Acetaminophen and Low Libido: What We Know and How to Cope

Short answer: Pure acetaminophen (paracetamol) is not commonly linked to low libido, but combination products that include an opioid (like codeine or oxycodone) can reduce sexual desire by affecting hormone pathways. ^[1] Combination acetaminophen–opioid labels warn that chronic opioid use may lead to androgen deficiency and symptoms such as low libido and erectile dysfunction. ^[2]

---

Does acetaminophen itself cause low libido?

Evidence in routine human use: Standard acetaminophen (without opioids) labeling does not list decreased sexual desire as a typical side effect. ^[1] Consumer and professional monographs for acetaminophen tablets focus on liver safety, dosing, and general adverse effects rather than sexual dysfunction. ^{[3] [4]}

Animal/tox data note: Some labeling for combination products mentions animal studies where high-dose acetaminophen was associated with reduced testicular weights and fertility measures, but the clinical significance for humans is unknown. ^[5] This means we cannot conclude it causes low libido in people at usual doses. ^[5]

Key takeaway: Low libido is not a recognized common side effect of acetaminophen alone, and when it is reported in public information, it typically relates to products that also contain opioids. ^{[1] [6]}

---

When acetaminophen is combined with opioids (codeine, oxycodone)

Codeine combinations: Patient information for acetaminophen–codeine lists “decreased sexual desire” among possible side effects. ^[6] This aligns with known opioid effects on the hormonal (hypothalamic–pituitary–gonadal) axis. ^[7]

Oxycodone combinations: Multiple oxycodone–acetaminophen labels state that chronic opioid use can influence the gonadal axis and lead to androgen deficiency, which may present as low libido, impotence, erectile dysfunction, amenorrhea, or infertility. ^{[8] [9] [2]} These statements reflect consistent warnings across consumer and professional versions. ^{[10] [11] [12] [13]}

Mechanism in plain terms: Opioids can lower sex hormone levels (like testosterone), which may reduce sexual desire and function; this effect appears to be related to dose and duration, and other health and lifestyle factors may contribute. ^[8] The causal role is described cautiously because many confounding factors exist in studies. ^[8]

---

Practical steps to cope safely

1. Identify your product and dose

• Check whether your pain reliever contains an opioid (e.g., “acetaminophen with codeine,” “oxycodone/acetaminophen”). If it does, low libido could be related to the opioid component. ^{[6] [8]}
• Review the medication guide or label to confirm ingredients and strength. ^[1]

2. Discuss symptoms with your clinician

• If you notice reduced sexual desire after starting an acetaminophen–opioid, talk to your clinician about timing, dose, and alternatives; they can assess for opioid-induced hypogonadism and other causes. ^[8]
• Reporting unusual problems is recommended, and serious adverse events can be reported to safety programs. ^[6]

3. Consider pain-management adjustments

• Dose reduction, switching to non‑opioid options, or multimodal pain strategies may improve libido if opioids are the driver. ^[8] Clinicians often tailor changes based on pain control and side-effect profile. ^[8]

4. Evaluate hormones when appropriate

• For persistent symptoms on chronic opioids, clinicians may check testosterone (in men) or other reproductive hormones and treat deficiencies if indicated. ^[8] This approach targets the suspected mechanism described in opioid labeling. ^[8]

5. Address contributing factors

• Sleep problems, stress, depression, alcohol, and other medicines can also affect libido; comprehensive review helps distinguish causes beyond medication effects. ^[8]

6. Safety first

• Do not stop opioids abruptly due to withdrawal risks; changes should be medically supervised. ^[8]
• Keep total acetaminophen dose within safe limits (generally not more than 3,000–4,000 mg/day depending on guidance and individual factors) to protect your liver, especially if considering alternatives. ^[1]

---

Bottom line

Acetaminophen alone is not typically associated with low libido, but combination products with opioids (like codeine or oxycodone) may reduce sexual desire through hormone effects, particularly with longer-term use. ^{[1] [6] [8]} If you experience low libido on an acetaminophen–opioid, work with your clinician on dose changes, non‑opioid alternatives, and possible hormone evaluation, and avoid abrupt medication changes. ^[8]