Acetaminophen and Anxiety: What to Know and How to Cope

Acetaminophen (paracetamol) alone is generally well tolerated, but anxiety has been reported as a nervous‑system side effect in some acetaminophen combination pain medicines, particularly those that include opioids like codeine or oxycodone. ^[1] Anxiety and related symptoms such as nervousness, shakiness, insomnia, and dizziness are listed among possible reactions with acetaminophen‑codeine products. ^[1] Similar anxiety symptoms can also appear with oxycodone‑acetaminophen combinations, often in the context of withdrawal or dose changes. ^{[2] [3]}

Where the anxiety comes from

• Opioid combinations: Many “stronger” prescription pain tablets pair acetaminophen with an opioid (codeine or oxycodone). These products list anxiety and nervousness among potential nervous‑system side effects. ^{[4] [5]} Opioid dose changes or withdrawal can also trigger anxiety symptoms. ^{[2] [3]}
• Not typical for acetaminophen alone: Plain acetaminophen (Tylenol) is less commonly associated with anxiety compared to combinations, although nervous‑system complaints are noted primarily in combo formulations. ^[1]
• Other contributors: Sleep disruption, caffeine, dehydration, or other medicines (for example, serotonergic drugs) can worsen anxiety while on opioid‑acetaminophen products. ^[4]

Common signs to watch

• Feeling unusually anxious, restless, or nervous shortly after starting an acetaminophen‑opioid tablet. ^[4]
• Trouble sleeping, tremor, sweating, palpitations, or shakiness, especially with dose changes or missed doses. ^{[2] [3]}
• Dizziness or visual disturbances accompanying mood changes. ^[1]

What you can do right now

• Check the label: See if your product includes codeine or oxycodone with acetaminophen; these are more likely linked with anxiety. ^{[4] [2]}
• Track timing and triggers: Note when anxiety starts relative to each dose, missed doses, caffeine intake, or sleep loss; this helps your clinician adjust the regimen safely. ^[2]
• Do not stop opioids abruptly: Sudden discontinuation can cause withdrawal with anxiety; tapers should be gradual under medical guidance. ^[3]
• Call your clinician promptly: Report new or worsening anxiety, insomnia, tremor, or palpitations; dose adjustments or switching pain medicines may be appropriate. ^[2]
• Supportive steps: Gentle breathing exercises, hydration, light activity, and limiting caffeine may ease mild symptoms while you wait for care. ^[2]

When to seek urgent care

• Severe agitation, chest pain, fainting, or confusion should be assessed urgently, as they may signal significant adverse effects or withdrawal complications. ^{[1] [2]}

Longer‑term coping and prevention

• Use the lowest effective dose and shortest duration of opioid‑acetaminophen combinations to reduce side effect risks. ^[2]
• Plan tapers: If you’ve been using oxycodone‑acetaminophen regularly, work with your clinician on a slow taper to minimize anxiety and other withdrawal symptoms. ^[3]
• Consider alternatives: Non‑opioid options (plain acetaminophen, NSAIDs if appropriate, topical agents, physical therapy) may control pain with fewer mood effects. ^[2]
• Monitor for interactions: Tell your clinician about all medicines, especially those affecting serotonin, since rare but serious reactions can occur when opioids are combined with serotonergic drugs. ^[4]

Bottom line

Anxiety is not a common side effect of plain acetaminophen, but it can occur with acetaminophen‑opioid combination products, and it may also appear during dose changes or withdrawal. ^{[1] [2]} If you notice anxiety after starting a product that contains acetaminophen plus codeine or oxycodone, reach out to your clinician; with careful dosing, potential tapering, and supportive strategies, most people can reduce these symptoms safely. ^{[4] [3]}