Tylenol 3 (Acetaminophen-Codeine) Dosing for Moderate Pain Management
For moderate pain management, Tylenol 3 (acetaminophen-codeine) should be dosed at 1-2 tablets (each containing acetaminophen 325mg and codeine 30mg) every 4-6 hours as needed, not exceeding 12 tablets per day. 1, 2
Dosing Guidelines
Standard Adult Dosing
- Initial dose: 1-2 tablets every 4-6 hours as needed
- Maximum daily dose:
- Maximum of 12 tablets per day (to avoid exceeding 4000mg acetaminophen)
- Do not exceed 6 doses in 24 hours 1
Special Populations
- Elderly patients: Consider starting at lower doses (1 tablet every 6 hours) and titrating more slowly 2
- Hepatic impairment: Use with caution; consider dose reduction and longer intervals between doses 3, 2
- Renal impairment: Use with caution; reduced doses and frequency recommended 3
Pain Management Approach
Assessment and Selection
- For mild pain (NRS 1-4): Non-opioid analgesics like acetaminophen alone or NSAIDs are preferred 3
- For moderate pain (NRS 5-7): Tylenol 3 or other weak opioids combined with non-opioids are appropriate 3
- For severe pain (NRS 8-10): Consider stronger opioids or higher doses 3
Administration Principles
- Administer at regular intervals for chronic pain rather than "as needed" 3
- For acute pain, PRN (as needed) dosing is appropriate 2
- Oral administration is preferred when possible 3
- Always prescribe rescue doses for breakthrough pain 3
Efficacy and Safety Considerations
Efficacy
- Combination of acetaminophen with codeine provides superior analgesia compared to acetaminophen alone 4
- Acetaminophen 1000mg + codeine 60mg (equivalent to 2 Tylenol 3 tablets) shows better pain relief than acetaminophen 2000mg alone 4
- Efficacy is comparable to NSAIDs for moderate pain management 5
Safety Precautions
- Hepatotoxicity risk: Never exceed 4000mg/day of acetaminophen 3, 2, 6
- Common side effects: Constipation (29-36%), dizziness (19-24%), nausea/vomiting, and dry mouth 7
- Monitoring: Follow patients closely for respiratory depression, especially within first 72 hours 2
- Drug interactions: Use caution when prescribing with benzodiazepines or other sedating medications 2
Important Clinical Considerations
- Tylenol 3 is classified as a "weak" opioid for moderate pain (WHO level 2) 3
- Laxatives should be routinely prescribed for prophylaxis of opioid-induced constipation 3
- Metoclopramide or antidopaminergic drugs should be considered for opioid-related nausea/vomiting 3
- For patients with cancer pain, regular dosing schedules are preferred over PRN dosing 3
Pitfalls to Avoid
- Exceeding maximum acetaminophen dose of 4000mg/day can cause hepatotoxicity 3, 2
- Combining with other acetaminophen-containing products without accounting for total daily dose
- Using in patients with severe hepatic impairment without appropriate dose adjustment
- Failing to provide prophylactic treatment for constipation
- Prescribing two products of the same pharmacological class simultaneously 3