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Overview: Tylenol® with Codeine #3

Tylenol with codeine #3 is the brand name for codeine/acetaminophen or codeine/paracetamol. It is prescribed for mild, moderate, and sometimes severe pain relief when acetaminophen or other nonsteroidal anti-inflammatory drugs (NSAIDs) do not provide enough relief.

Acetaminophen adjusts the way the body senses pain and cools it down. Codeine works as a pain medicine by changing the way the brain and nervous system respond to pain. When codeine is used to prevent coughing, it reduces the activity in the area of the brain that causes it.

However, the Tylenol and codeine pain reliever combination has some dangerous side-effects. Tylenol® with codeine can lead users to opioid addiction, abuse, and misuse, which can sometimes cause death. To limit these risks, doctors must assess each patient’s risk before prescribing them this medication.

In the United States and United Kingdom, combination products with codeine are only available through a prescription. Tylenol 3 is a Schedule III controlled substance, meaning it has a low to moderate potential for abuse and dependency.

Tylenol 3 Side Effects

Tylenol with codeine can cause both mild and severe side effects. Mild side effects include constipation and difficulty urinating.

More serious side effects include:

  • Nausea
  • Vomiting
  • Loss of appetite
  • Weakness or dizziness 
  • Lightheadedness
  • Irritability 
  • Hallucinations 
  • Fever
  • Increased sweating
  • Confusion
  • Increased heartbeat
  • Shivering
  • Severe muscle stiffness or twitching
  • Diarrhea 
  • Red, peeling, or blistering skin
  • Rashes 
  • Hives 
  • Itching 
  • Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs 
  • Difficulty breathing
  • Difficulty swallowing
  • Irregular menstruation 
  • Lack of sexual desire

If any of these symptoms are severe or persist, it’s essential to contact a doctor as soon as possible or call for emergency medical help.

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Tylenol 3 Addiction, Abuse, and Misuse

The Tylenol-codeine pain reliever combination can lead to a drug abuse and addiction, especially with prolonged use. With long-term use, the combination can cause liver damage. Sometimes this is serious enough to cause death or require liver transplantation. As such, users should always follow medical advice from a doctor.

Side effects and symptoms of Tylenol-codeine abuse include:

  • Mental illness such as anxiety or depression 
  • Mood disorders
  • Sleep apnea
  • Nodding off 
  • Loss of appetite 
  • Weight loss 
  • Clammy hands or feet 
  • Stomach pain 
  • Constipation 
  • Itching 
  • Slow breathing 
  • Changes in vision

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Complications and Dangers

Tylenol with codeine can lead to serious or life-threatening breathing problems. This is primarily during the first 24 to 72 hours of treatment, and any time the dose increases.

When a dose is taken of acetaminophen and codeine that’s higher than recommended, medical attention should be immediately called. This is even if the patient doesn’t show any symptoms of overdose.

Side effects and symptoms of a Tylenol-codeine overdose include:

  • Nausea 
  • Vomiting 
  • Loss of appetite 
  • Increased sweating 
  • Unusual bleeding or bruising 
  • Pain in the upper right area of the stomach 
  • A yellowing skin reaction
  • Difficulty breathing 
  • Sleepiness 
  • Lightheadedness
  • Loss of consciousness 
  • Loss of muscle tone 
  • Narrowed or widened pupils 
  • Cool and clammy skin 
  • Fainting 
  • Slow heartbeat

Various drug interactions with Tylenol and codeine can lead to severe or life-threatening side effects. Patients shouldn’t drink alcohol or take prescription drugs or over-the-counter medicines during treatment.

Certain drugs with Tylenol #3 can increase the risk of serious and life-threatening issues, including breathing problems, serotonin syndrome, sedation, and coma. Before taking the combination, doctors should know if patients receive any of the following medications:

  • Certain antifungal medications including itraconazole, ketoconazole, and voriconazole
  • Benzodiazepines including alprazolam (Xanax), diazepam, estazolam, flurazepam, lorazepam, and triazolam
  • Carbamazepine
  • Erythromycin 
  • Certain medicines used for HIV including indinavir, nelfinavir, and ritonavir
  • Muscle relaxants 
  • Blood pressure medication
  • Other pain medications including phenytoin, rifampin, oxycodone and hydrocodone 
  • Benzodiazepines, including sedatives, sleeping pills, and tranquilizers

For more information about the acetaminophen and codeine pain medication combination, read the medication guide provided by your healthcare provider and check the drug information on the prescription label. 

Codeine phosphate is milder than other opioids like heroin or morphine. However, high doses and long-term use can still lead to dependency and drug addiction. With time, liver disease can develop. 

People experiencing codeine addiction should speak to their doctor about treatment options. During most treatments, a healthcare provider will support patients through withdrawal side effects, symptoms, and addiction recovery.

Treatment Options for Opioid Abuse & Addiction

There are several options for people suffering from opioid addiction. These include:

  • Medication-Assisted Therapy (MAT) There are three medications approved to treat opioid use disorder: buprenorphine, methadone, and naltrexone. Buprenorphine and methadone can help you manage withdrawal symptoms throughout the detoxification process. Naltrexone is less commonly used, but it blocks your opioid receptors, making it impossible to get high. Medication-assisted therapy is most effective when combined with other forms of treatment.
  • Inpatient Programs — Inpatient programs are the most intensive and effective treatment options for opioid addiction. These programs guide you through medically supervised detoxification, then behavioral therapy and other services (possibly including MAT), will be added to your treatment. They typically last 30, 60, or 90 days, however they may be longer if necessary.
  • Partial Hospitalization Programs (PHPs) PHPs are also known as intensive outpatient programs (IOPs). They are the next most intensive type of treatment for opioid addiction. They provide similar services to inpatient programs such as detoxification, behavioral therapy medical services, and custom treatments such as MAT. The difference is that in a PHP, the patient returns home to sleep. Some programs will include transportation and meals, but this varies by program. Partial hospitalization programs are helpful for both new patients and patients who have completed inpatient treatment and still need intensive recovery therapy.
  • Outpatient Programs Outpatient programs work best for people who have a high level of motivation to recover. They create treatment programs that work around your schedule. These programs can either be an effective treatment option for new patients or a part of an aftercare program for people who complete inpatient or partial hospitalization program.

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Resources

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Acetaminophen and Codeine, Medline Plus, 2019, https://medlineplus.gov/druginfo/meds/a601005.html

Tylenol WITH CODEINE- acetaminophen and codeine phosphate tablet, DailyMed, 2020, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=936e481e-f46c-4e03-b8e3-25961cda1909

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