Acetaminophen And Codeine and Cabbage: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jun 30, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Acetaminophen And Codeine
Cabbage
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Your pain reliever contains two medicines: acetaminophen (like Tylenol) and codeine. This note is about the acetaminophen part. Eating a lot of cabbage may speed up how quickly your body breaks acetaminophen down and clears it out. When that happens, the acetaminophen may not work quite as well for your pain or fever.
This isn't dangerous, and it doesn't mean you can't enjoy cabbage. It just means a normal dose might feel a little weaker if you eat it often. If you notice your pain relief isn't lasting like it used to, talk with your pharmacist or doctor. They can help you sort it out easily.
Effect: Decreased acetaminophen effectiveness (PD consequence of increased clearance). Codeine component is not the affected agent here.
Mechanism: Cabbage may enhance hepatic glucuronidation of acetaminophen, increasing conversion to inactive metabolites and lowering active exposure (reduced AUC).
Direction: Reduced acetaminophen effect (not toxicity). Onset rapid; evidence probable (human data). Magnitude not well quantified.
- Monitor analgesic/antipyretic response.
- Dose may need to be individualized by the care team if efficacy appears diminished with regular high cabbage intake.
- No change to codeine dosing implied.
What happens
Decreased acetaminophen effectiveness
Interaction Deep Dive
In humans, cabbage was found to accelerate the metabolism of acetaminophen, an effect thought to arise from increased glucuronidation1. As a consequence, the clinical effectiveness of acetaminophen may be reduced.
Why it happens (mechanism)
Cabbage may enhance the glucuronidation of acetaminophen to inactive metabolites
How to manage this interaction
Keep taking your acetaminophen and codeine exactly as prescribed. Cabbage is a healthy food, and this is about how well the acetaminophen works, not about safety.
- Watch your response: Notice whether your usual dose still controls pain or fever, especially if you eat cabbage often.
- Individualized dosing: If relief seems weaker, your care team can adjust and tailor your dose and may monitor you more closely.
- Ask before changing anything: Don't increase your dose on your own. Check with your pharmacist or prescriber first.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) A diet including cabbage and brussels sprouts markedly enhanced acetaminophen metabolism by increasing glucuronidation in 10 healthy male participants. The subjects were given a test diet with 150 grams of brussels sprouts and 150 grams of cabbage, or a control diet consisting of a small lettuce-cucumber salad, 300 grams of green peas, and 100 grams of green beans. All of the vegetables were lightly steamed for preparation. The participants consumed the control diet for 10 days, followed by the test diet for 10 days, and then the control diet once more for 10 days. Acetaminophen 1500 milligrams was given on day 10. The cabbage and brussels sprouts diet significantly lowered plasma acetaminophen concentrations from 2 to 11 hours after dosing (p less than 0.05). With the test diet, acetaminophen area under the curve (AUC) fell 16%, metabolic clearance rate rose 17%, volume of distribution rose 7%, the plasma ratio of acetaminophen glucuronide to acetaminophen rose, and urinary recovery of acetaminophen glucuronide rose 8% (all p less than 0.05). The maximum acetaminophen concentration and the time to reach maximum concentration were not significantly changed. Acetaminophen glucuronide AUC and maximum concentration were not significantly influenced, although the time to maximum concentration was significantly shortened (p less than 0.05). Urinary recovery of the cysteine conjugate and 3-methoxyacetaminophen fell 13% and 22%, respectively (both p less than 0.05), showing a decrease in these oxidative metabolic pathways 1.
Common questions
Can I take Acetaminophen And Codeine and Cabbage together?
Regularly eating cabbage may make the acetaminophen in your medication a bit less effective by speeding its breakdown. Keep taking it as prescribed and tell your pharmacist or doctor if your pain or fever relief seems weaker. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acetaminophen And Codeine and Cabbage interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How is the Acetaminophen And Codeine and Cabbage interaction managed?
Keep taking your acetaminophen and codeine exactly as prescribed. Cabbage is a healthy food, and this is about how well the acetaminophen works, not about safety. Watch your response: Notice whether your usual dose still controls pain or fever, especially if you eat cabbage often. Individualized dosing: If relief seems weaker, your care team can adjust and tailor your dose and may monitor you more… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Acetaminophen And Codeine or Cabbage need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (1)
- Pantuck EJ, Pantuck CB, Anderson KE, et al: Effect of brussel sprouts and cabbage on drug conjugation. Clin Pharmacol Ther 1984; 35(2):161-169.
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