Table of ContentsView AllTable of ContentsUsesBefore TakingDosageSide EffectsWarnings and Interactions
Table of ContentsView All
View All
Table of Contents
Uses
Before Taking
Dosage
Side Effects
Warnings and Interactions
Tylenol #3 is an oral prescription drug used to relieve mild to moderately severe pain that is not well-controlled with over-the-counter medication.Tylenol #3 is better known as Tylenol with codeine.
This medication contains two active ingredients:
Tylenol #3 is used in adults and children 12 and over. There is a risk of addiction and abuse, which is why it should be used with caution.
This article looks at Tylenol #3, its uses, and dosage. It also discusses some of the side effects and precautions you should take when using this medicine.
Paul Bradbury / Getty Images
Tylenol #3 is also sold under a variety of brand names, such as:APAP-CodeineCapital with CodeinePyregesic-CVopac
Tylenol #3 is also sold under a variety of brand names, such as:
What Is Tylenol #3 Used For?
Tylenol #3 is used to relieve pain that isn’t well-controlled with over-the-counter (OTC) medication. It is a narcotic-analgesiccombination.
The termnarcoticrefers toopiatesandopioids. Opiates are drugs made from opium, such as morphine. Opioids are drugs like codeine, which have opiate-like effects. Ananalgesicis any drug designed to relieve pain.
Tylenol #3 may also be considered if non-opioid pain relievers are causing intolerable side effects.
Off-Label Use
In the past, health care professionals sometimes used this drug to treat coughs. It was often used for coughs related to an illness likestrep throator for a cough following a surgical procedure such astonsillectomy.
This practice is frowned upon today. This is because Tylenol #3 comes with a risk of respiratory depression, or abnormally slow and ineffective breathing. The risk is especially high in:
Opioids and Heart Problems
RecapTylenol #3 can be addictive and cause serious side effects. For this reason, it is almost always used to treat pain that hasn’t responded to other medications.
Recap
Tylenol #3 can be addictive and cause serious side effects. For this reason, it is almost always used to treat pain that hasn’t responded to other medications.
Before Taking Tylenol #3
Before taking Tylenol #3, make sure you understand the risk and benefits. Tylenol #3 is not right for everyone. Because codeine is an opioid drug, patients may become addicted to it. This kind ofaddictioncan be both physical and mental. Before prescribing this drug, doctors must be sure the benefits outweigh the risks.
To do this, doctors need to evaluate a patient’s risk of becoming addicted. Risk factors include:
Doctors should also provide counseling to ensure the drug is used safely.
In the United States, Tylenol #3 is available under a program called the Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS). This program aims to reduce the risk of abuse.
The REMS program applies to manufacturers of drugs that have a high risk of serious side effects. Under REMS, manufacturers have to give healthcare providers compliance education. This helps providers know when the drug is appropriate and when it is not.
A history of substance abuse doesn’t necessarily mean you can’t use Tylenol #3 if you need it. It just means there is a greater need for counseling and oversight.
People with untreated alcoholism or substance abuse disorder should not use Tylenol #3.
5 Classes of Drug Used to Treat Chronic Pain
Precautions and Contraindications
There are certain groups that should never use Tylenol #3. This is largely because of codeine’s impact on therespiratory system.
Because of this, the FDA says Tylenol #3 should not be used in:
Tylenol #3 should also not be used in:
Tylenol #3 should be used with extreme caution during pregnancy. Use during pregnancy can cause neonatal opioid withdrawal syndrome. This condition can be life-threatening to a newborn.
If you need any opioid during pregnancy, weigh the risks and benefits with your doctor. Breastfeeding is not recommended when taking Tylenol #3.
Other Narcotic Analgesic Combinations
Other narcotic analgesic combinations are available to treat breakthrough pain. These drugs also have a risk of addiction. In some cases, the risk of addiction may be greater than it is with Tylenol #3.
