WARNING

The risks of taking acetaminophen and codeine include:

• Respiratory Depression: Codeine can slow down breathing, which can be dangerous, especially in high doses or when combined with other depressants like alcohol.
• Liver Damage: Excessive use of acetaminophen can lead to severe liver damage or failure.
• Constipation: Codeine often causes constipation, which can be uncomfortable and require management.
• Dependence and Withdrawal: Long-term use of codeine can lead to physical dependence and withdrawal symptoms if the medication is stopped suddenly.
• Allergic Reactions: Severe allergic reactions, including rash, swelling, or difficulty breathing, can occur.
• Drowsiness and Dizziness: Both acetaminophen and codeine can cause drowsiness, dizziness, or impaired coordination, increasing the risk of accidents.
• Overdose Risk: Taking too much of the medication can lead to overdose, with symptoms including extreme drowsiness, slow breathing, or loss of consciousness.

Always use this medication as prescribed and be aware of these risks.

Why is this medication prescribed?

Acetaminophen and Codeine is a combination medication used to relieve moderate to severe pain. Acetaminophen (Tylenol) is a non-opioid pain reliever and fever reducer. It works by inhibiting the production of certain chemicals in the brain that cause pain and fever. Codeine is an opioid (narcotic) pain reliever. It works by altering the way the brain and nervous system respond to pain. This combination is typically prescribed when other pain relievers, like non-opioid medications (e.g., ibuprofen or acetaminophen alone), are not sufficient. In some cases, codeine is also used to suppress cough, although this use has become less common due to concerns about side effects.

How should this medicine be used?

Here’s a general overview of how it’s used:

• Dosage: Follow your doctor’s instructions carefully. The dosage depends on the severity of your pain and your medical history. It’s usually taken every 4 to 6 hours as needed for pain, but not more frequently than prescribed.
• Administration: Take the medication by mouth with or without food. If you experience nausea, taking it with food might help.
• Do Not Exceed Dosage: Be careful not to exceed the prescribed dose, particularly with acetaminophen, as taking too much can lead to liver damage.
• Avoid Alcohol: Do not consume alcohol while taking this medication, as it increases the risk of liver damage from acetaminophen and can enhance the sedative effects of codeine.
• Risk of Addiction: Codeine is habit-forming, so use it exactly as prescribed. Do not take larger doses, take it more often, or use it for a longer time than prescribed.
• Missed Dose: If you miss a dose and are using the medication on a regular schedule, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose. Do not double up to make up for a missed dose.
• Storage: Store the medication at room temperature, away from moisture and heat. Keep it out of reach of children and pets.
• Disposal: Dispose of unused or expired medication properly, following the guidelines provided by your pharmacist or local waste disposal company. Do not flush the medication down the toilet or pour it into a drain unless instructed.

Always follow your doctor’s instructions and consult them if you have any questions or experience any side effects.

Other uses for this medicine

• Cough Relief: Codeine, as an opioid, has cough suppressant properties and may sometimes be used to treat severe cough, though this is less common due to the risk of dependence and side effects.
• Post-Surgical Pain: It is commonly prescribed after surgery to manage pain when non-opioid pain relievers are insufficient.

What special precautions should I follow?

When using acetaminophen and codeine, certain precautions are necessary to minimize risks:

• Allergies: Inform your doctor if you have any allergies to acetaminophen, codeine, or other opioids, or if you have had allergic reactions to other medications.
• Medical History: Disclose any history of liver disease, kidney disease, breathing problems (e.g., asthma, sleep apnea), head injuries, brain disorders, or mental/mood disorders (e.g., depression, anxiety).
• Pregnancy and Breastfeeding: This medication should be used with caution during pregnancy and breastfeeding, as codeine can pass into breast milk and may harm a nursing infant.
• Interactions with Other Medications: Provide a full list of medications, supplements, and herbal products you are taking to your doctor, as acetaminophen and codeine can interact with other drugs, particularly other pain relievers, sedatives, antidepressants, and alcohol.
• Avoid Alcohol: Do not drink alcohol while taking this medication, as it can increase the risk of liver damage and enhance the sedative effects of codeine, leading to dangerous side effects.
• Operating Machinery: Since codeine can cause drowsiness and dizziness, avoid driving or operating heavy machinery until you know how the medication affects you.
• Signs of Overdose: Be aware of symptoms of overdose, such as extreme drowsiness, slow or difficult breathing, or loss of consciousness, and seek emergency medical help if they occur.
• Watch for Liver Damage: Acetaminophen in high doses can cause liver damage. Make sure you’re not taking other medications that contain acetaminophen to avoid exceeding the daily limit.
• Dependence and Tolerance: Long-term use can lead to tolerance, meaning higher doses are needed to achieve the same effect, and dependence, which means withdrawal symptoms may occur if you stop taking the medication. Use the lowest effective dose for the shortest duration possible.

Always follow your healthcare provider’s instructions and report any unusual or severe side effects immediately.

What special dietary instructions should I follow?

• General Diet: There are no specific dietary restrictions while taking acetaminophen and codeine. However, it’s important to stay hydrated and eat a balanced diet.
• Avoid Alcohol: Do not consume alcohol, as it can increase the risk of serious side effects, such as liver damage and respiratory depression.

