From the Guidelines
Tylenol 3 and Tylenol 4 differ primarily in their codeine content, with Tylenol 3 containing 30 mg of codeine per tablet and Tylenol 4 containing 60 mg of codeine per tablet, both also containing acetaminophen, and the choice between them should be based on the patient's specific pain management needs and medical history, considering the potential for increased side effects and dependency with the higher codeine content in Tylenol 4 1.
Key Differences
- Codeine content: Tylenol 3 (30 mg) vs. Tylenol 4 (60 mg)
- Acetaminophen content: typically 300-325 mg per tablet for both
- Indications: moderate to severe pain not relieved by acetaminophen alone
Considerations for Use
- Patients should be aware of the potential for dependence and side effects such as drowsiness, constipation, and nausea
- Neither medication should be combined with alcohol or other central nervous system depressants due to the risk of respiratory depression
- The decision to use Tylenol 3 or Tylenol 4 should consider factors such as pharmacokinetic properties, route of administration, half-life, neurotoxicity, and cost, as well as patient-specific factors such as medical history and current medications 1
Important Safety Information
- Codeine is a prodrug that requires metabolism by CYP2D6 to achieve analgesic effects, and its use may be limited by potential interactions with other drugs at the level of CYP2D6, 2B6, and 3A4 1
- Patients with renal insufficiency or end-stage renal disease (ESRD) should use opioids with caution and under close medical supervision, as they may be at increased risk of toxicity and accumulation of active metabolites 1
From the Research
Difference between Tylenol 3 and Tylenol 4
- The provided studies do not directly compare Tylenol 3 (Acetaminophen with Codeine) and Tylenol 4 (Acetaminophen with Codeine) 2, 3, 4, 5, 6.
- However, it can be noted that Tylenol 3 typically contains 300mg of Acetaminophen and 30mg of Codeine, while the composition of Tylenol 4 is not explicitly mentioned in the studies.
- Studies have compared the efficacy and tolerability of different combinations of acetaminophen with opioids, such as codeine, hydrocodone, and tramadol 3, 4, 5, 6.
- For example, a study compared the efficacy of acetaminophen plus codeine versus acetaminophen plus hydrocodone in patients with chronic cancer pain, and found that both combinations had comparable efficacy and tolerability 3.
- Another study compared the efficacy of acetaminophen plus codeine versus acetaminophen plus ibuprofen in patients undergoing outpatient general surgery, and found that the acetaminophen plus ibuprofen combination was associated with fewer side effects and higher patient satisfaction 4.
- A study also compared the efficacy of single-dose treatment with ibuprofen and acetaminophen or with three different opioid and acetaminophen combination analgesics in patients presenting to the emergency department with acute extremity pain, and found no statistically significant or clinically important differences in pain reduction at 2 hours among the treatments 5.
- A comparative trial compared the efficacy and tolerability of tramadol/acetaminophen combination tablets with codeine/acetaminophen combination capsules for the management of chronic pain, and found that tramadol/acetaminophen tablets were as effective as codeine/acetaminophen capsules and were better tolerated 6.