Tylenol #3 Uses, Side Effects, Precautions and More

If you’re experiencing pain and other medications aren’t working, your healthcare provider may prescribe a medication like Tylenol #3 to help. Tylenol #3 (acetaminophen/codeine) is an oral tablet that’s FDA-approved to treat mild to moderate pain. It contains two different medications that work together to treat pain.

But what makes Tylenol #3 different from other pain-relieving medications? And what side effects and precautions should you know about before taking it? Keep reading to learn more.

What is Tylenol #3?

Tylenol #3 is an oral tablet that contains two different medications: acetaminophen and codeine. Each tablet contains 300 mg of acetaminophen and either 15 mg, 30 mg, or 60 mg of codeine. It’s also available as an oral solution (liquid taken by mouth).

Acetaminophen (Tylenol) is a common medication used to treat mild pain and fever. How it works for pain isn’t fully understood. Codeine is an opioid that’s broken down into morphine in your body. It works by binding to targets in the brain involved in pain transmission. Together, these two medications work in different ways to relieve mild to moderate pain.

Your healthcare provider will determine if Tylenol #3 is an appropriate treatment option for you. 

Tylenol #3 side effects

Like many medications, Tylenol #3 can cause side effects. Some are more mild and bothersome, while others can be more serious. 

For example, the codeine in Tylenol #3 can make you feel drowsy, lightheaded, and dizzy. These effects can be worsened by alcohol and other medications that cause drowsiness. Because of this, avoid driving or operating machinery until you know how the medication affects you. 

Opioid medications like codeine also cause constipation. That’s because they slow down your intestines. This can happen even if you’re taking it for a short amount of time. Talk to your healthcare provider about ways to prevent or relieve constipation from treatment.

Other common side effects include:

• Shortness of breath

• Nausea and vomiting

• Sweating

Tylenol #3 can also cause more serious side effects. Examples of these include:

• Serious skin reactions

• Severe allergic reactions

• Greater risk of seizures in people with seizure disorders

• Severe low blood pressure

Get emergency medical attention if you start experiencing symptoms like having difficulty breathing, chest pain that won’t go away, or swelling of your tongue, face, or throat.

Tylenol #3 precautions 

Tylenol #3 has several boxed warnings — the FDA’s most serious warning for medications. Most of these are due to the serious risks associated with taking codeine.

• Risk of physical and mental dependence. Codeine is a controlled substance. This means it has a risk of physical and mental dependence. Because of this, you’ll likely be advised to take the lowest effective dose for the shortest time possible. You should also follow your healthcare provider’s instructions for discontinuing the medication to lessen potential withdrawal symptoms.

• Withdrawal symptoms in newborns. Long-term use of Tylenol #3 during pregnancy can result in your unborn baby developing physical dependence. This can cause withdrawal symptoms after birth. If you become pregnant while taking Tylenol #3, talk to your healthcare provider about your treatment options. 

• Tolerance. It’s also possible to develop tolerance to the medication’s effects. This is when you start needing higher doses to get similar relief. But it’s important not to take more medication than prescribed. Talk to your healthcare provider if your current prescription isn’t working for you.

• Slowed breathing rate. Codeine can also slow your breathing rate down too much. This can be life-threatening and potentially fatal. This risk is higher in older people and those with lung problems like asthma. Taking Tylenol #3 with alcohol or other medications that slow down your breathing (e.g., benzodiazepines) can also raise this risk.

• Overdose in children. Children may accidentally take Tylenol #3 tablets. Even one dose could result in a fatal overdose. That’s why it’s important to keep your medication secure and away from children, like in a medication lockbox. 

• Liver damage. Tylenol #3 contains acetaminophen, which can cause liver damage. Taking more than 3,000 to 4,000 mg of acetaminophen in 24 hours can raise this risk. Avoid taking other acetaminophen-containing products while you’re on Tylenol #3. Alcohol can also raise the risk of liver damage.

• Serious drug interactions. Tylenol #3 has a number of serious drug interactions. For example, certain medications can raise morphine levels (from codeine) in your body. It’s important to give your healthcare provider and pharmacist a full list of medications you’re taking to prevent serious interactions.

How is Tylenol #3 different from Vicodin?

Tylenol #3 and Vicodin (hydrocodone/acetaminophen) are both pain medications. But there are some notable differences. Based on these differences, your healthcare provider will determine which medication is right for you.

Vicodin and Tylenol #3 are both controlled substances — but they’re categorized differently. Vicodin is a Schedule II controlled substance. This means it has a high potential for abuse and dependence. It’s also more tightly regulated. 

Tylenol #3 is a Schedule III controlled substance. This means it has a lower abuse potential than Vicodin. But it can still cause physical and mental dependence.

Tylenol #3 and Vicodin both contain fixed doses of acetaminophen. They both also contain opioids, but Vicodin contains hydrocodone instead of codeine. More on the differences next.

Codeine vs. hydrocodone

Codeine is typically used to treat mild to moderate pain. It’s a prodrug, which means it’s turned into its active form (morphine) inside your body. How your body converts codeine into morphine can depend on your genetics. 

For example, some people convert codeine to morphine too slowly. In this case, codeine may not work as well for them. But others convert it too quickly. This can result in too much morphine, which can be dangerous. So, it’s important to monitor yourself for side effects like slowed breathing since you may not know how you’ll respond to the medication.

Hydrocodone is typically used to treat moderate to severe pain. It’s also a prodrug, but it’s converted into hydromorphone in your body. Like codeine, your genetics can influence how quickly you convert hydrocodone into its active form and how well it’ll work for you.

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Written by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Edited by:

Samvida Patel, MNSP, INHC

Samvida Patel, MNSP, INHC, is a health editor at GoodRx. She is a nutritionist and integrative nutrition health coach with over 8 years of experience in health communications.

Reviewed by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

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