These drugs include:
Types of Opioids Used for Chronic Pain Relief
RecapTylenol #3 isn’t right for people with certain risk factors. This includes a history of substance abuse and mental illness. Medical conditions like respiratory depression and the use of certain other drugs may also exclude you from being able to take Tylenol #3.
Tylenol #3 isn’t right for people with certain risk factors. This includes a history of substance abuse and mental illness. Medical conditions like respiratory depression and the use of certain other drugs may also exclude you from being able to take Tylenol #3.
Dosage of Tylenol #3
Tylenol #3 is available as a tablet or oral solution.
The recommended dosage for adults:
The analgesic effect of Tylenol #3 usually reaches a peak within two hours of taking a dose. It typically lasts between four and six hours.
Modifications
Always take the lowest effective dose. A doctor should determine thedose for children12 and over. The oral solution can be divided into smaller doses, so it is often used for children who are younger or have a smaller body size. Adolescents and teens may be able to take tablets.
When you first start taking Tylenol #3, your doctor will want to monitor you for 24 to 72 hours. This is to watch out for signs of respiratory depression. If the dose is ever increased, you’ll need to be monitored for another 24 to 72 hours.
During this period, your doctor will measure your oxygen saturation levels. This is done with either anarterial blood gas testorpulse oximetry.This is especially important for people with cancer, who often take Tylenol #3 to treat chronic pain.
How to Take and Store
Tylenol #3 can be taken with or without food. The oral solution bottle should be shaken thoroughly before use.
Always measure the oral solution with a medication-measuring device. You can get one from your doctor or pharmacist. Avoid “eyeballing” doses, which can lead to overdosing.
Tylenol #3 tablets or oral solution can be stored at room temperature, between 68 F and 77 F. It’s best to keep it in a cool, dry room in its original light-resistant container. Never use a drug past its expiration date. Be sure to keep this medication out of reach of children and pets.
Can You Overdose on Acetaminophen?
RecapYou should always take the lowest effective dose of Tylenol #3. Your doctor will need to monitor you for a day or two after you start taking this medication.
You should always take the lowest effective dose of Tylenol #3. Your doctor will need to monitor you for a day or two after you start taking this medication.
Side Effects of Tylenol #3
Tylenol #3 can cause a number of side effects. Some are low-grade and tend to resolve on their own without treatment. If you have a severe reaction, you may have to stop taking the drug.
Common
The most common side effects of Tylenol #3 are:
Less common side effects include:
Adrenal insufficiencycan develop when opioids are used for longer than one month. This is a condition whereadrenal gland functionis reduced. Symptoms include:
If this happens, you’ll need to gradually stop taking Tylenol #3. You may also be prescribedoral corticosteroid drugsto support adrenal function.
RecapSome people have mild side effects when taking Tylenol #3. These may include drowsiness, nausea, headache, and constipation.
Some people have mild side effects when taking Tylenol #3. These may include drowsiness, nausea, headache, and constipation.
Severe
High doses of acetaminophen can cause liver injury, even in healthy adults. Taking 4,000 mg within 24 hours can significantly increase the risk of liver poisoning, also calledhepatotoxicity. Damage to the liver can be permanent.
Two tablets of Tylenol #3 every four hours is very close to the daily limit of 3,600 mg. If you drink alcohol while taking acetaminophen, it significantly increases the risk of liver damage.
Signs of acetaminophen-induced hepatotoxicity include:
In the United States, acetaminophen hepatotoxicity is common. In fact, it’s responsible for more than 50% of overdose-relatedacute liver failuresand around 20% of allliver transplants.
On rare occasions, Tylenol #3 has also been known to causeanaphylaxis. This is a potentially life-threatening, whole-body allergic reaction. In most cases, the codeine causes this reaction. It can trigger symptoms within minutes of taking a dose.
