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Codeine can be a primary ingredient of certain prescribed versions of Tylenol, alongside acetaminophen. The quantities of codeine in Tylenol vary depending on the strength. Over-the-counter versions of Tylenol (acetaminophen) do not contain codeine.
- Due to health risks associated with taking high amounts of acetaminophen, the FDA enforced requirements that codeine-containing Tylenol products contain no more than 300mg of acetaminophen per dose.
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How much codeine is in Tylenol?
The combination of acetaminophen and codeine, sold under some brand names of Tylenol, has been a popular form of pain relief in the United States for many years, though Tylenol is not codeine in and of itself. Acetaminophen (Tylenol) is commonly sold over the counter in forms without codeine, and it is an effective pain reliever for mild-to-moderate pain.
Due to health risks associated with intaking high amounts of acetaminophen, the FDA enforced requirements that Tylenol products contain no more than 300mg of acetaminophen per dose. In addition to Tylenol (acetaminophen) without codeine, there are four variations of Tylenol that do contain codeine, each with varying strengths of codeine, labeled by number.
The doses in each form of Tylenol are below: [1]
| Tylenol type | Dose of Codeine and Acetaminophen |
|---|---|
| Tylenol No. 1 | 300mg Acetaminophen and 7.5mg Codeine |
| Tylenol No. 2 | 300mg Acetaminophen and 15mg Codeine |
| Tylenol No. 3 | 300mg Acetaminophen and 30mg Codeine |
| Tylenol No. 4 | 300mg Acetaminophen and 60mg Codeine |
Side effects of acetaminophen-codeine
Common side effects of acetaminophen-codeine include: [2][3]
- Nausea and vomiting
- Sweating
- Flushing
- Stomach pain
- ConstipationÂ
- Sexual dysfunction
These side effects are likely to be mild and will often go away on their own. If they persist or worsen, contact a doctor for medical attention.
Serious side effects
Sometimes, severe side effects can occur that require immediate medical attention, such as: [2][3]
- Chest pain
- Changes in heart rate
- Vomiting, nausea, or diarrhea that does not go away
- Rash, hives, or itching
- Difficulty breathing or swallowing
- Swelling in the face, mouth, hands, or feet
- Extreme fatigue and drowsiness
- New or unusual pain
- Confusion
- Fever
- New or unusual snoring or breathing difficulties during sleep
- Seizures
- Agitation
- HallucinationsÂ
Precautions and misuse potential
Because acetaminophen-codeine contains an opioid, careful consideration of individual risk factors and medical history is essential before and during treatment.
Dependence, tolerance, and addiction
Codeine is an opioid medication with a potential for tolerance, dependence, and addiction. As such, it is important to use it exactly as prescribed and not to increase the frequency or amount of use without professional guidance. [2]
Acetaminophen-codeine combination is a Schedule III controlled substance, with a risk of misuse and abuse. People with a history of substance use issues may be at increased risk of misuse and addiction. As such, this medication should be used only when non-opioid pain relief options are ineffective. [3]
Other health issues to look out for
Some people may be at increased risk of adverse effects when using acetaminophen-codeine and should take a reduced dose or avoid the medication completely. This includes people with a history of: [2][3]
- Breathing or lung problems
- Stomach or intestinal blockages
- Brain tumor or other brain conditionsÂ
- Seizure conditions
- Pancreas, gallbladder, heart, liver, or kidney conditions
Fertility issues and pregnancy
Acetaminophen-codeine can impact fertility and may cause harm to a fetus or breastfeeding infant. Inform the prescribing doctor if you are pregnant or planning to become pregnant. [2]
Interactions and overdose risk
Acetaminophen-codeine can interact with other substances, causing changes in medication effectiveness, increased risk of adverse effects, or increased risk of overdose. Using other central nervous system (CNS) depressants with acetaminophen-codeine can be particularly dangerous. This can include other opioids, benzodiazepines, or alcohol. [2]
Monoamine oxidase inhibitors (MAOIs), a type of antidepressant, can interact with acetaminophen-codeine and should not be used within two weeks of each other. [2]
Inform the prescribing doctor of any medications, illicit drugs, vitamins, or supplements that are currently or have recently been used before commencing acetaminophen-codeine.
Overdose
Acetaminophen-codeine can cause overdose, which may cause symptoms such as: [2][3]
- Sweating
- Cold and clammy skin
- Nausea and vomiting
- Pinpoint pupils
- Unusual bleeding and bruising
- Yellowing of the skin or eyes
- Difficulty breathing
- Slowed heartbeat
- Loss of consciousness
- Seizure
If an overdose is suspected, call a medical professional for advice. In case of an emergency, such as seizures, unconsciousness, or breathing difficulties, call 911 for emergency medical attention.
Safety tips
- Use acetaminophen-codeine exactly as prescribed. Never take more than prescribed or more frequent doses than prescribed.
- Store the medication in a safe space where it cannot be accessed by children or pets.
- Never share acetaminophen-codeine with others.
- Acetaminophen-codeine is available as tablets, which should be swallowed. Never administer acetaminophen-codeine in an unintended manner, including crushing and snorting or injecting, as this can increase the risk of harm and overdose.
- Avoid using other substances while taking acetaminophen-codeine, unless directed by a doctor, as they may interact and increase the risk of adverse effects and overdose.
- Do not suddenly stop taking acetaminophen-codeine, as this may cause the onset of withdrawal symptoms. The prescribing doctor will advise on a gradual taper if necessary.
