| Brand Name |
Tylenol 3 |
| Generic Name |
Acetaminophen and Codeine Phosphate |
| INN Name |
Paracetamol and Codeine |
| Drug Class |
Analgesic |
| Drug Subclass |
Opioid Analgesic Combination |
| Formulation |
Tablet |
| Strength |
Acetaminophen 300 mg, Codeine Phosphate 30 mg |
| Package Size |
Varies (e.g., 100 tablets) |
| Route of Administration |
Oral |
| Prescription Status |
Rx
|
| DIN Number |
01963958 (example for Canada, verify with Health Canada) |
| NDC Code |
Varies by manufacturer (e.g., 0045-0513-70 in US, verify with FDA) |
| ATC Code |
N02AJ06 (Paracetamol and Codeine combination) |
| Manufacturer |
Johnson & Johnson (McNeil Consumer Healthcare division, varies by region) |
| Mechanism of Action |
Acetaminophen inhibits prostaglandin synthesis in the central nervous system, reducing pain and fever. Codeine, an opioid agonist, binds to mu-opioid receptors in the brain and spinal cord, altering pain perception and providing analgesia. |
| Pharmacokinetics |
absorption: Acetaminophen: Rapidly absorbed from the gastrointestinal tract, peak plasma concentration in 0.5-2 hours. Codeine: Well absorbed orally, peak effect in 1-2 hours.
distribution: Acetaminophen: Widely distributed, minimal protein binding. Codeine: Crosses blood-brain barrier, moderate protein binding.
metabolism: Acetaminophen: Primarily hepatic via glucuronidation and sulfation, minor CYP2E1 pathway to toxic metabolite NAPQI. Codeine: Hepatic via CYP2D6 to morphine (active metabolite).
excretion: Acetaminophen: Primarily renal as conjugates. Codeine: Renal, with metabolites including morphine. |
| Pharmacodynamics |
Acetaminophen provides antipyretic and analgesic effects through central inhibition of cyclooxygenase (COX). Codeine exerts opioid effects, depressing the central nervous system, reducing pain perception, and potentially causing sedation and respiratory depression. |
| Indications |
Relief of mild to moderate pain (e.g., dental pain, postoperative pain, musculoskeletal pain)
Management of pain not responsive to non-opioid analgesics alone |
| Contraindications |
Hypersensitivity to acetaminophen, codeine, or any component
Severe hepatic impairment or active liver disease (risk of acetaminophen toxicity)
Respiratory depression or severe asthma (codeine risk)
Children under 12 years (codeine risk of ultra-rapid metabolism to morphine)
Acute alcohol intoxication or concurrent CNS depressants |
| Warnings |
Risk of acetaminophen hepatotoxicity with doses exceeding 4 g/day
Risk of respiratory depression with codeine, especially in ultra-rapid CYP2D6 metabolizers
Potential for dependence and abuse with codeine (opioid component)
Avoid alcohol due to increased risk of liver damage and CNS depression |
| Side Effects |
common: Nausea,Vomiting,Constipation (codeine),Drowsiness,Dizziness
serious: Hepatotoxicity (acetaminophen overdose),Respiratory depression (codeine),Allergic reactions,Dependence or withdrawal (codeine) |
| Adult Dosage |
1-2 tablets every 4-6 hours as needed for pain, not to exceed 4 g acetaminophen per day (approximately 12 tablets of Tylenol 3). |
| Pediatric Dosage |
Not recommended for children under 12 years due to risk of respiratory depression from codeine. For adolescents 12-18 years, use lowest effective dose with caution and monitor for adverse effects. |
| Geriatric Dosage |
Use with caution; start at lower dose (e.g., 1 tablet every 6 hours) due to increased sensitivity to codeine’s sedative and respiratory effects and potential for reduced hepatic/renal function. |
| Typical Duration |
Short-term use (e.g., 3-7 days) for acute pain; prolonged use increases risk of dependence (codeine) and liver damage (acetaminophen). |
| Storage |
Store at room temperature (15-25°C), away from moisture and light, in a secure location to prevent misuse (due to codeine content). |
| Pregnancy Category |
C (US FDA) - Risk cannot be ruled out; codeine may cause neonatal withdrawal if used near delivery, acetaminophen generally considered safer but avoid high doses. |
| Breastfeeding Notes |
Codeine is contraindicated during breastfeeding due to risk of respiratory depression in infants, especially with maternal ultra-rapid CYP2D6 metabolism. Acetaminophen is generally considered compatible with breastfeeding at therapeutic doses. |
| Herbal Alternatives |
Western Herbal Medicine: Turmeric (Curcuma longa): Anti-inflammatory and analgesic properties for mild pain, often used as curcumin supplements or in teas.,Willow Bark (Salix alba): Contains salicin, a precursor to aspirin, traditionally used for pain and inflammation.
Traditional Chinese Medicine (TCM): Corydalis (Yan Hu Suo): Used for pain relief, often in formulas for musculoskeletal pain, believed to move Qi and blood.,White Peony Root (Bai Shao): Often combined with other herbs for pain and to nourish blood, used in chronic pain conditions.
Ayurvedic Medicine: Boswellia (Shallaki): Resin used for anti-inflammatory and analgesic effects, often for joint and musculoskeletal pain.,Ashwagandha (Withania somnifera): Adaptogen with potential pain-relieving and anti-inflammatory effects, used for stress-related pain. |
| Naturopathic Notes |
Tylenol 3 combines acetaminophen, which is effective for pain and fever but carries significant risk of hepatotoxicity at high doses, with codeine, an opioid that poses risks of dependence and respiratory depression. Naturopathic approaches prioritize non-pharmacologic pain management strategies such as acupuncture, physical therapy, and dietary interventions (e.g., anti-inflammatory diets rich in omega-3s). Herbal alternatives like turmeric and willow bark may be considered for mild to moderate pain, though efficacy varies and evidence is less robust than for pharmaceuticals. For patients using Tylenol 3, support liver health with nutrients like N-acetylcysteine (NAC) or milk thistle under guidance, and monitor for signs of dependency on codeine. Encourage tapering and transitioning to safer alternatives when possible, addressing underlying causes of pain through lifestyle and holistic therapies. |