Tylenol #3 Just as Good as Vicodin for Pain

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Vicodin (hydrocodone/acetaminophen) is the number one drug prescribed in this country for any reason. The myth around vicodin is that it works better than Tylenol #3 (Tylenol with codeine). But remember that Vicodin will be harder to get now that the DEA is reclassifying hydrocodone-containing drugs (Vicodin, Norco, Lortab) from schedule III to schedule II drugs.

Well, Tylenol #3 (30 mg/300 mg) worked just as well for pain compared to Vicodin 5 mg/500 mg in patients discharged from the emergency room. Both are currently schedule III narcotics, but that will change for Vicodin.

In this trial patients with acute extremity pain were discharged home from the emergency room with a 3-day supply of Vicodin (hydrocodone/acetaminophen 5 mg /500 mg) or Tylenol #3 (codeine/acetaminophen 30 mg/300 mg).

Despite the popular belief that Vicodin is superior, both medications decreased pain scores by approximately 50%, with both Vicodin and Tylenol #3 performing the same. There were also no clinically or statistically important differences in side-effect profiles or patient satisfaction. If the DEA reclassifies Vicodin (hydrocodone/acetaminophen) as a schedule II narcotic, Tylenol #3 (codeine/acetaminophen) may be a reasonable substitute as it will remain schedule III.


Dr O.

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