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acetaminophen/codeine (Tylenol with Codeine)
DEA-controlled substance: class 3.
Indications:
1) treatment of mild to moderate acute pain-related syndromes
2) cough suppressant
3) not for chronic pain
Contraindications:
Caution:
- in patients with glucose-6-phosphate dehydrogenase deficiency
pregnancy-category C
safety in lactation ?
Dosage:
#2 (300 mg acetaminophen + 15 mg codeine):
#3 (300 mg acetaminophen + 30 mg codeine):
#4 (300 mg acetaminophen + 60 mg codeine):
- 1-2 tabs PO every 4 hours.
Pediatric Elixir: DEA-controlled substance: class 5.
(120 mg acetaminophen + 12 mg codeine)/5 mL:
- 5 mL/dose 3-6 years, 10 mL/dose 7-12 years.
Pharmacokinetics:
1) well absorbed orally
2) onset of action 15-30 minutes
3) duration 4-6 hours
4) metabolized in liver
5) excreted by kidney
6) elimination: liver > kidney
7) small amount metabolized to electrophilic aromatic intermediate
8) metabolic capacity is saturatable
9) 1/2 life (1-4 hours) shorter with pregnancy & hyperthyroidism, longer with liver disease
Dosage adjustment in renal failure:
creatinine clearance dosage
10-50 (mL/min) every 6 hours
< 10 (mL/min) every 8 hours (metabolites may accumulate)
Adverse effects:
1) common (> 10%)
a) light-headedness
b) dizziness
c) sedation
d) nausea/vomiting
e) shortness of breath
2) less common (1-10%)
- euphoria, dysphoria, pruritus, constipation, abdominal pain, histamine release
3) uncommon (< 1%)
- palpitation, hypotension, bradycardia, peripheral vasodilation, increased intracranial pressure, antidiuretic hormone release, biliary tract spasm, urinary retention, miosis, respiratory depression, physical & psychologic dependence
4) other [2]
- rash, blood dyscrasias, nephrotoxicity with chronic use hepatotoxicity, drowsiness, respiratory depression is rare, tolerance
Drug interactions:
1) agents that increase acetaminophen hepatotoxicity
-> carbamazepine, hydantoin, barbiturates, chronic alcohol use, rifampin
2) acetaminophen can elevate INR in patients takin warfarin
3) naloxone is a direct opiate antagonist
Laboratory:
- acetaminophen+codeine in serum/plasma
Mechanism of action:
1) see acetaminohen
2) see codeine
Interactions
drug interactions
drug adverse effects of opiates
General
narcotic combination
Database Correlations
PUBCHEM cid=656762
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
Components
acetaminophen (Tylenol, Paracematol, Panadol, Tempra, Datril, APAP, non-Aspirin)
codeine