Healthy Living

Tylenol-Codeine Side Effects

Tylenol-codeine may cause certain side effects. Although not all side effects occur, some may require immediate medical attention if they do.


Tylenol (acetaminophen) and codeine are used for the treatment of mild to moderate pain. Aside from pain, acetaminophen is also used to reduce fever. Tylenol is not a habit-forming drug. However, when this drug is taken in large dosages, serious liver damage including other negative side effects may occur.

Codeine is a narcotic analgesic that acts on the central nervous system to ease pain. Unlike Tylenol, codeine may become habit-forming when used for a long period of time. This drug causes both physical and mental dependence. However, when narcotics are taken for chronic pain relief, mental dependence is unlikely to occur. When codeine is suddenly stopped, it may lead to withdrawal symptoms (physical dependence). To help prevent severe withdrawal symptoms, the dose should be gradually reduced over a period of time before stopping its usage.

This drug is only available under a restricted program called the Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS) in the following forms:

  • Tablet
  • Elixir
  • Solution

Brand Names and Other Names

  • Tylenol with Codeine (#3, #4)
  • Capital and Codeine
  • Fioricet with Codeine (acetaminophen, caffeine, codeine, butalbital)
  • APAP and Codeine

Side Effects of Tylenol-Codeine

Tylenol-codeine may cause certain side effects. Although not all side effects occur, some may require immediate medical attention if they do. If you experience any of the following side effects, make sure to check with your healthcare provider:

  • Drowsiness
  • Lightheadedness
  • Calm or relaxed feeling
  • Dizziness
  • Unusual weakness or tiredness
  • Hoarseness
  • Sore throat
  • Bleeding gums
  • Cough
  • Difficulty swallowing
  • Difficulty breathing
  • Chest tightness
  • Mouth sores or ulcers
  • White spots in the mouth or on the lips
  • Swelling of the face, eyes, lips, or tongue
  • Blood in stool or urine
  • Black stool
  • Unusual bruising or bleeding
  • Fever with or without chills
  • Rapid heartbeat
  • Skin rash
  • Itching
  • Hives
  • Tiny red spots on the skin
  • Difficult or painful urination
  • Lower side pain
  • Lower back pain
  • Blue or pale lips, skin, or fingernails

Side effects that do not usually require immediate medical attention:

Overdose Symptoms

Seek immediate medical help if you experience any of the following overdose symptoms:

  • Constricted pupils
  • Headache
  • Nausea
  • Loss of consciousness
  • Seizure
  • Vomiting with or without blood
  • Stomach pain
  • Dark-colored urine
  • Cloudy or bloody urine
  • Light-colored stools
  • Jaundice (yellowing of the skin and eyes)
  • Chills
  • Loss of appetite
  • Increased sweating
  • Bad breath

Tylenol-codeine may also cause other side effects. Consult your doctor if you experience certain side effects while on this medication. 

Drug Interactions

Drug interactions may occur when certain medications are used at the time of consuming certain types of food. An example would be using tobacco and alcohol along with certain medications. 

Also, inform your doctor if you are using any of the following medications:

  • Antibiotics
  • Antifungals
  • Blood pressure medications
  • Medications for heart disease
  • Anticonvulsants or anti-seizure medications
  • Medications for hepatitis C or HIV
  • Bronchodilators and other medications for asthma and COPD
  • Cold or allergy medications
  • Diuretics (water pills)
  • Medications for an overactive bladder, irritable bowel syndrome (IBS), and motion sickness
  • Sedatives (e.g., diazepam, lorazepam, alprazolam)
  • Mood stabilizers
  • Antidepressants
  • Other narcotic drugs (prescription cough medications or opioids)

Your healthcare provider may need you to undergo certain laboratory tests to check on how you respond to Tylenol (acetaminophen) and codeine. Before having these tests, particularly those with methylene blue, inform your doctor and laboratory personnel that you are currently using Tylenol and codeine. 

Tylenol-codeine is a controlled substance. Make sure not to let other people take your medicine. It is also important to keep a list of all your prescription and over-the-counter medications, including vitamins and dietary supplements. Bring this list whenever you see a doctor or if you are advised for hospital admission. This list may become handy and could be helpful during medical emergencies. 

Other Medical Conditions

The use of this medication may be affected by the presence of other health problems, which include:

  • Sulfite sensitivity
  • Acute or severe asthma
  • Respiratory depression (hypoventilation)
  • A combination of Tylenol and codeine that has sodium metabisulfite content
  • An ongoing or history of brain tumor and respiratory problems, such as sleep apnea, chronic obstructive pulmonary disease (COPD), hypoxia, and cor pulmonale
  • Central nervous system (CNS) depression
  • Increased pressure in the head
  • Head injuries
  • Alcohol or drug dependence
  • A history of mental illness
  • Hypothyroidism
  • Addison’s disease
  • A history of an enlarged prostate
  • Difficulty urinating
  • Bowel obstruction
  • Liver disease
  • Kidney disease
  • Obesity
  • Patients who require tonsil and adenoid surgery
  • Weakened physical condition

Other information you should know

If your pain gets worse, does not go away, or if you have developed a different type of pain, inform your healthcare provider right away. You may develop drug or medication tolerance, which means that a higher dose of the drug is required to achieve pain relief. If you take a certain medication for a longer period of time, drug tolerance is usually an expected outcome.

A severe reaction may also develop if you suddenly stop taking this medicine. Although your body gets used to this medicine, it does not necessarily mean that you are dependent on it. Addiction is usually related to the behavior of using or getting a type of drug for non-medical reasons. If your condition involves chronic pain, you have a medical reason to take pain medications, and your healthcare provider will tell you the correct dosage of your medicine. You will be given a schedule for tapering off your medication if your doctor thinks that you no longer need it. Slowly decreasing the dose until you completely stop taking the medicine will help avoid side effects.

This medicine should not be used with other types of medications that contain acetaminophen. Carefully read the medicine labels and ask your healthcare provider or pharmacist if you have questions. If you have taken too much acetaminophen, seek emergency medical help since excessive acetaminophen intake can cause serious liver damage. 


Acetaminophen and Codeine: MedlinePlus Drug Information. (2018).

Tylenol-Codeine (Acetaminophen and Codeine) Patient Information: Side Effects and Drug Images at RxList. (2018)

Acetaminophen-Codeine. (2018).