What’s best for pain relief? Tylenol with codeine, hydrocodone, or oxycodone

Tylenol | Tylenol with codeine | Tylenol with hydrocodone | Tylenol with oxycodone | Dosage & storage | Serious side effects

Recovering from an injury, surgery, long-term illness, or other serious health condition can be painful, to say the least. Natural remedies and over-the-counter medicine sometimes just don’t cut it. In that case, your doctor may prescribe Tylenol with codeine, hydrocodone, or oxycodone to alleviate the pain you’re experiencing. Before taking these medications, which are all a type of narcotic, learn about each acetaminophen combination. Use the table below for quick data retrieval or continue reading to find out what each narcotic does, why it may be prescribed to you, and the side effects you may experience while taking these prescription-strength painkillers.

Tylenol (acetaminophen)

Tylenol, or acetaminophen (pronounced as “a-SEET-a-MIN-o-fen”), is an analgesic medicine that treats mild to moderate pain and reduces fever. It’s available over the counter and is commonly used to treat headaches, back pain, and muscle aches. It is generally safe to take, however, rare side effects may include a severe skin reaction called Stevens-Johnson syndrome, skin swelling (angioedema), hives, shortness of breath, or dizziness. Taking too much Tylenol can damage your liver or even cause a fatal overdose. Pain in your upper stomach, loss of appetite, dark urine, or jaundice may require immediate medical attention.

RELATED: What is Tylenol?

Tylenol with codeine

Codeine (pronounced as “KOE-deen”) is a part of the opioid drug class. Codeine works by changing the way the brain and nervous system respond to pain, while acetaminophen changes the way the body senses pain.

Acetaminophen-codeine generally comes in the form of immediate-release oral tablets. Some of the more popular brands can be found in the form of Tylenol 3 or Tylenol 4. Tylenol 3 contains 300 mg of acetaminophen mixed with 30 mg of codeine. Tylenol 4 has 300 mg of acetaminophen and 60 mg of codeine. These drugs are only available with a prescription from your doctor.

Why it’s prescribed

The combination of acetaminophen and codeine is best for mild to moderate short-term pain, as a result of a recent injury or surgery. For example, a doctor may prescribe a mixture of acetaminophen and codeine phosphate for those who are undergoing a tonsillectomy, adenoid removal, or hand surgery. It’s sometimes prescribed to treat coughing too. Opioids are believed to treat coughing by suppressing the part of the brain responsible for generating the cough mechanism (1). More recent studies have not shown the benefit of opioids and coughing that older studies have.

Side effects of Tylenol with codeine

Common side effects of acetaminophen with codeine include:

• Dizziness
• Lightheadedness
• Extreme drowsiness
• Breathing problems, like shortness of breath or noisy breathing
• Constipation
• Nausea and vomiting
• Sweating

While a mixture of acetaminophen with codeine is great for relieving short-term pain, it’s not recommended for long-term use as there’s an increased risk of serious side effects. Call your healthcare provider for medical advice if you experience pain in your upper stomach, generate pinpoint pupils, have a loss of appetite, or notice a yellowing on your skin or in your eyes while taking this narcotic.

When high-dose codeine is combined with alcohol, it can cause respiratory issues or, in extreme cases, death. Also, if you mix acetaminophen-codeine with antidepressants, you may develop serotonin syndrome, which can change how your brain, muscles, and digestive system work. 

Related: What is Codeine 

Tylenol with hydrocodone

Acetaminophen and hydrocodone (pronounced as “hye-droh-KOH-done”) contain opioids and non-opioid pain relievers. This prescription drug targets your brain to change how your body feels and responds to pain.

This combination typically comes in the form of immediate-release tablets, but it’s also available in elixirs and solutions. Short-acting hydrocodone-acetaminophen can be prescribed in a variety of doses, with the hydrocodone component ranging between 2.5 and 10 mg, combined with 300 or 325 mg of acetaminophen. The dosage prescribed to you will depend on your medical condition and response to treatment. 

Some brand names you might be familiar with are Vicodin, Norco, and Zydone. There’s a new, long-acting form of hydrocodone without the acetaminophen component that was recently approved by the Federal Drug Administration (FDA), called Zohydro ER. However, you won’t need to take Zohydro ER if you have pain that’s not forecasted to last long.

Why it’s prescribed

Doctors might prescribe a mix of acetaminophen and hydrocodone to relieve moderate short-term pain. This narcotic is typically used to treat fibromyalgia, pain in your lower back, and muscle pain. It can also be taken to treat arthritis.

Side effects of Tylenol with hydrocodone

Common side effects of acetaminophen with hydrocodone include:

• Dizziness
• Drowsiness
• Constipation
• Nausea
• Stomach pain
• Loss of appetite
• Itching

Related: What is hydrocodone

Tylenol with oxycodone

Oxycodone (pronounced as “OX-ee-KOH-done”) also belongs to the opioid family of drugs. Similar to hydrocodone, oxycodone works in the brain to change how your body feels and reacts to pain. It doesn’t decrease pain, rather it increases your tolerance to pain. 

Oxycodone-acetaminophen is available by prescription only. Percocet and Roxicet are two of the more popular brand names in this category of drugs. Pure oxycodone is available in a formulation called Oxycontin, which is a controlled-release formulation, or Roxicodone, an immediate-release formulation.

