About Acetaminophen with Codeine

Every day, patients stop at the pharmacy and ask for acetaminophen containing codeine. The general belief is that it can't be harmful if they don't need a prescription to get it, and the codeine must make it a better pain killer.

Codeine is an opiate used for treating mild to moderate pain, and an antitussive (cough suppressant) used for coughs that don't respond to non-opiate medications. The "High Test" acetaminophen contains 8 mg of codeine in addition to 300 mg of the acetaminophen found in regular tablets.

Although most textbooks list the addictive potential of codeine as low, because it provides little euphoria compared to more potent opioids like   heroin, codeine preparations can result in both physical and psychological dependence.

Physical dependence with low doses of codeine (defined as less than 200 mg per day, or 25 acetaminophen with codeine tablets) over the short term is uncommon. However, regular and frequent use of codeine over extended periods can lead to tolerance of its pain relief and cough suppression. Signs of physical dependence may be seen as soon as eight hours after the last dose. The symptoms will usually peak within two days and disappear within a week. Symptoms may include anxiety, sweating, yawning, runny nose, watery eyes, abdominal discomfort and "gooseflesh", as well as a return of the pain that the codeine was originally intended to relieve. Sometimes this pain can return at an even higher intensity than was first experienced, which often leads the patient back to the codeine to escape the pain. Psychological dependence is common in low dose daily users

For cough suppression, a minimum of 15 mg of codeine is required, or two acetaminophen with codeine tablets. Before trying this medication option, you should speak to a pharmacist or to your doctor, because it is generally not a good idea to suppress a cough. Coughs are designed to help rid the lungs and throat of foreign matter, and suppressing them may prolong an illness or aggravate an infection. However, sometimes it's necessary to suppress an annoying cough temporarily, in order to get a good night's sleep.  The non-prescription codeine preparations can help in this case.

Codeine and acetaminophen attack pain via different routes,  so when acetaminophen alone doesn't work, it's thought that adding codeine may take the edge off that pesky pain. Research has shown that you may see some benefit from a dose of 60 mg of codeine in combination with high doses (more than 600 mg) of acetaminophen, but there is no literature to support the effectiveness of the low dose (8 mg) non- prescription codeine preparations. In order to get a 60 mg dose of codeine, it is necessary to take 7.5 acetaminophen with codeine tablets.

This would result in a dose of 2250 mg of acetaminophen. It is recommended for adults to take a maximum of only 1000 mg of acetaminophen every 4 to 6 hrs, or about three 325 mg tablets. (The maximum daily dose of acetaminophen is 4000 mg or 12 tablets). At higher doses, you run the risk of having serious liver problems while your body tries to metabolize the acetaminophen.

So, the "High Test" acetaminophen is not always the best choice to relieve your pain. Talk to a pharmacist about the other non-prescription products available. We can help you identify the type of pain you arc experiencing, and we will suggest appropriate types of pain relief medication, or other courses of action, to help put you at ease.