Tylenol 3 (with Codeine)

Informational only — not medical advice. Always consult a licensed healthcare provider or pharmacist before taking any medication. In case of overdose call Poison Control: 1-800-222-1222 (US) or 911.

Tylenol 3 — properly called Tylenol with Codeine No. 3 — is a prescription-only, controlled combination medicine that pairs the pain and fever reliever acetaminophen with codeine, an opioid. According to the product’s prescribing information, each tablet contains 300 mg of acetaminophen and 30 mg of codeine phosphate. It is used for short-term, mild-to-moderate pain when a non-opioid pain reliever alone is not enough, and it can only be obtained with a valid prescription from a licensed clinician.

Because Tylenol 3 combines two very different drugs, it carries two very different sets of risks: the opioid side (drowsiness, constipation, slowed breathing, and the potential for dependence) and the acetaminophen side (liver injury if the daily limit is exceeded). This guide explains what the medicine is, how it is dosed by a prescriber, who should avoid it, and — critically — why every tablet must be counted toward your daily acetaminophen total.

What is Tylenol 3?

Tylenol 3 is a fixed-dose combination tablet. The “Tylenol” part is acetaminophen (called paracetamol outside North America), which relieves pain and lowers fever. The “3” refers to the amount of codeine, an opioid that acts on the brain and spinal cord to change how pain is perceived. Together, the two ingredients relieve pain through different mechanisms, which is why the combination can work when acetaminophen alone falls short.

Codeine itself is a relatively weak opioid. Much of its pain-relieving effect comes after the body converts it into morphine in the liver. That conversion is one reason codeine’s effect varies so much from person to person, a point we return to below.

The medicine is available only by prescription. A prescriber decides whether it is appropriate, at what dose, and for how long — almost always the shortest course that controls the pain.

What do the numbers 1, 2, 3, and 4 mean?

Tylenol with Codeine comes in numbered strengths, and the number always refers to the codeine content, not the acetaminophen. The acetaminophen amount in each tablet is typically the same (300 mg); only the codeine changes. Historically the numbering follows an old apothecary system, where No. 4 carried the most codeine.

The table below summarizes the numbered strengths as described in standard prescribing references. Confirm the exact figures for your specific prescription against its label and your pharmacist.

Because the acetaminophen amount is the same across the numbered tablets, taking more tablets to get more codeine also raises your acetaminophen intake in lockstep — which is exactly why the daily count matters so much.

What are the two active ingredients?

Understanding the roles of the two ingredients makes the safety rules easier to follow.

The acetaminophen side

Acetaminophen is generally well tolerated at labeled doses, but taking too much can cause serious, sometimes fatal, liver injury. The daily limit applies to total acetaminophen from every source combined — so the 300 mg in each Tylenol 3 tablet is part of that budget. Read more about how the drug affects the liver in our guide to Tylenol and liver damage.

The codeine (opioid) side

As an opioid, codeine can cause drowsiness, dizziness, constipation, nausea, and — at higher exposures — dangerously slowed breathing (respiratory depression). With repeated use it can cause physical dependence and, in some people, addiction. These are the same categories of risk seen across opioids, which is why codeine is controlled.

What is Tylenol 3 used for?

Prescribers use Tylenol 3 for mild-to-moderate pain that a non-opioid has not adequately controlled. Common short-term scenarios include recovery after dental procedures such as wisdom-tooth removal, some injuries, and certain post-surgical situations. It is a treatment for acute pain over a limited period, not a long-term therapy for everyday aches — those are better handled by over-the-counter options like Extra Strength Tylenol or, where appropriate, an NSAID.

Codeine also has a cough-suppressant effect and appears in some prescription cough formulas, but Tylenol 3 specifically is prescribed for pain. Whether it is right for you is a clinical decision that weighs the benefit against the opioid risks.

How strong is Tylenol 3?

On the ladder of opioid pain relievers, codeine sits toward the weaker end. At 30 mg of codeine per tablet, Tylenol 3 is meant for pain that ordinary acetaminophen has not settled, not for severe pain that needs a strong opioid. Much of its punch depends on the body converting codeine into morphine, and — as noted above — that conversion varies widely from person to person, so the “strength” a given patient feels is not fully predictable.

Comparing it to over-the-counter Tylenol can be misleading. The acetaminophen in one Tylenol 3 tablet is 300 mg, which is actually less than the 500 mg in an Extra Strength tablet. What sets Tylenol 3 apart is the added codeine, not more acetaminophen. In other words, its extra strength comes from the opioid, which is precisely why it is controlled and prescription-only.