Why it’s prescribed

Oxycodone-acetaminophen is often prescribed to treat moderate to severe pain around the clock. Used as pain medicine and a cough suppressant, this painkiller can also be used to treat head injuries and other severe pain from accidents, recent surgeries, or chronic pain.

Side effects of Tylenol with oxycodone

Common side effects of acetaminophen with oxycodone include:

• Dizziness
• Drowsiness
• Fatigue
• Nausea
• Vomiting
• Dry mouth
• constipation

You may also experience withdrawal symptoms once you stop taking acetaminophen and oxycodone. Because oxycodone is a habit-forming drug, read the prescription label carefully and ask your doctor any questions you have before taking the medication for long-term use.

Related: What is oxycodone

Standard dosage & storage of Tylenol with codeine, hydrocodone, and oxycodone

The dose of these common painkillers will vary by patient depending on the amount of pain a patient is in, their age, weight, drug history, and other factors. Your doctor may adjust your dose depending on your pain and current condition. 

Always read the medication guide before taking any prescription drugs. If you miss a dose of medicine, take it as soon as possible, but do not ‘double up’ on the dose. If it’s almost time for your next dose, skip the missed dose and refer back to your regular dosing schedule.

To ensure each drug is safely secure and not altered, you should store all medications at room temperature (68 degrees to 77 degrees Fahrenheit). Store away from moisture, heat, and extreme temperatures. Keep all drugs out of the reach of children.

Serious side effects of codeine, hydrocodone, and oxycodone

In general, codeine, hydrocodone, and oxycodone may all cause shallow breathing, sleepiness, dizziness, constipation, nausea, and vomiting. All three drugs can cause life-threatening consequences if used improperly. Excessive use of these drugs can cause urinary retention, infections, liver toxicity, and liver damage. Not to mention, long-term use can lead to drug abuse and dependence and may cause you to experience withdrawal symptoms when you stop taking your medication.

Talk to a healthcare provider for a complete list of possible adverse effects and drug interactions. Side effects may be more likely to occur depending on your health condition. For example, breathing problems are more likely among older adults who are taking these pain medications for the first time. 

Nearly everyone who takes these medications for longer than a few months will become physically dependent on them, meaning they will require higher and higher doses to achieve the same pain relief. For this reason, long-acting opioids are recommended if someone is going to need chronic pain relief. Physical dependence will not be an issue for short-term (a few weeks or less) use. These medications should never be crushed, snorted, or injected in an improper manner. This is common when someone is using these medications in an abusive manner (in other words, to “get high”). Signs of overdose include pinpoint pupils, lethargy (difficult to arouse), low blood pressure, and shallow breathing. Call 911 immediately if your loved one has these symptoms. The EMS personnel are likely to give a medication called Narcan (naloxone) in this situation, which will reverse the effects of the opioids.

Who should not take Tylenol with codeine, hydrocodone, or oxycodone?

If you fall into one or more of the following categories, talk to your doctor before taking a combination of acetaminophen and codeine, hydrocodone, or oxycodone:

• You have asthma or breathing problems, like sleep apnea
• You’re pregnant or breastfeeding (use of opioids may interfere with a mother’s breast milk)
• You have kidney disease or liver disease
• You’re taking antidepressants, blood pressure medicine, or other medications
• You’ve taken an MAO inhibitor, like linezolid, phenelzine, tranylcypromine sulfate, selegiline, or isocarboxazid, in the last 14 days
• You operate heavy machinery for a living

Codeine, hydrocodone, and oxycodone are Schedule II narcotics, meaning they have a high potential for abuse. Consult your doctor or pharmacist about the risk of psychological and physical dependence on narcotics if you’re unsure whether these prescription drugs are right for you.

Legal and regulatory issues with Tylenol with codeine, hydrocodone, or oxycodone

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Frequently asked questions about Tylenol with codeine, hydrocodone, or oxycodone

How strong is Tylenol 3? / How strong is Tylenol 4?

Tylenol #3 contains acetaminophen plus 30 mg of codeine, while Tylenol #4 contains the same amount of acetaminophen, but with 60 mg of codeine. Tylenol #3 would be considered a moderate dose of codeine, while Tylenol #4 would be a large dose of codeine. Keep in mind, that there are two lower doses of Tylenol with codeine available: Tylenol #1 has 7.5mg of codeine, and Tylenol #2 has 15 mg of codeine, to put things in perspective.

What is the difference between Tylenol 3 and Tylenol 4?

Tylenol #3 contains acetaminophen plus 30 mg of codeine, while Tylenol #4 contains the same amount of acetaminophen, but with 60 mg of codeine. So, Tylenol #4 has double the amount of opioid codeine in it.

Can I take Tylenol with codeine with other medications?

The answer is, it depends. You would not want to combine this with other medications containing acetaminophen, such as OTC cold and flu medications. You would also not want to combine this medication with other painkillers, such as oxycontin, fentanyl patch, suboxone, or methadone. As discussed above, you also would want to be careful taking Tylenol-codeine with MAO inhibitors and certain antidepressant medications. Always consult your doctor prior to taking any opioids.

Is Tylenol 3 addictive?

Tylenol # 3 does have the potential to become addictive. Although this is a relatively weak opioid compared to others, such as fentanyl, Dilaudid (hydromorphone), and morphine, Tylenol #3 can cause the same physical and psychological dependency if taken for long enough and at high enough doses. This medication is only intended for short-term use for acute (recent and short-lived) pain.