Combination

Mixing Codeine (lean) and Tylenol PM

OpioidCombination
Verdict

Unsafe · Delirium plus sedation

Diphenhydramine at anything above a normal dose produces genuine delirium — confusion, memory gaps, and hallucinations you cannot tell from reality. Layering a sedative on top removes the coordination and the awareness you would need to keep yourself safe through it, and makes the state very hard to tell apart from an overdose from the outside.

  1. Do not use diphenhydramine to sleep off or come down from something else. This is how most of these cases start.
  2. Stay with them. Keep the room cool and free of things to fall onto or against.
  3. Hot dry skin, a temperature, or hallucinations mean hospital. Anticholinergic delirium has a specific treatment and does not simply wear off safely.
What “Unsafe” means
In an emergency, call 911911Never Use AlonePoison Control
What to do
  • Say what was taken and how much.Responders need it, and in most US states Good Samaritan laws protect both of you from drug possession charges when you call for an overdose.
  • Unresponsive: put them on their side, tilt the head back, and stay until help arrives.Never leave someone alone to “sleep it off”.
  • Give naloxone (Narcan) if you have it.It is sold over the counter in every US state and does no harm if opioids turn out not to be involved.
  • Never Use Alone 1-800-484-3731Stays on the line and sends help if you stop responding.
  • Full steps: what to do if it is already happeningOverdose signs, the recovery position, what to say on the call, and whether you can be charged for making it.
  • Poison Control 1-800-222-1222Free and 24/7, for “is this bad?” before it becomes an emergency.

Can you take Codeine with Tylenol PM?

Tylenol PM contains acetaminophen and diphenhydramine. Diphenhydramine at anything above a normal dose produces genuine delirium — confusion, memory gaps, and hallucinations you cannot tell from reality. Layering a sedative on top removes the coordination and the awareness you would need to keep yourself safe through it, and makes the state very hard to tell apart from an overdose from the outside. MixSafe rates Codeine with Tylenol PM as "Unsafe" — risk of serious physical or psychological harm. Not recommended under any circumstances. Sources: the Drug Facts labels on DailyMed, the TripSit combination chart and MixSafe research. Educational information, not medical advice.

What is in it

Tylenol PM
Acetaminophen + Diphenhydramine.

Delirium plus sedation

Unsafe

Tylenol PM + Codeine

What to do
  1. 01Do not use diphenhydramine to sleep off or come down from something else.This is how most of these cases start.
  2. 02Stay with them.Keep the room cool and free of things to fall onto or against.
  3. 03Hot dry skin, a temperature, or hallucinations mean hospital.Anticholinergic delirium has a specific treatment and does not simply wear off safely.
Signs it is happening
  1. Talking to people who are not there, or no memory of the last stretch of time
  2. Hot, dry, flushed skin with no sweating, and a rising temperature
  3. Racing heart, inability to urinate, severe confusion
Why this happens

Diphenhydramine at anything above a normal dose produces genuine delirium — confusion, memory gaps, and hallucinations you cannot tell from reality.

Layering a sedative on top removes the coordination and the awareness you would need to keep yourself safe through it, and makes the state very hard to tell apart from an overdose from the outside.

More on anticholinergic delirium

Ingredient by ingredient

  • Codeine + Tylenol PM (Diphenhydramine)Unsafe

    Each makes the other stronger, raising the risk of memory loss, collapse and unconsciousness. Avoid this combination. Keep naloxone nearby.

    Both substances are CNS depressants, potentiating each other strongly and unpredictably, raising the chances of memory loss, severe ataxia, and unconsciousness. The interaction will cause greater inhibition and risk of injury. DPH reduces histamine release by opioids, which reduces the itching side effect from opioids. DPH may reduce the nausea caused by opioids. DPH inhibits CYP2D6 activity which can lead to a reduction of effects in some opioids and potentiation of effects in others.

    Class-level answer, inherited from Opioids. Nothing specific to this exact pair is documented, so treat it as the default for the class rather than a measurement of this drug.

    Source: TripSit drug combination chart

    More on CodeineMore on Diphenhydramine

  • Codeine + Tylenol PM (Acetaminophen)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.

    Sources: Prescott LF. Paracetamol, alcohol and the liver. Br J Clin Pharmacol. 2000 · Acetaminophen: A Liver Killer or Thriller

    More on CodeineMore on Acetaminophen

Sources

Ingredient lists checked 2026-09-27. Formulas change and store brands differ, so the Drug Facts box on your own packet is the final word.

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