reddening
  • Blisters
  • rash

If a skin reaction occurs, stop use and seek medical help right away.
Do not use

  • With any other drug containing acetaminophen (prescription or nonprescription). If you are not sure whether a drug contains acetaminophen, ask a doctor or pharmacist.
  • With any other product containing diphenhydramine, even one used on skin
  • In children under 12 years of age
  • If you have ever had an allergic reaction to this product or any of its ingredients

Ask a doctor before use if you have

  • Liver disease
  • A breathing problem such as emphysema or chronic bronchitis
  • Trouble urinating due to an enlarged prostate gland
  • Glaucoma

Ask a doctor or pharmacist before use if you are

  • Taking the blood thinning drug warfarin
  • Taking sedatives or tranquilizers

When using this product

  • Drowsiness will occur
  • Avoid alcoholic drinks
  • Do not drive a motor vehicle or operate machinery

Stop use and ask a doctor if

  • Sleeplessness persists continuously for more than 2 weeks. Insomnia may be a symptom of serious underlying medical illness.
  • Pain gets worse or lasts more than 10 days
  • Fever gets worse or lasts more than 3 days
  • Redness or swelling is present
  • New symptoms occur

These could be signs of a serious condition.
If pregnant or breast-feeding, ask a health professional before use.
Keep out of reach of children.
Overdose warning: In case of overdose, get medical help or contact a Poison Control Center right away. (1-800-222-1222) Quick medical attention is critical for adults as well as for children even if you do not notice any signs or symptoms.
Temporary relief of occasional headaches and minor aches and pains with accompanying sleeplessness.

Finally, when it comes to medicines like NyQuil, Tylenol PM, or Advil PM, people may find themselves using these as sleep aids because they happen to have them in the cabinet at home. These medications each include either diphenhydramine or doxylamine, but they also include other ingredients that are meant to treat other things.

Any time you find yourself taking add-on medicines you don’t need is a major downside, Dr. Raj says. That’s especially true when it comes to nonsteroidal medications that may cause gastrointestinal upset or, ultimately, ulcers.

Supplement Options as OTC Sleep Aids

There are also supplement options commonly used by individuals to self-treat insomnia. Two of the most well-known types are melatonin and valerian, the latter of which is often referred to as valerian root. Valerian root works on the same receptors in our brains as sedative hypnotics and is also thought to come with a high risk for liver toxicity, Dr. Raj says. Again, not the best option.

Melatonin, on the other hand, could be useful as an OTC sleep aid, if taken properly. With this naturally occurring substance, it’s all about timing. When taken six hours before bedtime, this supplement may help to adjust a person’s circadian rhythm, says Dr. Heidi Roth, MD, who is a neurologist and the codirector of the sleep clinic at the University of North Carolina at Chapel Hill. That’s because people naturally produce melatonin at dusk, so taking a small amount, like 0.5-1 mg of melatonin six hours before a person hopes to go to bed may help that individual sort of schedule the beginning of his or her sleep phase.

Melatonin, however, is not well-regulated in terms of dosage, and the typical dose found in stores of 3-10 mg may be higher than needed, doctors say. Dr. Roth also cautions that at high dosages, melatonin has been linked to headaches.

Other supplements that are rumored to help make you more sleepy, like chamomile and tryptophan (which is found in turkey, and what everyone loves to blame for feeling tired after a big Thanksgiving meal), haven’t really been studied conclusively enough to say whether they actually work as sleep aids, Dr. Raj says, citing a lack of evidence-based medicine.

One absolute no-no, though, is kava-kava, he says, which is an herb derived from a plant native to the Western Pacific and known for its liver toxicity.

He also says thinking outside of the box is not a bad thing when it comes to dealing with insomnia, and that he’s open in his practice to making appropriate herbal recommendations, while stressing that patients absolutely must tell their doctors anything and everything that they are taking in order receive the proper care.

The Problem With Treating Symptoms Versus Curing the Cause

Dr. Roth says it’s incredibly rare that she sees someone who doesn’t have an underlying cause for their sleep issues. For example, sleep apnea may present as something as simple as snoring. In reality, that snoring could be a symptom of the quite serious sleep disorder, where an individual stops breathing repeatedly during their sleep. If left untreated, sleep apnea can increase a person’s risk for hypertension, possibly stroke, and even cardiovascular death, Dr. Roth says. For that reason, “Medical evaluation for sleep problems should always come first,” Dr. Roth says.