When to Call 911Call 911 or go to the ER if you have any of these symptoms after taking Tylenol #3:Hives or rashShortness of breathWheezingDizziness or faintingNausea or vomitingSwelling of the face, tongue, or throat
When to Call 911
Call 911 or go to the ER if you have any of these symptoms after taking Tylenol #3:Hives or rashShortness of breathWheezingDizziness or faintingNausea or vomitingSwelling of the face, tongue, or throat
Call 911 or go to the ER if you have any of these symptoms after taking Tylenol #3:
If left untreated, anaphylaxis can lead to shock, coma, asphyxiation, heart or respiratory failure, and even death.
How Tylenol Damages the Liver
RecapSevere side effects can include liver poisoning and anaphylaxis. These side effects require immediate treatment.
Severe side effects can include liver poisoning and anaphylaxis. These side effects require immediate treatment.
Warnings and Interactions for Tylenol #3
Some people withepilepsy, for example, may have moreseizureswhen taking Tylenol #3. Elderly people with reduced kidney function may also have seizures.Because there is no way to know who might be affected, doctors should monitor those at risk for seizures. If seizures occur or worsen, treatment should be stopped.
Acetaminophen can stress the liver, so people with chronic liver disease should take no more than 2,000 mg per day. Someone with severe liver disease may need to take even less. Even if you don’t have liver disease, you should always use the smallest amount of acetaminophen you need.
Interactions
To avoid this, most doctors will find an alternative to Tylenol #3. If there are no reasonable alternatives, the lowest possible dose should be used for the shortest amount of time. The patient should be kept under constant medical supervision while taking the drug.
When you take Tylenol #3 with one of these other drugs, you may have increases or decreases in the blood concentration of one or both drugs. Decreases mean the drugs won’t work as well. Increases can make side effects worse.
With Tylenol #3, any drug interaction that causes a drop in blood concentration can lead to significant and sometimes profound opioidwithdrawal symptoms.
Some of the drugs that pose the greatest risk for CYP450 interactions are:
Because these interactions can be severe, Tylenol #3 should not be used with any of these drugs.
There are literally dozens of other drugs that can interact with Tylenol #3. You may need to adjust the dose of these medications or take them at intervals of one to six hours.
To avoid drug interactions, always let your doctor know about any drugs you’re taking. This includes:Prescription drugsOver-the-counter medicationHerbal supplementsRecreational drugs
To avoid drug interactions, always let your doctor know about any drugs you’re taking. This includes:
Withdrawal
One of the major concerns about the long-term use of Tylenol #3 is the risk of addiction and abuse. Another concern is withdrawal symptoms. These can happen when treatment is suddenly stopped.
Don’t stop taking Tylenol #3 abruptly if you’ve been taking it for a long period of time and are showing signs of opioid dependence. Stopping suddenly can cause side effects like:
To avoid this, your doctor will have you taper off your dose over time. Current guidance from the Centers for Disease Control and Prevention recommends starting with a 10% reduction in dose per week.
If you aren’t able to quit Tylenol #3 and have signs of physical or mental dependence, speak with your doctor. Adrug treatment programmight be able to help you overcome your addiction.
Treatment Options for Opioid Addiction
RecapTylenol #3 can cause dependency. If you quit taking it suddenly, it can also cause severe withdrawal symptoms. Always make sure you stop taking Tylenol #3 under a doctor’s supervision.
Tylenol #3 can cause dependency. If you quit taking it suddenly, it can also cause severe withdrawal symptoms. Always make sure you stop taking Tylenol #3 under a doctor’s supervision.
Summary
Tylenol #3 is a prescription pain reliever that contains a combination of acetaminophen and codeine. It is typically only used if other pain medications haven’t worked.
Tylenol #3 isn’t for everyone. It can be addictive and may cause withdrawal symptoms. It may also cause serious side effects like respiratory depression and liver damage.
