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Why some opiates mixed with Acetaminophen for pain relief?

  1. May 15, 2015 #1
    Whether it's Hydrocodone, Oxycodone, Codeine or any other opiate derived pain relievers are almost always combined with Acetaminophen (Tylenol). Why would they do this considering that Tylenol is actually more harmful for you. Are opiates even a proper analgesic? They seem to be more like sedatives to me. The only conclusion I can draw from this is that the Tylenol is the ACTUAL pain reliever and that the varies strength of opiates are only there to knock you out so you can sleep through the pain.

    Please correct me if I'm wrong
  2. jcsd
  3. May 15, 2015 #2


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    Good question.

    I looked at the Wki page for codeine
    (not coming up as a link ?? )

    but it does say
  4. May 15, 2015 #3
    Is Codeine by itself an analgesia or is it a sedative?
  5. May 15, 2015 #4
    You are wrong. I will correct..

    Opiates are the archetypal analgesic. Opiate and analgesic are pretty much synonymous terms.

    That's pretty much true, although there do exist pills that are pure Hydrocodone and Oxycodone.

    This is actually incorrect. The opiate is the principal pain killer/analgesic in these hybrid pills. I don't know if the pharmaceutical makers have ever said this or would admit it, but the conventional thought behind why they add acetaminophen (or less frequently ibuprofin) is to discourage abuse. The thought being that the tylenol is going to make you sick if you take too much of it. Which it does. Other than that, its inclusion in these pain pills makes little sense, as you have mentioned. The analgesic effect compared to the opiate portion is negligible. Tylenol does have an anti-inflammatory property to it that opiates might not have, but that's really not a justifiable reason to include it in the pills. You could just take tylenol over the counter separately if you needed that.
  6. May 15, 2015 #5
    That makes absolutely no sense. The vast majority of people do not know that Tylenol is even lethal at all. In fact people who are subscribed opiate pain killers are not told that it's mixed with Tylenol.

    So how is it related to abuse?
  7. May 15, 2015 #6
    What does that have to do with the discussion?

    It typically says it right on the bottle, e.g., Vicodin, hydrocodone/acetaminophen 5/500. The 5 being the hydrocodone, the 500 being the tylenol.

    It's related to abuse because once you've developed a tolerance to opiates, you can take handfuls of hydrocodone pills that don't have tylenol in them and not get physically sick. The same is not true for the 5/500 hybrid pills. You will get nauseated from the tylenol and/or your liver will shut down at some point from the tylenol, so there's a limit to the level of tolerance you can attain. Again, I don't know for sure that this is the reason they make the pills hybrids in this fashion, but it's the prevailing theory, at least in the "junkie" community. There is no other reason to include it otherwise, unless it was some clever marketing scheme concocted by the Tylenol company in the early days.
  8. May 17, 2015 #7
    Yeah it's to prevent massive abuse. Tylenol poisoning is the number one reason for ER poisoning visits in the U.S. And UK. People need to watch their Tylenol intake. Swallow a bottle and avoid the hospital and you'll be dead from liver damage.
  9. May 18, 2015 #8
    I tried doing some research but could not find any official explanation. The most common explanation is basically what you said. But it still makes little sense to me why they would mix a more harmful substance with a less harmful one in order to discourage abuse. That's like putting a little bit of cyanide into every bottle of alcohol in order to discourage people from abusing it. Besides if that's really the case why don't pharmaceutical companies do something similar to substances that are much more addictive and dangerous than opiates like Xanax or Valium? And since when did pharmaceutical companies care about people abusing their products?

    That makes it sound like Tylenol was intentional put in there in order to kill junkies rather than them being a burden to society.
  10. May 18, 2015 #9


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    Thread closed for Moderation...
  11. May 18, 2015 #10


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    Thread re-opened.

    An important reminder to all -- conspiracy theory discussions are not allowed on the PF, so let's all lose the "Tylenol did this on purpose" angle. Thank you.

    And given the 5/500 ratio and the LD50 levels of Tylenol, it would seem pretty hard to get Tylenol poisoning without a serious opiate overdose, but I'm not that familiar with patients with high levels of opiate tolerance...


  12. May 18, 2015 #11


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    Can you post a mainstream medical reference for that? I don't work in the ED, but in the field that is not my experience.
  13. May 19, 2015 #12


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    Tylenol is known as Paracetamol in the UK and it is the most common drug overdose here at 48% of overdose cases:

    Paracetamol overdose: an evidence based flowchart to guide management
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