In addition to being masked, certain kinds of underlying sleep disorders, like restless leg syndrome (RLS), may even be made worse by taking OTC sleep medications that contain diphenhydramine. RLS is the urge to move your legs that comes on when you’re resting and inactive, which for many people occurs in the evening and at night. It’s a feeling of creeping, crawling, pulling, itching, tingling, burning, aching, or electric shocks that doesn’t go away until you move your legs, and sometimes, your arms. You can see how this might disrupt a person’s sleep.

Roth explains that one test for RLS requires giving a patient Benadryl (which contains diphenhydramine) to see if it makes those symptoms worse, thus making an RLS diagnosis more likely.

This is just one example of how these medication may adversely affect someone, without them even realizing it. “Every medication has a side effect, and if it’s not necessary, it can cause harm,” Dr. Roth says. ” are not necessary medications and it’s much better to find out what you can do to improve your sleep while at the same time, improving your health.”

Behavioral Changes Can Make a Huge Difference

The method most recommended by the doctors we talked with was CBT-I, which stands for cognitive behavioral therapy for insomnia. This is thinking- and actions-based therapy, Dr. Raj says, and it’s based on the idea that there are reversible causes for insomnia.

“One of the biggest causes for sleep problem is caffeine intake, even in the morning,” Dr. Roth says. “Cutting out caffeine could help your sleep, and spare you the side effects of OTC medications. And lots of things may contain caffeine that people may not realize.”

Dr. Roth also says sleep restriction is a helpful form of CBT-I, where you set a sleep window and stick to it. “When you set the sleep window, you cannot go to bed before or get off after, but you can stay up later and get up earlier,” she says. The idea behind this is that, at least initially, not getting enough sleep will help kick-start those internal sleep drives.

Dr. Das says another easy adjustment is keeping things cool, dark, and quiet. “Data supports that cooler room temperatures, in the mid-to-upper 60s , is optimal,” she says. That’s because as your core body temperature drops, you tend to sleep better, she says, so go ahead and wear your socks to bed, because warming your extremities will also help lower that core body temp.

Stimulus control therapy is another form of behavioral therapy, Dr. Das says, where you’re only in bed for sleep and nothing else, which means no scrolling through Twitter and Instagram late night on those smartphones! Also, as part of this aspect of CBT-I, if you go to bed and after 15-20 minutes find you can’t sleep, you simply leave the room and go do something nonstimulating elsewhere in low light until you’re tired. “It may take up to two to three months for patients to see benefits,” Dr. Raj says. “Break the rules once, and you’re back into those habits.”

Clearly, CBT-I is a major commitment. Thankfully, if you need support while undergoing this type of sleep treatment, there are resources available to help.

There Are Apps to Help With Insomnia

It’s kind of ironic that there are apps out there to help with insomnia, since there’s lots of literature that says spending less time on our phones, especially before bed, will help us sleep better. But for better or worse, smartphones and other devices are one way that we get a lot of information these days. So we’ve found a few you may find helpful.

One particular app, called CBT-i Coach, is free to download and comes with an entire mini course called Sleep 101 that talks its users through different types of sleep therapies. Developed through the US Department of Veterans’ Affairs, it’s intended to be used along with face-to-face care from a medical professional.

Another, called SHUTi, is not free but claims to be the “industry-leading online CBT-I program, with unsurpassed, proven results.”

What to Know If You’re Going to Take OTC Sleep Aids, Anyway

“Insomnia is super common,” Dr. Raj says, acknowledging it’s a real disease and flat out just no fun to deal with.

All three experts we talked to said the same thing: before you take OTC medications of any kind, you should talk to your doctor about potential side effects and drug interactions. “Even though these medications are OTC, they are still drugs,” Dr. Das says.

If you’re taking anything else, prescription or otherwise, OTC medications could react with those ingredients and lead to even more harmful side effects than the ones already discussed here.

Additionally, people should avoid combining OTC sleep aid medications with alcohol, the doctors all say. Although alcohol is a depressant and may have the initial effect of increasing drowsiness, consuming it actually increases sleep fragmentation in the second half of the night, and so decreases sleep quality, overall, Dr. Das says.

“Most people have multifactorial causes for sleep problems. It’s often not just one thing, so using CBT-I plus addressing medical issues is a good route,” Dr. Roth says. “Sleep is important for health, just like nutrition and exercise, and it should be protected.”

Image Source: Unsplash / gbarkz

Tylenol PM (acetaminophen / diphenhydramine) Drug Interactions

A total of 452 drugs are known to interact with Tylenol PM (acetaminophen / diphenhydramine).

  • 19 major drug interactions
  • 417 moderate drug interactions
  • 16 minor drug interactions

Show all medications in the database that may interact with Tylenol PM (acetaminophen / diphenhydramine).

