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Common brand name: Tylenol 3 contains codeine as well as acetaminophen. Codeine also is combined with other medicines, including aspirin.

Description: Codeine is a narcotic pain-relieving drug. It is most effective for dental pain when given along with acetaminophen (as in Tylenol 3).

Dental uses: Codeine is most commonly prescribed for relief of mild to moderate pain after dental surgery. It also is used for temporary relief of toothache. Codeine preparations are available in various strengths: 15 milligrams, 30 milligrams and 60 milligrams.

Dosages for dental purposes: One tablet of Tylenol 3 has 300 milligrams of acetaminophen plus 30 milligrams of codeine. In adults, two tablets should be taken every 4 to 6 hours as needed for pain. People take pills that include codeine for varying lengths of time. However, it usually is given for fewer than 5 days after surgery. It is important not to exceed the daily maximum dosage of acetaminophen with these combination drugs. Older patients should take a lower dose to start.

Concerns and possible side effects: Tell your dentist and physician about all the medicines you take. This should include over-the-counter vitamins and herbal supplements. Also, let your dentist know if you have had a sensitive or allergic reaction to any medicine. If you are pregnant or nursing, or might be pregnant, talk to your primary care doctor before starting any new medicine. This also includes vitamins and supplements.

Codeine and other narcotic pills produce a relatively high rate of side effects. They may include dizziness, drowsiness, nausea, vomiting and constipation. Other narcotic pills include hydrocodone, oxycodone and propoxyphene. If you take codeine while taking various sleep aids, such as Ambien, you may sleep longer than expected. Breathing problems are possible as well.

Do not operate dangerous machinery or drive a car while taking narcotics. You also should avoid alcohol. Drinking alcohol greatly increases the risk of drowsiness, impaired thinking and unconsciousness. It also increases the risk of stomach bleeding and ulcers from pills that combine aspirin and codeine. Alcohol increases the risk of liver damage from pills that combine acetaminophen and codeine.

Some other medicines taken with codeine may keep it from working well. They include certain medicines used to treat abnormal heart rhythms, depression, psychosis and HIV infection. The list of which medicines may interact with codeine can only increase.

Short-term use (a few days) of narcotic painkillers after dental surgery does not lead to drug addiction. Some health professionals are concerned that longer-term use (weeks or months) may cause addiction in some people. This concern is largely unfounded, but is still the subject of debate. Codeine should not be prescribed to people with a history of narcotic drug abuse.

People who are allergic to acetaminophen should not take Tylenol with codeine. People with allergies to aspirin should not take aspirin with codeine. Allergic reactions can be mild, such as a rash. Or the allergy can cause a life-threatening closing of the airway and a fall in blood pressure.

In August 2007, the U.S. Food and Drug Administration (FDA) issued a "Special Alert" about the use of codeine in nursing mothers. In one case, a woman's breast milk had high amounts of a codeine byproduct. This led to feeding problems and then death of her baby. The FDA now recommends that doctors use caution when prescribing codeine to nursing mothers. They should use the lowest dose for the shortest amount of time. They also should watch the baby for any changes in sleep, feeding or breathing.

Tell your doctor about any reaction to a prescribed medicine, no matter how minor it might be.

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