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Pharmacy and Medications

Difference between tylenol w/ codeine



what is difference between tylenolw/ codeine and percocet? how many tyl w/ codeine equal 1 percocet?


Tylenol with Codeine and Percocet are similar medications used to treat acute pain. They are both immediate release pain medicines that combine an opioid with acetaminophen. They cause similar side effects, including:

Both products are available in several dose strengths. Percocet is a combination of oxycodone and acetaminophen, while Tylenol with Codeine is a combination of codeine with acetaminophen. Tylenol with codeine is typically used to treat mild to moderate pain, while Percocet is used to treat moderate to severe pain.

Tables of so called equi-analgesic doses of opioid pain medicines exist to help clinicians switch patients from one opioid analgesic to another. These tables generally compare the list of available opioids to morphine. At best these tables provide a rough approximation of equivalent doses. One such table suggests that that 200mg of codeine or 20mg of oxycodone are approximately equivalent in therapeutic efficacy to 30mg of oral morphine. From this information, oxycodone appears to be about 10 times more potent than codeine. Accordingly, a single Percocet containing 5mg oxycodone and 325mg acetaminophen should be roughly equivalent to a Tylenol #4 with Codeine containing 60mg codeine and 300mg of acetaminophen. Clinicians avoid doses of Codeine greater than 60mg because higher doses increase side effects like constipation, but do not increase pain relief. Oxycodone does not seem to have the same sort of ceiling effect seen with codeine so increasing the dose of oxycodone produces a proportional increase in both pain and side effects.

Both Tylenol with Codeine and Percocet contain acetaminophen. When given alone, acetaminophen is a good analgesic. It has a synergistic effect when combined with opioids, meaning that the effect of the combination produces greater pain relief than the sum of the effects of each of the ingredients alone.

It is important to take these pain medicines the way your doctor prescribed them. It is dangerous to do otherwise. These medicines are not interchangeable. Attempting to take Tylenol with Codeine to mimic a dose of Percocet could result in toxicity from either the codeine or the acetaminophen. The toxicity associated with acetaminophen is one of the most common causes of liver failure. If you have additional questions or concerns, talk to your doctor or a pharmacist who knows you.

This response was prepared in part by Eric Nordman, a PharmD student at the University of Cincinnati College of Pharmacy

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Response by:

Robert James Goetz, PharmD, DABAT
Assistant Professor of Pharmacy Practice
College of Medicine
University of Cincinnati