Drug & supplement interaction

Brussels Sprout + Acetaminophen, Butalbital, Caffeine, Codeine

Acetaminophen, Butalbital, Caffeine, Codeine brand names: Esgic with Codeine, Fioricet w/ Codeine.

Moderate Interaction
The bottom line Moderate

Acetaminophen, Butalbital, Caffeine, Codeine falls into 3 drug categories that Brussels Sprout can interact with; the most serious is rated moderate. Animal research suggests that Brussels sprout can induce cytochrome P450 1A2 (CYP1A2) activity.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions3
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Brussels Sprout and Acetaminophen, Butalbital, Caffeine, Codeine

These two interact in 3 distinct ways. Each one is explained separately below.

Why Are There 3 Interactions?

Brussels Sprout interacts with whole categories of medication. Acetaminophen, Butalbital, Caffeine, Codeine falls into 3 of those categories, so it can interact with Brussels Sprout in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES

1 of 3

Why this applies to Acetaminophen, Butalbital, Caffeine, Codeine

Acetaminophen, Butalbital, Caffeine, Codeine falls under CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES — the group Brussels Sprout interacts with.

Animal research suggests that Brussels sprout can induce cytochrome P450 1A2 (CYP1A2) activity. Theoretically, Brussels sprout might increase the clearance and decrease the effects of drugs metabolized by CYP1A2. Some drugs metabolized by CYP1A2 include clozapine (Clozaril), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), olanzapine (Zyprexa), pentazocine (Talwin), propranolol (Inderal), tacrine (Cognex), theophylline, zileuton (Zyflo), zolmitriptan (Zomig), and others.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the practical takeaway for your Fioricet with Codeine combo. The piece of this interaction that matters most is the caffeine ingredient, which your body clears using an enzyme called CYP1A2. Animal studies hint that Brussels sprouts might nudge that enzyme to work a little faster, so in theory caffeine could be cleared sooner and feel slightly weaker. That part isn't a safety worry.

Honestly, this is very low on my list of concerns. The evidence is only lab and animal data, and the amount of Brussels sprouts in a normal meal is unlikely to change how your medication works. If you eat large amounts regularly, just mention it to your pharmacist so they can keep an eye on things.

References
  1. Wortelboer HM, de Kruif CA, van Iersel AAJ, et al. Effects of cooked Brussels sprouts on cytochrome P-450 profile and phase II enzymes in liver and small intestinal mucosa of the rat. Food Chem Toxicol 1992;30(1):17-27. PubMed
Moderate

GLUCURONIDATED DRUGS

2 of 3

Acetaminophen, Butalbital, Caffeine, Codeine also falls under GLUCURONIDATED DRUGS.

A cabbage and Brussels sprout-containing diet seems to boost elimination through glucuronide conjugation. Theoretically, these foods might also lower levels of other drugs that are metabolized through glucuronide conjugation, including acetaminophen (Tylenol, others) and oxazepam (Serax), haloperidol (Haldol), lamotrigine (Lamictal), morphine (MS Contin, Roxanol), zidovudine (AZT, Retrovir), and others.
Severity Moderate Likelihood Probable Evidence B

Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the practical takeaway for your Fioricet with Codeine. One of its ingredients, acetaminophen (the Tylenol part), is cleared from your body partly through a process called glucuronidation. Brussels sprouts and other cabbage-family veggies may gently speed that process up, so in theory they could nudge acetaminophen levels a little lower. That might mean slightly less pain relief, but this is mostly based on diet studies and is considered theoretical, not a dramatic effect.

For everyday eating, this is really not something to worry about. A normal serving of Brussels sprouts won't undo your medication. If you're eating large amounts regularly or using concentrated supplements, just mention it to your pharmacist or doctor so they can keep an eye on how well your pain is controlled.