Check for interactions

Type in a drug name to check for interactions with Tylenol PM (acetaminophen / diphenhydramine).

Most frequently checked interactions

View interaction reports for Tylenol PM (acetaminophen / diphenhydramine) and the medicines listed below.

  • Adderall (amphetamine / dextroamphetamine)
  • Aleve (naproxen)
  • Ambien (zolpidem)
  • amlodipine
  • aspirin
  • Aspirin Low Strength (aspirin)
  • atorvastatin
  • Benadryl (diphenhydramine)
  • Cymbalta (duloxetine)
  • Fish Oil (omega-3 polyunsaturated fatty acids)
  • gabapentin
  • hydrocodone
  • ibuprofen
  • levothyroxine
  • Lexapro (escitalopram)
  • lisinopril
  • melatonin
  • melatonin
  • meloxicam
  • metformin
  • naproxen
  • omeprazole
  • oxycodone
  • Percocet (acetaminophen / oxycodone)
  • prednisone
  • prednisone
  • simvastatin
  • tramadol
  • tramadol
  • trazodone
  • trazodone
  • Tylenol (acetaminophen)
  • Vitamin B12 (cyanocobalamin)
  • Vitamin D3 (cholecalciferol)
  • wine
  • Xanax (alprazolam)
  • Zoloft (sertraline)

Tylenol PM (acetaminophen / diphenhydramine) alcohol/food interactions

There is 1 alcohol/food interaction with Tylenol PM (acetaminophen / diphenhydramine)

Tylenol PM (acetaminophen / diphenhydramine) disease interactions

There are 11 disease interactions with Tylenol PM (acetaminophen / diphenhydramine) which include:

  • alcoholism
  • liver disease
  • depression
  • PKU
  • anticholinergic effects
  • asthma/COPD
  • cardiovascular
  • renal/liver disease
  • glaucoma
  • liver disease
  • resp depression
  • Side Effects
  • During Pregnancy
  • Dosage Information
  • Drug Images
  • Support Group
  • En Español
  • 22 Reviews
  • Drug class: analgesic combinations
  • FDA Alerts (4)
  • Insomnia
  • Headache
  • Pain

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.

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

Medical Disclaimer

7 things you can do to avoid drug interactions

4. Be suspicious of supplements

Some of the most serious drug interactions involve prescription medications and supplements. Not only are supplements less likely than FDA-approved medications to be listed in the databases of drug interactions, but health care providers also may not know what supplements people are taking. Since there isn’t much evidence that supplements have health benefits, it’s best to avoid them unless your doctor prescribes them.

5. Go easy on grapefruit juice

While it’s true that grapefruit juice affects the metabolism of several drugs, it usually takes about a quart of the juice to make a difference. If you love the juice, ask your pharmacist if any of the drugs you take are affected by it. If they are, you should still be able to enjoy half a grapefruit or an 8-ounce glass of juice daily as long as you wait a few hours after taking the medication.

6. Limit alcohol

It isn’t a good idea for women to have more than a drink a day in general, and it can be even worse to drink while you’re taking drugs. Alcohol increases drowsiness—an intended effect of sleeping pills and a side effect of many antihistamines, antidepressants, and anti-anxiety medications. It can also irritate the lining of the esophagus and stomach—a special concern if you’re taking aspirin, other nonsteroidal anti-inflammatory drugs, or an oral bisphosphonate for low bone density.

7. Talk to your pharmacist

When you pick up a prescription, you may find as many as three different sheets or leaflets with your medication, each detailing the conditions the drug is approved to treat, how to take the drug, and the drug’s possible side effects. If your first reaction is “too much information!” your next step should be to ask the pharmacist to summarize how to take the drug and what to expect.

Pharmacists have an extensive knowledge of how drugs work, their side effects, and the medications, supplements, and foods they interact with. In fact, you may want to bring all your prescription and nonprescription drugs, as well as any supplements you take, to the pharmacy when you pick up a new prescription. If the pharmacist identifies any possible interactions among your medications, he or she may be able to suggest a schedule for taking them that will minimize the likelihood of interactions.

Your pharmacist may also be willing to talk to your health care team about adjusting a medication dose or finding an alternative that will work better. Some health plans have medication therapy management (MTM), or programs that allow an annual in-depth consultation with a pharmacist. Check yours to see if you qualify for MTM services.

For up-to-date information

The repository of information about the medications we take is continually growing. Although any printed list of potential drug-drug, drug-supplement, or drug-food interactions is soon out of date, the consumer website developed by the Institute for Safe Medication Practices (www.consumermedsafety.org) has a wealth of current information on prescription and nonprescription drugs and supplements, including potential interactions and safety alerts from the FDA.

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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