Can you take Tylenol and Tums together?

Why

These two drugs do different jobs in different places and do not compete. Tylenol Extra Strength is "Acetaminophen 500 mg" per tablet, a "Pain reliever/fever reducer" that acts centrally and is cleared by the liver. Tums is an antacid — Tums Regular Strength is "Calcium Carbonate USP 500mg" per tablet, Tums Extra Strength is "Calcium Carbonate USP 750 mg", Tums Ultra is "Calcium carbonate 1000 mg" — and it works chemically in the stomach lumen, neutralizing acid it physically contacts. Nothing in the Tylenol label lists antacids as an interaction; the label's named drug caution is warfarin ("Ask a doctor or pharmacist before use if you are taking the blood thinning drug warfarin"), and the Tums label's caution is generic: "Ask a doctor or pharmacist before use if you are presently taking a prescription drug. Antacids may interact with certain prescription drugs." Acetaminophen is not one of the drugs that becomes useless in a less-acidic stomach. That last point matters more than the pairing itself: antacids DO block absorption of plenty of other medicines by binding them or by raising gastric pH, which is why MedlinePlus says "Do not take calcium carbonate within 1-2 hours of taking other medicines. Calcium may decrease the effectiveness of the other medicine." So Tums plus Tylenol is fine, but Tums plus a thyroid tablet, a tetracycline or fluoroquinolone antibiotic, or an iron supplement needs spacing. The real ceiling risk is acetaminophen, and it is not on the Tylenol box you are looking at — it is on the second box. Tylenol Extra Strength directions are "take 2 tablets every 6 hours while symptoms last" and "do not take more than 6 tablets in 24 hours" — that is 3,000 mg, already three-quarters of the 4,000 mg daily limit, and the label warns "Severe liver damage may occur if you take more than 4,000 mg of acetaminophen in 24 hours, with other drugs containing acetaminophen, or 3 or more alcoholic drinks every day while using this product." Combination boxes are where people blow through it: Tylenol Cold Plus Flu Severe caplets contain "Acetaminophen 325 mg" per caplet at up to 10 caplets a day (3,250 mg of acetaminophen on its own) — take that alongside Extra Strength Tylenol and you are over the limit. MedlinePlus is blunt: you should "not take more than one product that contains acetaminophen at a time." Tums has its own ceilings, stated per strength, which almost nobody reads because it tastes like candy: "do not take more than 15 tablets in 24 hours" for Regular Strength (500 mg, and no more than 10 in 24 hours if pregnant), "do not take more than 10 tablets in 24 hours" for Extra Strength (750 mg, and no more than 6 if pregnant), and "do not take more than 7 tablets in 24 hours" for Ultra (1000 mg, and no more than 5 if pregnant); every strength also warns against using the maximum dose for more than 2 weeks except under a doctor's supervision. Acetaminophen, notably, carries no stomach-bleeding warning — which is exactly why it is often the better painkiller for someone whose stomach already hurts.