References
  1. Pantuck EJ, Pantuck CB, Anderson KE, et al. Effect of brussels sprouts and cabbage on drug conjugation. Clin Pharmacol Ther 1984;35:161-9. PubMed
Moderate

ACETAMINOPHEN (Tylenol, others)

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A cabbage and Brussels sprout-containing diet can increase metabolism and decrease levels of acetaminophen. In clinical research, a diet that includes daily consumption of cabbage and Brussels sprout decreases acetaminophen levels by as much as 16%. This appears to occur due to a boost of elimination through glucuronide conjugation.
Severity Moderate Likelihood Probable Evidence B

Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

The piece of this combo pill we care about here is the acetaminophen (the Tylenol part). Research found that eating cabbage and Brussels sprouts daily can nudge your body to clear acetaminophen a little faster, lowering its blood levels by up to about 16%. Your liver attaches acetaminophen to a molecule (a process called glucuronidation) before flushing it out, and these veggies seem to speed that step up.

In plain terms, your acetaminophen might work slightly less for pain or fever. This is a modest effect from a steady, vegetable-heavy diet, not a single serving, and it does not change the butalbital, caffeine, or codeine parts. Please don't adjust your dose on your own. If your pain isn't well controlled, check in with your pharmacist or doctor.

References
  1. Pantuck EJ, Pantuck CB, Anderson KE, et al. Effect of brussels sprouts and cabbage on drug conjugation. Clin Pharmacol Ther 1984;35:161-9. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Brussels Sprout Also Interacts With Other Medications

Brussels Sprout has 240 moderate known drug interactions in our database — the Acetaminophen, Butalbital, Caffeine, Codeine one above is among them. If you take anything else, check it against the full list below.

Taking anything else?

Check Another of Your Medications Against Brussels Sprout

Covers the 2,830 medications we’ve checked against Brussels Sprout. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Acetaminophen, Butalbital, Caffeine, Codeine

This page covers Brussels Sprout only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Acetaminophen, Butalbital, Caffeine, Codeine page lists 305 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: 1,4-butanediol (major), Activated Charcoal (major), Asarabacca (major), Beer (major) and Ephedra (major).

By severity: 15 major · 245 moderate · 45 minor.

Open the Acetaminophen, Butalbital, Caffeine, Codeine interaction page

How much people look this up

Where Brussels Sprout and Acetaminophen, Butalbital, Caffeine, Codeine Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Brussels Sprout
Steady interest

#1,199 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Acetaminophen, Butalbital, Caffeine, Codeine
Top half

#911 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Brussels Sprout

What is Brussels Sprout?

  • General nutrition and fiber
  • Antioxidant support
  • Digestive health
  • Heart health support
  • Cancer-prevention interest

Brussels sprouts are a nutritious cruciferous vegetable rich in fiber, vitamin C, vitamin K, and plant compounds called glucosinolates. Eating them as part of a balanced diet is healthy and safe for most people, but supplement-style claims (like preventing cancer) are not well proven. If you take blood thinners or have thyroid concerns, talk with your pharmacist or doctor about your intake.

Read the full Brussels Sprout monograph & all interactions
Keep checking

Other Drugs & Brussels Sprout

Browse every other medication we’ve checked against Brussels Sprout — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
240Moderate
0Minor
2,589No known interaction
Moderate

240 interactions

Showing 60 of 240 moderate interactions — see all 240 on the Brussels Sprout page.

No interaction 2,589 drugs checked — show the list
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

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Pharmacist Counseling Corner

Taking Brussels Sprout and Acetaminophen, Butalbital, Caffeine, Codeine Together: Common Questions

Can you take Brussels Sprout with Acetaminophen, Butalbital, Caffeine, Codeine?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 3 interactions listed for Brussels Sprout and Acetaminophen, Butalbital, Caffeine, Codeine?
Acetaminophen, Butalbital, Caffeine, Codeine belongs to more than one drug category, and Brussels Sprout interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Brussels Sprout and Acetaminophen, Butalbital, Caffeine, Codeine interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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