Codeine is a prescription opioid that is often combined with other drugs to increase its effectiveness. Paracetamol, also known as acetaminophen, is one such drug that is commonly combined with codeine. This combination boosts codeine’s pain-relieving effects, but there are certain risks to consider when taking this prescription medication.

The following overview explores paracetamol and codeine combinations and the potential side effects and risks these drugs can create.

What Is Codeine?

Codeine is a relatively mild prescription opioid that can help treat moderate pain and cough. In some cases, it may also be used to treat diarrhea. Codeine may be mild compared to other opioids, but it’s still a controlled substance that carries the risks of physical dependence and addiction.

When someone takes codeine, it converts into morphine and then binds to opioid receptors in the body. This suppresses a person’s cough reflex, reduces sensations of pain and depresses the central nervous system.

Like other opioids, codeine can trigger a flood of certain neurotransmitters in the brain and cause a euphoric high in some people, particularly when larger doses are taken. This is one of the reasons why codeine can be addictive, but the risk of addiction is lower when you take it for a short period and as prescribed.

What Is Paracetamol?

Paracetamol, or acetaminophen, is an over-the-counter drug used in brand-name medications like Tylenol. Paracetamol treats mild to moderate pain caused by conditions like backaches and headaches. It’s one of the most commonly used pain relievers in the world, and there are many brands of paracetamol available. Paracetamol is often used in combination with other pain relievers and drugs to boost effectiveness.

As long as dosage instructions are followed, paracetamol is considered a safe medicine. However, paracetamol can cause liver damage when large amounts are used. This can also occur when people who are predisposed to liver problems use paracetamol.

Paracetamol and Codeine

Codeine is often combined with other drugs, including paracetamol, to improve its effectiveness as a pain reliever. When paracetamol and codeine are combined, however, there are certain risks to be aware of.

Together, paracetamol and codeine can be potentially dangerous. This is partly due to the addictive opioid component, but also because paracetamol can cause liver damage or acute liver failure if more than a certain dosage is taken in a 24-hour period.

Codeine and Paracetamol Tablets

Codeine and paracetamol tablets are available as drugs like Tylenol with Codeine #3 and Tylenol with Codeine #4. Some tablets also contain other substances, such as caffeine. Codeine and paracetamol tablets can be prescribed for a variety of reasons, including headaches, migraines and pain related to dentistry, surgery or accidents.

Codeine and paracetamol tablets are only recommended for people who are at least 12 years old. Since they contain paracetamol, it’s important to follow dosing instructions very carefully to avoid liver damage. Codeine and paracetamol tablets shouldn’t be used for more than five days in a row unless directed by a doctor.

Paracetamol and Codeine Phosphate

Codeine is available as either codeine sulfate and codeine phosphate. The difference in the name simply refers to the chemical process used to create it. The following side effect information and dosage guidelines apply to both types of codeine.

Paracetamol and Codeine Side Effects

Most of the potential side effects of a paracetamol and codeine combination are caused by the codeine. Common side effects can include:

  • Itching
  • Nausea
  • Drowsiness
  • Constipation
  • Lightheadedness
  • Dizziness

Severe but uncommon paracetamol and codeine side effects can include:

  • Mood or mental changes
  • Severe abdominal pain
  • Vision changes
  • Problems urinating
  • Fainting
  • Liver damage or acute liver failure

People who take paracetamol and codeine may also feel high due to how the codeine impacts the brain. It is possible to abuse or become addicted to this drug, but the risk is lower when you follow dosing instructions.

If you take too much, it can slow respiration to a dangerous level or cause a potentially fatal overdose. Most people don’t have serious side effects as long as they use the drug as directed by their doctor.

Paracetamol and Codeine Dosage

When a physician determines a paracetamol and codeine dosage, they look at individual factors like liver functionality, age and opioid tolerance. However, some general dosage guidelines can be used. Usually, paracetamol and codeine is dosed as:

  • Codeine 30 mg and paracetamol 300 mg every four hours as needed for pain
  • Codeine 60 mg and paracetamol 300 mg every four hours as needed for pain
  • Codeine 60 mg and paracetamol 600 mg every four hours as needed for pain

These are just rough guidelines and should never be used instead of your doctor’s advice.

If you or someone you love is struggling with a codeine addiction, help is available at The Recovery Village. Contact us today to speak with a representative and learn more about treatment programs that can work well for your needs.

Dosage Guidelines:

  • The paracetamol codeine dosage for the oral liquid form of the drug is 15 mL every four hours as needed for adults
  • For children ages 7 to 12 taking the liquid, it’s 10 mL 3 or 4 times a day, and for children ages 3 to 6 it’s 5 mL 3 or 4 times a day
  • For tablet paracetamol codeine dosages, it’s 1 to 2 tablets every four hours as needed for pain in adults, and child dosages have to be determined by a doctor.

These are just rough guidelines and should never be used instead of your doctor’s advice.

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Editor – Jonathan Strum
Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor's in Communication in 2017 and has been writing professionally ever since. Read more
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Medically Reviewed By – Dr. Jessica Pyhtila, PharmD
Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more

U.S. National Library of Medicine. “Acetaminophen and Codeine.” DailyMed, September 11, 2019. Accessed September 5, 2021. “Acetaminophen.” July 3, 2020. Accessed September 5, 2021. “Tylenol with Codeine #3.” February 5, 2021. Accessed September 5, 2021. “Tylenol with Codeine #4.” February 5, 2021. Accessed September 5, 2021.

American Academy of Family Physicians. “Opioid Conversion Table.”  Accessed September 5, 2021.

Drug Enforcement Administration. “Controlled Substances.” August 27, 2021. Accessed September 5, 2021.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.