Maximum Daily Dose of Tylenol #3
The maximum daily dose of Tylenol #3 (acetaminophen/codeine 300mg/30mg) is limited by the acetaminophen component to 4000 mg per day, which translates to approximately 12 tablets per day, though practical dosing should not exceed 3000-3250 mg of acetaminophen daily to minimize hepatotoxicity risk. 1, 2
Acetaminophen Dosing Limits
The acetaminophen component is the dose-limiting factor in Tylenol #3:
- Standard maximum: 4000 mg (4 grams) of acetaminophen per 24 hours 3, 1, 2
- Recommended safer maximum: 3000-3250 mg per day to reduce hepatotoxicity risk 2, 4
- Maximum single dose: 1000 mg (1 gram) 1, 2
Since Tylenol #3 contains 300 mg of acetaminophen per tablet, the theoretical maximum would be 13 tablets (3900 mg), but this exceeds current safety recommendations.
Practical Dosing Recommendations
For standard adult patients, limit Tylenol #3 to 10 tablets per day (3000 mg acetaminophen total) to maintain an adequate safety margin. 2, 4
- Typical dosing: 1-2 tablets every 4-6 hours as needed
- Maximum frequency: Every 4 hours
- Do not exceed 10-12 tablets in 24 hours
Critical Safety Considerations
Hepatotoxicity Risk
Exceeding 4 grams per day can cause severe hepatotoxicity, liver failure, and death. 3, 1, 2
- Repeated supratherapeutic ingestions (doses just over 4 g/day) have resulted in hepatotoxicity, hepatic failure, and death 3
- Even doses of 2 grams daily (1 gram twice daily) for 12 weeks caused small but statistically significant ALT elevations in healthy adults 5
Special Populations Requiring Dose Reduction
Patients with liver disease or cirrhosis should limit acetaminophen to 2-3 grams per day (6-10 tablets of Tylenol #3). 3, 2
- Elderly patients (≥60 years): Consider reducing maximum to 3000 mg daily 2
- Chronic alcohol users: Limit to 2-3 grams daily despite conflicting evidence on increased risk 3
- Patients with decompensated cirrhosis: 2-3 grams daily maximum 3
Common Pitfalls to Avoid
Patients frequently do not know that combination products contain acetaminophen, leading to unintentional overdose. 6
- 49% of patients did not know Tylenol contains acetaminophen 6
- 66-90% did not know that Vicodin, Percocet, or Lortab contain acetaminophen 6
- Only 7% of patients knew the correct maximum daily dose 6
Always counsel patients to:
- Avoid taking additional acetaminophen-containing products (Tylenol, cold medications, other prescription combinations) 1, 2
- Check all medication labels for acetaminophen content
- Not exceed the prescribed number of tablets per day
Warning Signs of Toxicity
Monitor for early signs of acetaminophen toxicity: 2
- Nausea, vomiting, abdominal pain
- Elevated liver enzymes (AST/ALT >50 IU/L)
- Any elevation in transaminases warrants immediate evaluation