8 Tylenol With Codeine Side Effects You Should Know About

Tylenol with Codeine is an oral, prescription-only medication used to treat mild-to-moderate pain. It contains a combination of two medications, acetaminophen (Tylenol) and codeine, that work together for pain relief. The brand-name products — know as Tylenol with Codeine #1, #2, #3, or #4 — are no longer available, but there are still generic versions on the market.

Pain relief with Tylenol with Codeine can be just that: a big relief. But, along with relief, you may also experience side effects. Constipation, drowsiness, and nausea are just a few examples of Tylenol with Codeine side effects.

Tylenol with Codeine side effects at a glance

Tylenol with Codeine contains an opioid, which means it can cause many of the same side effects as other opioids. Some side effects are more common and can be managed from home, while others can be more serious.

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Examples of common Tylenol with Codeine side effects include:

• Drowsiness

• Lightheadedness

• Dizziness

• Itchiness

• Sedation

• Shortness of breath

• Nausea and vomiting

• Constipation

Examples of less common but serious Tylenol with Codeine side effects include:

• Allergic reactions

• Misuse and dependency

• Liver damage

• Serious skin reactions

• Dangerously slowed breathing

Whether you’ve just started taking Tylenol with Codeine or you’ve been taking it for a while, it helps to know what you can do if these side effects occur. Below, we dig deeper into eight of them.

3. Drowsiness

Drowsiness is one of the most common Tylenol with Codeine side effects. This is due to the codeine component, and it’s common with all opioid medications. Drowsiness from Tylenol with Codeine can be worse if you take it with other medications that also cause drowsiness, such as sedatives.

Don’t drive or perform activities that require you to be alert until you know how Tylenol with Codeine affects you. Seek immediate medical attention if you or someone you know experiences severe drowsiness while taking the medication.

4. Dizziness

You may also feel dizzy or lightheaded while taking Tylenol with Codeine. This is because codeine causes your blood vessels to widen, which can make your blood pressure drop. You may notice this side effect when changing positions quickly, like if you go from sitting to standing rapidly.

Dizziness from Tylenol with Codeine can increase the risk of falls, especially in older adults. Take care when changing positions and moving around to avoid falling down or passing out.

Talk to your healthcare provider if you’re experiencing frequent dizziness after starting treatment with Tylenol with Codeine. Keep in mind that other medications and health conditions can make you feel dizzy, too. Your provider can help pinpoint the cause of your dizziness and recommend ways to address it.

5. Constipation

Tylenol with Codeine can cause constipation, which is a typical opioid side effect. Your healthcare provider or pharmacist may suggest an over-the-counter (OTC) laxative to take ahead of time, which can help prevent constipation or make it more manageable if it happens. Your pharmacist can also help you identify any other medications that are making your constipation worse.

It’s also a good idea to incorporate lifestyle changes to manage constipation. These changes include staying active, drinking plenty of fluids, and getting enough fiber in your diet. 

Contact your healthcare provider if your constipation is painful or doesn’t go away with OTC medications. They can help you come up with a plan to resolve it.

6. Nausea and vomiting

You may experience nausea and vomiting when taking Tylenol with Codeine, especially with higher dosages. If you’ve been taking your dose on an empty stomach and you’re experiencing these side effects, try taking the medication with a small meal or snack instead.

If your nausea continues or you start vomiting, speak with your healthcare provider. They may recommend trying an anti-nausea medication. But if you have uncontrolled vomiting, go to the closest emergency department for evaluation and treatment. 

5. Slowed breathing

Opioids, including codeine, can cause dangerously slowed breathing, or respiratory depression. The risk is highest when you first start taking Tylenol with Codeine, if your dosage is increased, or if you’re taking other medications that slow your breathing. Respiratory depression can happen if you take more than the recommended amount of the medication, but it’s also possible with prescribed dosages.

If you or someone you know has difficulty breathing while taking Tylenol with Codeine, call 911 right away. If the risk of respiratory depression concerns you, talk to your pharmacist or healthcare provider about OTC Narcan (naloxone). This can help reverse the medication’s effects in the event of a known or suspected overdose.

6. Misuse and dependency

Tylenol with Codeine has the potential for misuse and dependency. These risks are present even if you take the medication as prescribed. It’s generally recommended to take the lowest effective dosage for the shortest time possible to help manage these risks.

Because Tylenol with Codeine can cause dependency, you may experience withdrawal symptoms if you stop taking it abruptly. This may be more likely to happen the longer you take the medication. Before stopping treatment with Tylenol with Codeine, check with your healthcare provider. They can give you instructions for how to stop taking it safely.

Misusing opioids can have life-threatening consequences. If you notice that you’re having difficulty controlling how much Tylenol with Codeine you’re taking, you develop cravings for the medication, or your usual dosage isn’t enough, contact your healthcare provider right away.

If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-HELP (4357) to learn about resources in your area.

7. Liver damage

The acetaminophen component of Tylenol with Codeine can be hard on your liver. If you take too much acetaminophen, liver damage is possible.

Each Tylenol with Codeine pill contains 300 mg of acetaminophen with varying amounts of codeine. For most adults, 4,000 mg is the maximum amount of acetaminophen that should be taken within a 24-hour period. But some people may be instructed to take a lower amount, including those with preexisting liver problems.

You can help minimize the risk of liver damage by not exceeding your prescribed dosage of Tylenol with Codeine. And be mindful of how much acetaminophen you take in a day from additional sources, including OTC products. It’s also a good idea to avoid or minimize alcohol intake while taking the medication.

Contact your healthcare provider immediately if you notice the following symptoms, which may suggest liver damage:

• Loss of appetite or unexplained weight loss

• Abdominal pain or swelling

• Dark-colored urine

• Severe nausea or vomiting

• Yellowing of your skin or eyes (jaundice)

8. Severe skin reactions

In rare cases, the acetaminophen in Tylenol with Codeine can cause very serious skin reactions. These include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis (AGEP). If left untreated, these skin reactions can be fatal.

Serious skin reactions can happen any time while taking the medication, but are mostly likely in the first few weeks. Watch out for flu-like symptoms followed by a skin rash. If this happens, go to the nearest emergency room.

Good to know: Codeine can also cause itchy skin that’s not related to a severe skin reaction. This itchy feeling is usually mild. But if it’s accompanied by hives or difficulty breathing, you may be having an allergic reaction. If this happens, get medical help right away.

When should you contact your healthcare provider about Tylenol with Codeine side effects?

Most Tylenol with codeine side effects, including constipation and dizziness, can be managed at home. But speak with your healthcare provider if you have any side effects that are bothersome, don’t go away, or become severe.

Seek immediate medical attention if you experience severe vomiting or symptoms of serious skin reactions. And make sure your friends and family know how to spot and respond to dangerously slowed breathing or other signs of an opioid overdose.

If you want to stop taking Tylenol with Codeine, talk to your healthcare provider first. They can help you stop taking it safely, in a way that will minimize the risk of withdrawal symptoms.

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Written by:

Brian Leonard, PharmD, BCACP, BCGP

Brian Leonard earned his doctorate in pharmacy from the University of Florida College of Pharmacy and is board certified in Ambulatory Care and Geriatric Pharmacy.

Edited 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.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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