Is Tylenol 3 a narcotic or controlled substance?

Yes on both counts. “Narcotic” is an older term for opioids, and codeine is an opioid, so Tylenol 3 is a narcotic in that sense. Legally, it is a Schedule III controlled substance in the United States. Schedule III sits below Schedule II opioids (such as oxycodone) in terms of restrictions, but it still means the medicine has a recognized potential for misuse and dependence.

Practically, the controlled status affects how you get and keep the drug: it requires a valid prescription, prescription quantities and refills are limited by law, and pharmacies track it. It is illegal to possess it without a prescription or to share it with another person, even a family member with similar pain. This site cannot and does not supply it.

How long does Tylenol 3 take to work and how long does it last?

Taken by mouth, Tylenol 3 generally begins to relieve pain within roughly 30 to 60 minutes, and a dose commonly lasts about four to six hours, which is why prescribers typically direct doses spaced several hours apart as needed. Your prescription label states the interval for your situation; do not shorten it on your own.

Onset can feel slower if you take it with a large, fatty meal, though taking it with some food may reduce stomach upset. Because effect and duration depend partly on individual codeine metabolism, two people on the same dose may notice different timing. If a dose wears off well before the next one is due and pain returns strongly, that is a reason to call your prescriber rather than to take an early or extra tablet.

How is Tylenol 3 dosed?

Dosing is set by your prescriber and printed on your prescription label, so follow that exactly rather than any general figure. In broad terms, the prescribing information describes dosing individual tablets every few hours as needed for pain, with a ceiling on how many tablets can be taken in 24 hours — a ceiling driven largely by the acetaminophen content, since exceeding the acetaminophen maximum is what threatens the liver.

Because the acetaminophen adds up quickly, do not combine Tylenol 3 with any other acetaminophen-containing product. That includes over-the-counter Tylenol, store-brand acetaminophen, and multi-symptom cold, flu, and sinus remedies — many of which contain acetaminophen (sometimes labeled “APAP”). See how easily this adds up in our overview of the maximum dose in 24 hours.

Who should avoid or be cautious with Tylenol 3?

Tylenol 3 is not appropriate for everyone. Several groups face higher risk and need a careful conversation with a clinician before using it.

• Children. The FDA warns strongly against codeine in children. Some people are ultra-rapid metabolizers who convert codeine to morphine very fast, which can cause life-threatening breathing problems. Codeine is contraindicated for pain in children under 12 and after tonsil or adenoid surgery.
• People who are pregnant or breastfeeding. Codeine passes into breast milk, and ultra-rapid metabolism has been linked to serious harm in nursing infants. The FDA advises against codeine while breastfeeding; discuss alternatives with your provider.
• People who drink alcohol. Alcohol compounds both the sedation from codeine and the liver stress from acetaminophen. Avoid alcohol entirely while taking Tylenol 3.
• People with liver disease. Reduced liver function lowers the safe acetaminophen ceiling.
• People with breathing disorders, such as severe asthma or COPD, in whom opioids are riskier.
• People taking sedatives or other central-nervous-system depressants, including benzodiazepines, sleep aids, muscle relaxants, and other opioids. These combinations can dangerously suppress breathing.
• People taking other serotonergic drugs — for a related codeine-family caution, see tramadol and Tylenol.

For a deeper look at the acetaminophen-plus-codeine combination and its interactions, see our dedicated page on Tylenol with codeine.

Why codeine affects people so differently

Codeine is a “prodrug”: its pain relief depends on the liver enzyme CYP2D6 converting it into morphine. People inherit different versions of this enzyme.

• Ultra-rapid metabolizers make morphine quickly and can be exposed to unexpectedly high, potentially dangerous opioid levels from a standard dose.
• Poor metabolizers make very little morphine and may get little pain relief, which can tempt someone to take more — raising the acetaminophen risk without much added benefit.

This genetic variability is a major reason codeine is used cautiously and is avoided in children, and it is another argument for never adjusting your own dose.

What are the side effects of Tylenol 3?

Most side effects come from the codeine component and mirror those of opioids generally. Common, usually milder effects include drowsiness, dizziness or lightheadedness, nausea, vomiting, and constipation, which can be persistent enough that prescribers sometimes suggest steps to manage it. Some people also feel a flushed, sweaty, or mildly euphoric sensation.