Tylenol #3 can interact with certain other drugs. Make sure to tell your doctor about any medications you’re taking, and always take the smallest effective dose.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.DailyMed.Tylenol with codeine acetaminophen and codeine phosphate tablets.Tobias JD, Green TP, Coté CJ, et al.Codeine: Time to say “no.".Pediatrics.2016;138(4):e20162396. doi:10.1542/peds.2016-2396U.S. Food and Drug Administration.Opioid analgesic risk evaluation and mitigation strategy (REMS).Whittaker MR.Opioid use and the risk of respiratory depression and death in the pediatric population.J Pediatr Pharmacol Ther. 2013;18(4):269-76. doi:10.5863/1551-6776-18.4.269Nair V, Soraisham AS, Akierman A.Neonatal withdrawal syndrome due to maternal codeine use.Paediatr Child Health. 2012;17(5):e40-e41. doi:10.1093/pch/17.5.e40Boland J, Boland E, Brooks D.Importance of the correct diagnosis of opioid-induced respiratory depression in adult cancer patients and titration of naloxone.Clin Med (Lond). 2013;13(2):149-51. doi:10.7861/clinmedicine.13-2-149Saljoughian M.Acetaminophen intoxication: a critical-care emergency.US Pharm.2016;41(12):38-41.Yoon E, Babar A, Choudhary M, Kutner M, Pyrsopoulos N.Acetaminophen-induced hepatotoxicity: a comprehensive update.J Clin Transl Hepatol. 2016;4(2):131-42. doi:10.14218/JCTH.2015.00052Chen HY, Albertson TE, Olson KR.Treatment of drug-induced seizures.Br J Clin Pharmacol. 2016;81(3):412-9. doi:10.1111/bcp.12720American College of Gastroenterology.Medications and the liver.Overholser BR, Foster DR.Opioid pharmacokinetic drug-drug interactions.Am J Manag Care. 2011;17:S276-S287Mackey K, Anderson J, Bourne D, Chen E, Peterson K.Opioid tapering. In:Evidence brief: benefits and harms of long-term opioid dose reduction or discontinuation in patients with chronic pain. Washington, DC: Department of Veterans Affairs (US); 2019.
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.DailyMed.Tylenol with codeine acetaminophen and codeine phosphate tablets.Tobias JD, Green TP, Coté CJ, et al.Codeine: Time to say “no.".Pediatrics.2016;138(4):e20162396. doi:10.1542/peds.2016-2396U.S. Food and Drug Administration.Opioid analgesic risk evaluation and mitigation strategy (REMS).Whittaker MR.Opioid use and the risk of respiratory depression and death in the pediatric population.J Pediatr Pharmacol Ther. 2013;18(4):269-76. doi:10.5863/1551-6776-18.4.269Nair V, Soraisham AS, Akierman A.Neonatal withdrawal syndrome due to maternal codeine use.Paediatr Child Health. 2012;17(5):e40-e41. doi:10.1093/pch/17.5.e40Boland J, Boland E, Brooks D.Importance of the correct diagnosis of opioid-induced respiratory depression in adult cancer patients and titration of naloxone.Clin Med (Lond). 2013;13(2):149-51. doi:10.7861/clinmedicine.13-2-149Saljoughian M.Acetaminophen intoxication: a critical-care emergency.US Pharm.2016;41(12):38-41.Yoon E, Babar A, Choudhary M, Kutner M, Pyrsopoulos N.Acetaminophen-induced hepatotoxicity: a comprehensive update.J Clin Transl Hepatol. 2016;4(2):131-42. doi:10.14218/JCTH.2015.00052Chen HY, Albertson TE, Olson KR.Treatment of drug-induced seizures.Br J Clin Pharmacol. 2016;81(3):412-9. doi:10.1111/bcp.12720American College of Gastroenterology.Medications and the liver.Overholser BR, Foster DR.Opioid pharmacokinetic drug-drug interactions.Am J Manag Care. 2011;17:S276-S287Mackey K, Anderson J, Bourne D, Chen E, Peterson K.Opioid tapering. In:Evidence brief: benefits and harms of long-term opioid dose reduction or discontinuation in patients with chronic pain. Washington, DC: Department of Veterans Affairs (US); 2019.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
