I was not aware that multivitamins had a tendency to cause nausea (they don't for me, personally). That said, I've been told that taking them on an empty stomach means it won't be absorbed nearly as well compared to with a meal. Perhaps the absorption and nausea are related?

Does your mutli-vitamin have iron? Iron can be the reason. I had to switch my prenatal vitamin to before bed during first trimester

I see others commenting about iron, but it is probably the zinc, because multivitamins usually don't have enough iron in them to cause problems.

Tylenol is well recognized to cause upset stomach. Vitamin C and D, iron, and fish oil can all upset your stomach, as well. Your multivitamin prob has C and D, others would have iron too.

Generally, consuming pills with acidic ingredients on an empty stomach means they are not being diluted, and the environment becomes more acidic than your body is happy with.

It’s possible that the Tylenol has a coating specifically to avoid stomach upset. The vitamin likely isn’t coated and may dissolve faster which is causing you irritation.

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I have this issue big time. Even if I eat a meal beforehand. I’ve heard it’s because of the iron and some vitamins like folate and vitamin c are acidic. Had to stop drinking as much coffee for the same reason.