What should I do if I forget a dose?

• Take the Missed Dose: If you remember shortly after the scheduled time, take the missed dose as soon as you remember.
• Skip if Close to Next Dose: If it’s almost time for your next dose, skip the missed dose. Do not double up to make up for the missed dose, as this could increase the risk of side effects.
• Resume Regular Schedule: Continue with your regular dosing schedule after the missed dose.

What side effects can this medication cause?

Acetaminophen and codeine can cause a range of side effects, some of which may require medical attention. These side effects can be divided into common, less common, and serious categories.

Common Side Effects: These side effects are usually mild and may go away as your body adjusts to the medication:

• Drowsiness or Dizziness
• Nausea or Vomiting
• Constipation
• Lightheadedness
• Headache
• Mild Itching or Rash
• Sweating

Less Common Side Effects: These side effects occur less frequently but may still be experienced:

• Dry Mouth
• Blurry Vision
• Mood Changes (e.g., anxiety, confusion)
• Urinary Retention
• Loss of Appetite
• Tiredness or Weakness
• Difficulty Sleeping

Serious Side Effects: These side effects are less common but require immediate medical attention:

• Respiratory Depression: Codeine can slow your breathing, which can be dangerous, especially at higher doses.
• Liver Damage: High doses of acetaminophen (exceeding recommended limits) can cause liver damage. It’s important to monitor your intake of acetaminophen from all sources.
• Allergic Reactions: Some people may experience severe allergic reactions, including rash, itching, swelling, severe dizziness, or trouble breathing.
• Dependence and Withdrawal: Codeine is an opioid and can be habit-forming, leading to physical dependence and withdrawal symptoms if stopped suddenly.
• Confusion or Mood Changes: Some may experience confusion, agitation, or mood swings.
• Severe Stomach Pain: This can indicate a more serious issue and should be reported to a doctor immediately.

Less Common but Serious Side Effects:

• Severe Skin Reactions: In rare cases, acetaminophen can cause serious skin reactions, such as Stevens-Johnson syndrome.
• Severe Hypotension: A significant drop in blood pressure can occur, leading to fainting or shock.

If you experience any severe or concerning side effects, it’s important to seek medical help right away.

What should I know about storage and disposal of this medication?

Storage and Disposal of Acetaminophen and Codeine:

Storage:

• Temperature: Store the medication at room temperature, away from moisture and heat. A temperature range of 20-25°C (68-77°F) is typically recommended.
• Secure Location: Keep it in a secure place, out of reach of children, pets, and anyone who should not take it. Since codeine is a controlled substance, extra precautions are needed to prevent misuse or abuse.
• Original Container: Store the medication in its original container with the label intact to ensure you have important information on hand.
• Avoid Bathrooms: Avoid storing it in the bathroom, where humidity can degrade the medication.

Disposal:

• Do Not Flush: Do not flush the medication down the toilet unless the label or accompanying patient information specifically instructs you to do so.
• Take-Back Programs: Utilize drug take-back programs or events that allow you to safely dispose of unused medications. These are often run by pharmacies or local law enforcement.
• Household Disposal: If a take-back program is not available, mix the medication with an unappealing substance (e.g., dirt, cat litter, coffee grounds) in a sealed plastic bag and dispose of it in the trash. Ensure it is not accessible to children or pets.

In case of emergency/overdose

Signs of Overdose:

• • Extreme drowsiness or difficulty staying awake.
  • Slow or shallow breathing.
  • Blue or pale lips, fingernails, or skin.
  • Loss of consciousness or inability to wake up.
  • Confusion, nausea, or vomiting.
  • Sweating or clammy skin.

Immediate Actions:

• Call 911: If you suspect an overdose, call emergency services immediately.
• Poison Control: You can also contact your local poison control center at 1-800-222-1222 for guidance. Keep this number handy.
• Naloxone: If available, administer naloxone (a medication that can reverse the effects of an opioid overdose) while waiting for emergency responders. Naloxone is available as an injection or nasal spray, and some pharmacies provide it without a prescription.

What other information should I know?

• Regular Monitoring: If you’re using acetaminophen and codeine long-term, your doctor may want to monitor you for side effects, including liver function tests and assessments for signs of dependence or abuse.
• Avoid Double Dosing: Be cautious when taking other medications that contain acetaminophen to avoid exceeding the recommended daily limit, which can lead to liver damage. The maximum recommended daily dose for acetaminophen is typically 4,000 mg for adults.
• Medication Interactions: Inform your healthcare provider about all other medications you are taking, including over-the-counter drugs and supplements, to avoid potentially harmful interactions.
• Follow-Up: Keep all follow-up appointments with your doctor, and do not increase your dose or take the medication more often than prescribed.
• Withdrawal: If you need to stop taking acetaminophen and codeine after long-term use, your doctor may recommend tapering the dose gradually to avoid withdrawal symptoms. Do not stop taking the medication abruptly without consulting your healthcare provider.
• Avoid Sharing: Do not share this medication with others, especially those with a history of substance abuse or addiction, as it can be habit-forming and dangerous.