Tylenol 3 is the most commonly used medication for acute pain and is often used after minor surgical or dental procedures. Some patients complain that Tylenol 3 does not work for them, while others experience extreme nausea, dizziness and other symptoms of delirium. These side effects can be so serve that individuals may prefer to suffer from pain rather than deal with the side effects. Unfortunately, when these individuals look for alternative painkillers, physicians tend to prescribe stronger opioid medications like Oxycontin and Percocet, but often times those do not help either.
Why Tylenol 3 doesn’t work for some patients
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’. Codeine is a common component of many cough syrups, and is a moderately effective analgesic. The response to Tylenol 3 depends on an individual’s ability to metabolize codeine to morphine. The transformation of codeine to morphine in the liver is the critical step, as codeine by itself is not pharmacologically effective.
A liver enzyme called CYP2D6 does the job of metabolizing codeine, but some individuals are born with an inactive form of the enzyme and are called poor CYP2D6 metabolizers. Approximately 10% of Caucasians are poor codeine metabolizers, but the rate of poor metabolizers is higher in other ethnic groups, particularly in Asians. Poor metabolizers do not benefit from Tylenol 3, as their bodies cannot convert it to morphine. Even worse, these people also do not respond to stronger analgesics like Oxycontin (oxycodone) and Percocet (acetaminophen and oxycodone) for the same reason – they simply cannot convert pro-opioids into its active chemicals. Not knowing the underlying cause, physicians tend to increase the dose of the same medication or try switching to similar formulations, with no improvements.
Uncontrolled acute pain increases the risk of developing chronic pain. Even a simple root canal treatment can lead to devastating chronic pain. For some patients, antiepileptic medications like carbamazepine, gabapentin and pregabalin have (been shown to be more effective in controlling chronic pain than Tylenol 3), Oxycontin or Percocet.
Codeine-induced delirium is another problem that afflicts some individuals taking Tylenol 3. This results in rapid elation, followed by blurry vision, slurry speech and motoric impairment. This may occur when patients metabolize codeine to morphine faster than usual. Such individuals, called ultrafast metabolizers, report a profound but short lasting pain relief on Tylenol 3. A CYP2D6 gene duplication leads to enhanced metabolism of codeine, as well as Oxycodone and Percocet, making these individuals more sensitive to all pro-opioids. Ultrafast metabolizers are at much higher risk of accidental drug overdose, especially if they are given a higher drug dose.
Gord, one of our clients, told us that he cannot tolerate Tylenol 3 and prefers to be in pain rather than experience the wooziness and sickness induced by codeine. He had to avoid strong painkillers while he was hospitalized because Percocet caused him severe delirium – he felt completely dysfunctional because “the world was spinning around, and all objects were constantly changing shapes”. Genetic testing revealed that he in fact has the CYP2D6 gene duplication. For ultrafast metabolizers ibuprofen and other NSAIDs, COX2 blockers and antiepileptic medications could be a better and safer choice.
Women who are breastfeeding while taking Tylenol 3 or codeine may produce high morphine concentration in their milk, leading to accidental overdose in babies – the risk is increased substantially for ultrafast metabolizers.
How can you know what medication is right and safe for you and your loved ones?
The answer is very easy – genetic testing for CYP2D6 gene variations can tell you what type of metabolizer you are. The ideal time to get tested is before you take the medication so that you can avoid the risk of serious side effects. However, many people wait until it is too late – get tested today so you can have piece of mind!
If you would like to learn more about finding the correct treatment for pain through genetic testing, continue reading this related blog post: “Are you Tylenol or Advil person? Alleviating pain through genetics.
Learn more how PillCheck may help you to manage your medications.