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Acetaminophen/ codeine

Generic Name: acetaminophen/codeine (a-SEET-a-MIN-oh-fen/KOE-deen)
Brand Name: Tylenol w/ Codeine

Acetaminophen/codeine contains acetaminophen. Severe and sometimes fatal liver problems, including the need for liver transplant, have been reported with the use of acetaminophen. Most cases of these liver problems occurred in patients taking excessive doses of acetaminophen (more than 4,000 mg per day). Also, patients who developed these liver problems were often using more than 1 medicine that contained acetaminophen. Discuss any questions or concerns with your doctor.

Some children have had serious and sometimes fatal breathing problems when using acetaminophen/codeine after surgery to remove tonsils or adenoids. Acetaminophen/codeine should not be used in children to treat pain after surgery to remove tonsils or adenoids. Talk with your doctor for more information.


Acetaminophen/ codeine is used for:

Relieving mild to moderately severe pain. It may also be used for other conditions as determined by your doctor.

Acetaminophen/codeine is a narcotic and analgesic/antipyretic combination. It works in the brain and nervous system to decrease pain.

Do NOT use acetaminophen/ codeine if:

  • you are allergic to any ingredient in acetaminophen/codeine
  • you have very slow or difficult breathing, or you are having an asthma attack
  • you are taking quinidine or sodium oxybate (GHB)
  • the patient is a child being treated for pain after surgery to remove tonsils or adenoids

Contact your doctor or health care provider right away if any of these apply to you.

Before using acetaminophen/ codeine:

Some medical conditions may interact with acetaminophen/codeine. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you are allergic to other narcotic medicines (eg, hydrocodone, morphine, oxycodone)
  • if you have severe drowsiness, or you have or recently had any head injury, increased pressure in the brain, growths in the brain (eg, tumors), or an infection of the brain or nervous system
  • if you have a history of heart problems (eg, cor pulmonale, slow or irregular heartbeat), low blood pressure, stomach or bowel problems (eg, blockage, inflammation, paralysis), inflammation of the pancreas (pancreatitis), gallbladder problems, liver problems (eg, hepatitis), kidney problems, seizures, thyroid problems, adrenal gland problems (eg, Addison disease), curvature of the spine (scoliosis), prostate problems (eg, an enlarged prostate), or trouble urinating
  • if you have asthma, chronic obstructive pulmonary disease (COPD), or other lung or breathing problems
  • if you have recently had surgery (eg, stomach or bowel surgery) or are scheduled to have surgery
  • if you are in very poor health, are very overweight, are dehydrated or have low blood volume, or have stomach pain or constipation
  • if you drink alcohol; have a history of drug or alcohol abuse or dependence, mood or mental problems, or suicidal thoughts or actions; or are going through withdrawal from alcohol or other substances

Some MEDICINES MAY INTERACT with acetaminophen/codeine. Tell your health care provider if you are taking any other medicines, especially any of the following:

  • Isoniazid, other narcotic pain medicines (eg, morphine), perampanel, or sleep medicines (eg, zolpidem) because they may increase the risk of acetaminophen/codeine's side effects
  • Buprenorphine, naltrexone, or quinidine because they may decrease acetaminophen/codeine's effectiveness
  • Anticoagulants (eg, warfarin) or sodium oxybate (GHB) because the risk of their side effects may be increased by acetaminophen/codeine
  • Medicines that may harm the liver (eg, methotrexate, ketoconazole, certain medicines for HIV infection) because the risk of liver side effects may be increased. Ask your doctor if you are unsure if any of your medicines might harm the liver

This may not be a complete list of all interactions that may occur. Ask your health care provider if acetaminophen/codeine may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use acetaminophen/ codeine:

Use acetaminophen/codeine as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • Take acetaminophen/codeine by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.
  • If you have been taking acetaminophen/codeine regularly or for longer than a few weeks, do not suddenly stop taking it without checking with your doctor. Your doctor may need to gradually lower your dose.
  • If you miss a dose of acetaminophen/codeine and you are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use acetaminophen/codeine.

Important safety information:

  • Acetaminophen/codeine may cause drowsiness, dizziness, or light-headedness. These effects may be worse if you take it with alcohol or certain medicines. Use acetaminophen/codeine with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
  • Acetaminophen/codeine may cause dizziness, light-headedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.
  • Do not drink alcohol while you are using acetaminophen/codeine.
  • Check with your doctor before you use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using acetaminophen/codeine; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.
  • Acetaminophen/codeine may harm your liver. Your risk may be greater if you drink alcohol while you are using acetaminophen/codeine. Talk to your doctor before you take acetaminophen/codeine or other fever reducers if you drink alcohol.
  • A very bad skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis) may happen. It can cause very bad health problems that may not go away and sometimes death. Get medical help right away if you have signs like red, swollen, blistered, or peeling skin (with or without fever); red or irritated eyes; or sores in your mouth, throat, nose, or eyes.
  • Do not take more than the recommended dose, take more often than prescribed, or use for longer than prescribed without checking with your doctor.
  • Tell your doctor or dentist that you take acetaminophen/codeine before you receive any medical or dental care, emergency care, or surgery.
  • Some of these products contain sulfites. Sulfites may cause an allergic reaction in some patients (eg, asthma patients). If you have ever had an allergic reaction to sulfites, ask your pharmacist if your product has sulfites in it.
  • Acetaminophen/codeine has acetaminophen in it. Before you start any new medicine, check the label to see if it has acetaminophen in it too. If it does or if you are not sure, check with your doctor or pharmacist.
  • Contact your doctor right away if you take more than 4,000 mg of acetaminophen per day, even if you feel well.
  • Acetaminophen/codeine may cause constipation. Talk with your doctor or pharmacist about using a stool softener or laxative to prevent constipation. It is also important to maintain a diet adequate in fiber, drink plenty of water, and exercise to prevent constipation. If you become constipated while taking acetaminophen/codeine, talk with your doctor or pharmacist.
  • Acetaminophen/codeine may interfere with certain lab tests. Be sure your doctor and lab personnel know you are taking acetaminophen/codeine.
  • Use acetaminophen/codeine with caution in the ELDERLY; they may be more sensitive to its effects, especially confusion, drowsiness, and breathing problems.
  • Acetaminophen/codeine should be used with extreme caution in CHILDREN younger than 3 years old; safety and effectiveness in these children have not been confirmed.
  • PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using acetaminophen/codeine while you are pregnant. Long-term use of acetaminophen/codeine during pregnancy may cause dependence in the fetus or newborn. Discuss any questions or concerns with your doctor. Acetaminophen/codeine is found in breast milk. If you are or will be breast-feeding while you use acetaminophen/codeine, check with your doctor. Discuss any possible risks to your baby.

When used for long periods of time or at high doses, acetaminophen/codeine may not work as well and may require higher doses to obtain the same effect as when originally taken. This is known as TOLERANCE. Talk with your doctor if acetaminophen/codeine stops working well. Do not take more than prescribed.

Some people who use acetaminophen/codeine for a long time may develop a need to continue taking it. People who take high doses are also at risk. This is known as DEPENDENCE or addiction. If you suddenly stop taking acetaminophen/codeine, you may experience WITHDRAWAL symptoms, including anxiety; diarrhea; fever, runny nose, or sneezing; goose bumps and abnormal skin sensations; nausea; vomiting; pain; rigid muscles; rapid heartbeat; seeing, hearing, or feeling things that are not there; shivering or tremors; sweating; and trouble sleeping.

Possible side effects of acetaminophen/ codeine:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; dizziness; drowsiness; light-headedness; mild stomach pain; nausea; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, throat, or tongue; unusual hoarseness); change in the amount of urine produced; confusion; fainting; fever, chills, or persistent sore throat; mental or mood changes (eg, agitation, anxiety, depression); severe or persistent constipation; severe or persistent dizziness, drowsiness, headache, or light-headedness; shortness of breath; slow, shallow, or difficult breathing; symptoms of liver problems (eg, dark urine, pale stools, persistent loss of appetite, unusual or severe stomach pain, yellowing of the skin or eyes); trouble urinating; unusual bruising or bleeding; unusual tiredness or weakness; vision changes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include bluish skin or nails; cold and clammy skin; coma; decreased urination; fainting; limp muscles; loss of consciousness; nausea or vomiting; pinpoint pupils; seizures; severe dizziness, drowsiness, or light-headedness; slow heartbeat; slow, shallow, or difficult breathing; symptoms of liver problems (eg, dark urine, pale stools, persistent loss of appetite, unusual or severe stomach pain, yellowing of the skin or eyes); unusual bruising or bleeding; unusual sweating or tiredness.

Proper storage of acetaminophen/codeine:

Store acetaminophen/codeine at room temperature, between 68 and 77 degrees F (20 and 25 degrees C), in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep acetaminophen/codeine out of the reach of children and away from pets.

General information:

  • If you have any questions about acetaminophen/codeine, please talk with your doctor, pharmacist, or other health care provider.
  • Acetaminophen/codeine is to be used only by the patient for whom it is prescribed. Do not share it with other people.
  • If your symptoms do not improve or if they become worse, check with your doctor.
  • Check with your pharmacist about how to dispose of unused medicine.

This information should not be used to decide whether or not to take acetaminophen/codeine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about acetaminophen/codeine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to acetaminophen/codeine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using acetaminophen/codeine.

Issue Date: September 3, 2014
Database Edition 14.3.1.003
Copyright © 2014 Wolters Kluwer Health, Inc.

Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using this medicine.

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