Acetaminophen and codeine overdose

Definition

Acetaminophen (Tylenol) and codeine is a prescription pain medicine. It is an opioid pain reliever used only for pain that is severe and is not helped by other types of painkillers.

Acetaminophen and codeine overdose occurs when someone takes more than the normal or recommended amount of this medicine, either by accident or on purpose.

This article is for information only. Do not use it to treat or manage an actual overdose. If you or someone you are with overdoses, call your local emergency number (such as 911), or your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

Alternative Names

Tylenol #3 overdose; Phenaphen with codeine overdose; Tylenol with codeine overdose

Poisonous Ingredient

Acetaminophen combined with codeine

Where Found

Acetaminophen with codeine is commonly sold under the name Tylenol #3.

Symptoms

Below are symptoms of an overdose of acetaminophen combined with codeine in different parts of the body.

AIRWAYS AND LUNGS

EYES

  • Very small pupils

HEART AND BLOOD VESSELS

  • Low blood pressure

NERVOUS SYSTEM

  • Coma (lack of responsiveness)
  • Convulsions (seizures)
  • Drowsiness
  • Stupor (lack of alertness)

SKIN

  • Bluish skin (fingernails and lips)
  • Cold, clammy skin
  • Heavy sweating

STOMACH AND GASTROINTESTINAL SYSTEM

  • Nausea and vomiting
  • Spasms of the stomach and intestines
  • Liver failure

URINARY SYSTEM

  • Kidney failure

Home Care

Seek medical help right away. This type of overdose can cause death. Do not make the person throw up unless poison control or a health care provider tells you to.

Before Calling Emergency

Have this information ready:

  • The person's age, weight, and condition
  • Name of the medicine and the strength of the medicine (if known)
  • Time it was swallowed
  • Amount swallowed
  • If the medicine was prescribed for the person

Poison Control

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

What to Expect at the Emergency Room

Take the container with you to the hospital, if possible.

Your provider will measure and monitor your vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated. You may be admitted to the hospital.

Tests that may be done include:

  • Blood and urine tests
  • Chest x-ray
  • CT scan (advanced imaging) of the brain
  • Electrocardiogram (ECG)

Treatment may include:

  • Activated charcoal
  • Breathing support, including oxygen, tube through the mouth into the lungs, and breathing machine (ventilator)
  • Fluids through a vein (IV)
  • Laxative
  • Medicine to reverse the effects of the overdose and treat symptoms.

If there is a high level of acetaminophen in the blood, the person will be given N-acetyl cysteine (NAC) as soon as possible.

This medicine is called an antidote. It counteracts the effects of the acetaminophen. Without it, deadly liver failure may occur. Several doses may be required until the blood level drops to a safer value.

If there are signs of a severe opioid overdose, the antidote naloxone will be given.

Outlook (Prognosis)

How well a person does, depends on the amount of medicine swallowed and how quickly the treatment was received. The faster a person gets medical help, the better the chance for recovery. If breathing has been depressed for a long period before treatment, brain injury may occur.

If an antidote can be given, recovery from an acute overdose often occurs within 24 to 48 hours. Recovery takes longer, if the liver is affected, and the person may not fully recover.

References

Aronson JK. Opioid receptor agonists. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:348-380.

Ganetsky M. Acetaminophen. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 138.

Hatten BW. Aspirin and nonsteroidal agents. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 139.

Nikolaides JK, Thompson TM. Opioids. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 151.

Review Date: 7/1/2023
Reviewed By: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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