DailyMed.Tylenol with codeine acetaminophen and codeine phosphate tablets.Tobias JD, Green TP, Coté CJ, et al.Codeine: Time to say “no.".Pediatrics.2016;138(4):e20162396. doi:10.1542/peds.2016-2396U.S. Food and Drug Administration.Opioid analgesic risk evaluation and mitigation strategy (REMS).Whittaker MR.Opioid use and the risk of respiratory depression and death in the pediatric population.J Pediatr Pharmacol Ther. 2013;18(4):269-76. doi:10.5863/1551-6776-18.4.269Nair V, Soraisham AS, Akierman A.Neonatal withdrawal syndrome due to maternal codeine use.Paediatr Child Health. 2012;17(5):e40-e41. doi:10.1093/pch/17.5.e40Boland J, Boland E, Brooks D.Importance of the correct diagnosis of opioid-induced respiratory depression in adult cancer patients and titration of naloxone.Clin Med (Lond). 2013;13(2):149-51. doi:10.7861/clinmedicine.13-2-149Saljoughian M.Acetaminophen intoxication: a critical-care emergency.US Pharm.2016;41(12):38-41.Yoon E, Babar A, Choudhary M, Kutner M, Pyrsopoulos N.Acetaminophen-induced hepatotoxicity: a comprehensive update.J Clin Transl Hepatol. 2016;4(2):131-42. doi:10.14218/JCTH.2015.00052Chen HY, Albertson TE, Olson KR.Treatment of drug-induced seizures.Br J Clin Pharmacol. 2016;81(3):412-9. doi:10.1111/bcp.12720American College of Gastroenterology.Medications and the liver.Overholser BR, Foster DR.Opioid pharmacokinetic drug-drug interactions.Am J Manag Care. 2011;17:S276-S287Mackey K, Anderson J, Bourne D, Chen E, Peterson K.Opioid tapering. In:Evidence brief: benefits and harms of long-term opioid dose reduction or discontinuation in patients with chronic pain. Washington, DC: Department of Veterans Affairs (US); 2019.
DailyMed.Tylenol with codeine acetaminophen and codeine phosphate tablets.
Tobias JD, Green TP, Coté CJ, et al.Codeine: Time to say “no.".Pediatrics.2016;138(4):e20162396. doi:10.1542/peds.2016-2396
U.S. Food and Drug Administration.Opioid analgesic risk evaluation and mitigation strategy (REMS).
Whittaker MR.Opioid use and the risk of respiratory depression and death in the pediatric population.J Pediatr Pharmacol Ther. 2013;18(4):269-76. doi:10.5863/1551-6776-18.4.269
Nair V, Soraisham AS, Akierman A.Neonatal withdrawal syndrome due to maternal codeine use.Paediatr Child Health. 2012;17(5):e40-e41. doi:10.1093/pch/17.5.e40
Boland J, Boland E, Brooks D.Importance of the correct diagnosis of opioid-induced respiratory depression in adult cancer patients and titration of naloxone.Clin Med (Lond). 2013;13(2):149-51. doi:10.7861/clinmedicine.13-2-149
Saljoughian M.Acetaminophen intoxication: a critical-care emergency.US Pharm.2016;41(12):38-41.
Yoon E, Babar A, Choudhary M, Kutner M, Pyrsopoulos N.Acetaminophen-induced hepatotoxicity: a comprehensive update.J Clin Transl Hepatol. 2016;4(2):131-42. doi:10.14218/JCTH.2015.00052
Chen HY, Albertson TE, Olson KR.Treatment of drug-induced seizures.Br J Clin Pharmacol. 2016;81(3):412-9. doi:10.1111/bcp.12720
American College of Gastroenterology.Medications and the liver.
Overholser BR, Foster DR.Opioid pharmacokinetic drug-drug interactions.Am J Manag Care. 2011;17:S276-S287
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