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Acetaminophen and codeine

Alternative names

This poisoning is from an overdose of acetaminophen with codeine.

Poisonous Ingredient

  • Acetaminophen
  • Codeine

Where Found

  • Tylenol No. 3
Note: This list may not be all inclusive.


  • Respiratory
    • Breathing slow and labored (from the codeine)
    • Breathing shallow (from the codeine)
    • Respiratory arrest (from the codeine)
  • Eyes, ears, nose, and throat
    • Pinpoint pupils (from the codeine)
  • Skin
    • Bluish skin (fingernails and lips)
  • Gastrointestinal
    • Spasms of the stomach and/or intestinal tract
    • Vomiting
    • Acetaminophen overdose over a certain toxic level leads to liver failure unless the antidote, N-Acetyl-cysteine, is given
  • Heart and blood vessels
    • Low blood pressure (from the codeine)
  • Nervous system
    • Drowsiness (from the codeine)

Home Treatment

Seek emergency medical care immediately. Both Tylenol and codeine overdoses can be rapidly fatal. DO NOT INDUCE VOMITING .

Before Calling Emergency

Determine the following information:
  • The patient's age, weight, and condition
  • The name of the product (as well as the ingredients and strength, if known)
  • The time it was swallowed
  • The amount swallowed
  • If the medication was prescribed for the patient

Poison Control, or a local emergency number

See Poison Control Centers for telephone numbers and addresses. Take the container with you to the emergency room.

What to expect at the emergency room

  • For swallowed poison
    • Placement of a tube down the nose and into the stomach (a nasogastric tube, or an NG tube) to wash out the stomach (gastric lavage).
    • Activated charcoal administration.
    • Give IV fluids.
    • Admission to the hospital.
    • For Tylenol, N-Acetyl cysteine is given if the blood Tylenol level is high enough. Without the antidote, the patient has fatal liver failure.
    • Treat the symptoms.
    • Give a counteracting medication (narcotic antagonist). Multiple doses may be needed.

Expectations (prognosis)

If an antidote can be given, recovery from an acute overdose often occurs within 24-48 hours.

Update Date: 1/29/2004

Cherlin Johnson, M.D., Department of Emergency Medicine, University of Southern California, Los Angeles, CA. Review provided by VeriMed Healthcare Network.

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Last updated: Tue, 06 Jan 2009 00:20:03 GMT