Mixing Acetaminophen (Tylenol) and Codeine (lean)
Caution
Most codeine tablets already contain acetaminophen, so more codeine means more acetaminophen, and liver damage gives no warning for a day or more. Check the label and count every source.
Not an interaction between the drugs so much as a counting problem that sends people to hospital. Most codeine sold over the counter is a combination tablet, so escalating the codeine escalates the paracetamol in lockstep. Eight co-codamol tablets is already 4g of paracetamol — the entire daily ceiling — and liver injury from that has no warning symptoms for a day or more, by which point it is well advanced. Add any separate paracetamol and you are over. If you are taking codeine at above-label doses, use a single-ingredient formulation.
The risk here is to the body — breathing, heart, temperature or organs. Set limits before you start, because this kind of harm does not announce itself in time to react.
Headspace vs physical riskCan you mix Acetaminophen (Tylenol) and Codeine (lean)?
MixSafe rates mixing Acetaminophen and Codeine as "Caution" — carries risk that is worth understanding before combining. Reduce doses and do not use alone. Source: MixSafe research. Educational information, not medical advice.
- Codeine
- Weak, but metabolised unpredictably between people
- Acetaminophen also called
- tylenol, paracetamol, apap, panadol, calpol, mapap
- Codeine also called
- lean, purple drank, co-codamol, dihydrocodeine
- Prescott LF. Paracetamol, alcohol and the liver. Br J Clin Pharmacol. 2000. https://pubmed.ncbi.nlm.nih.gov/10759684/
- Acetaminophen: A Liver Killer or Thriller. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645398/
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Checking more than two?
Combinations of three or more carry risks that no pair-by-pair chart can show. The checker rates every pair at once and flags the whole-mix ones on top.
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All combinations →Rated caution. Educational information only, not medical advice. Absence of a documented interaction is not evidence of safety.