More serious effects need prompt attention. The most dangerous is respiratory depression — breathing that becomes slow, shallow, or difficult — which is more likely at higher doses or when Tylenol 3 is combined with alcohol, sedatives, or other opioids. Signs to treat as emergencies include extreme sleepiness or trouble staying awake, confusion, very slow breathing, and bluish lips or fingertips.

Because the medicine also contains acetaminophen, a rare but important concern is a serious skin or allergic reaction to acetaminophen; any rash, blistering, or swelling of the face or throat is a reason to stop and seek care. For the broader picture of acetaminophen reactions, see our guide to Tylenol side effects. Because codeine slows the gut and dulls alertness, avoid driving or operating machinery until you know how it affects you.

Can you get addicted to Tylenol 3?

Yes, dependence and addiction are possible, which is a core reason codeine is controlled. It helps to separate two related ideas. Physical dependence means the body adapts to the drug so that stopping abruptly causes withdrawal; this can develop with regular opioid use even when the medicine is taken exactly as prescribed. Addiction is a different, compulsive pattern of seeking and using a drug despite harm.

Short courses taken as directed carry lower risk, but the risk is never zero, and it is higher for people with a personal or family history of substance use disorder. Warning signs worth flagging to a prescriber include using more than prescribed, running out early, craving the medicine, or using it to cope with stress rather than pain. If you have taken it regularly for a while, do not stop suddenly — ask your prescriber how to taper safely and avoid withdrawal symptoms such as restlessness, sweating, aches, and nausea.

Tylenol 3 vs Tylenol 4, Percocet, and Norco

It helps to see where Tylenol 3 sits among common combination opioids. Each pairs acetaminophen with a different opioid or a different amount of the same one.

The key takeaways: Tylenol 4 is the same medicine as Tylenol 3 with double the codeine; Norco (hydrocodone) and Percocet (oxycodone) use stronger opioids and are typically Schedule II, meaning tighter controls. A closely related non-opioid-scheduled painkiller, tramadol, carries some of the same serotonergic and dependence cautions — see tramadol and Tylenol. Critically, every product in this table contains acetaminophen, so the same “count it toward your daily limit” rule applies to all of them, and none should be combined with over-the-counter Tylenol.

Dependence, misuse, and safe storage

Like other opioids, codeine can lead to physical dependence with regular use and, for some people, addiction. Using Tylenol 3 exactly as prescribed and only for as long as needed lowers this risk. Do not stop a longer course abruptly without guidance, as that can cause withdrawal.

Store Tylenol 3 securely, out of reach of children, teens, and visitors, and dispose of unused tablets through a pharmacy take-back program rather than leaving them in a cabinet. Never give your prescription to anyone else. If you notice you are using it more often or in larger amounts than prescribed, that is a reason to call your prescriber promptly.

Overdose: a double danger

An overdose of Tylenol 3 is dangerous in two ways at once. The codeine can slow or stop breathing, especially when combined with alcohol or other sedatives. The acetaminophen can silently injure the liver, often with few early symptoms — a person may feel only nausea or nothing at all in the first day while damage begins.

Warning signs that need emergency help include very slow or shallow breathing, extreme drowsiness or inability to wake, blue-tinged lips or fingertips, and confusion. If you have been prescribed an opioid, ask your pharmacist whether keeping naloxone on hand is appropriate for you.

How Tylenol 3 differs from over-the-counter Tylenol

Regular over-the-counter Tylenol contains only acetaminophen — no opioid — and can be bought without a prescription. Tylenol 3 adds codeine and therefore becomes a controlled prescription medicine with an entirely different risk profile. You cannot substitute one for the other, and you should never take both together, because doing so stacks acetaminophen from two sources.

If your goal is routine pain or fever relief, an over-the-counter product such as Extra Strength Tylenol is the appropriate starting point, and possible drug interactions still apply — review our list of common Tylenol interactions. Tylenol 3 is reserved for situations where a clinician has judged that an added opioid is warranted for a short time. For the full range of possible reactions to acetaminophen, see our guide to Tylenol side effects.

Bottom line

Tylenol 3 is a prescription-only, controlled combination of 300 mg acetaminophen and 30 mg codeine per tablet, prescribed for short-term mild-to-moderate pain when a non-opioid is not enough. Treat it with the respect any opioid deserves: take it only as prescribed, avoid alcohol and other sedatives, keep it stored securely, and never add other acetaminophen products on top of it, since every tablet already counts toward your daily acetaminophen limit. This is general information, not medical advice — your prescriber and pharmacist set your safe dose, and Poison Control (1-800-222-1222) is available around the clock if you ever suspect an overdose.