The risk of accidental overdose in Ultrafast Metabolizers is the main reason why the US Food and Drug Administration banned the use of Tylenol 3, codeine-containing cough syrups and tramadol for children under 12 years of age, and breastfeeding women. Ultrafast metabolizers are at much higher risk of an accidental drug overdose, especially if they are given a higher drug dose. Genetic factors related to the CYP2D6 gene leads to enhanced metabolism of codeine, as well as tramadol, Oxycodone and Percocet, making these individuals more sensitive to all opioids. Such individuals, called ultrafast metabolizers, report stronger but short lasting pain relief on Tylenol 3. Rapid elation, followed by blurry vision, slurry speech and impaired movement, and breath suppression may occur when patients metabolize codeine to morphine faster than usual. People with reduced CYP2D6 activity, called Intermediate Metabolizers, require higher doses of codeine, tramadol or oxycodone to achieve adequate pain control.Ĭodeine-induced delirium is another problem that affects some individuals taking Tylenol 3. Pillcheck follows guidelines created by the Clinical Pharmacogenetics Implementation Consortium (CPIC) which recommends avoiding the use of codeine, tramadol and oxycodone in people who are Poor CYP2D6 metabolizers. Since many physicians do not know the underlying cause for this issue, they may increase the dose of the same medication or try switching to other analgesics, with no improvements. Even worse, these people also do not respond to stronger opioid-based analgesics including tramadol, hydrocodone, Oxycontin (oxycodone) and Percocet (acetaminophen and oxycodone) for the same reason – they simply cannot convert opioids into more active chemicals. Poor metabolizers do not benefit from Tylenol 3, as their bodies cannot convert it to morphine. Approximately 10% of Caucasians are poor codeine metabolizers, and the rate is higher in other ethnic groups, particularly in Asians. This transformation of codeine to morphine in the liver is the critical step, as codeine by itself is not effective at relieving pain.Ī liver enzyme called CYP2D6 does the job of changing codeine to morphine, but some individuals do not process (or metabolize) codeine well. A person’s response to codeine depends on one’s ability to convert codeine in to morphine. There are other less common formulations available such as Tylenol 2, which contains a 20mg of codeine, and Tylenol 4 with 40mg. Codeine is an opioid related drug, a common component of many cough syrups, and is a moderately effective pain reliever.

Tylenol is a brand name for acetaminophen and the 3 in Tylenol 3 stands for 30mg of codeine, which is the component responsible for the extra ‘kick’. Why Tylenol 3 doesn’t work for some patients Below, we explain why Tylenol 3 does not work for over 25% of patients, and which pain relievers, also called analgesics, can be more safe and effective for those people.

Unfortunately, when Tylenol 3 does not work, physicians tend to prescribe stronger opioid medications like Oxycontin and Percocet, but often times those do not help either. These side effects can be so severe that sometimes individuals prefer to suffer from the pain rather than deal with the side effects. Some patients complain that Tylenol 3 does not work for them, while others experience extreme nausea, dizziness and other symptoms of delirium. Tylenol 3 is one of the most commonly used medications for acute pain and is often used after minor surgical or dental procedures.

Side effect of tylenol