acetaminophen/codeine (Tylenol with Codeine)
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Introduction
DEA-controlled substance: class 3.
Indications
- treatment of mild to moderate acute pain-related syndromes
- cough suppressant
- not for chronic pain
Contraindications
Caution:
- in patients with glucose-6-phosphate dehydrogenase deficiency
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:
Dosage adjustment in renal failure
-..........-
creatinine clearance dosage
10-50 (mL/min) every 6 hours < 10 (mL/min) every 8 hours (metabolites may accumulate)
Pharmacokinetics
- well absorbed orally
- onset of action 15-30 minutes
- duration 4-6 hours
- metabolized in liver
- excreted by kidney
- elimination: liver > kidney
- small amount metabolized to electrophilic aromatic intermediate
- metabolic capacity is saturatable
- 1/2 life (1-4 hours) shorter with pregnancy & hyperthyroidism, longer with liver disease
Adverse effects
- common (> 10%)
- less common (1-10%)
- euphoria, dysphoria, pruritus, constipation, abdominal pain, histamine release
- uncommon (< 1%)
- palpitation, hypotension, bradycardia, peripheral vasodilation, increased intracranial pressure, antidiuretic hormone release, biliary tract spasm, urinary retention, miosis, respiratory depression, physical & psychologic dependence
- other[2]
- rash, blood dyscrasias, nephrotoxicity with chronic use hepatotoxicity, drowsiness, respiratory depression is rare, tolerance
- drug adverse effects of opiates
- drug adverse effects of psychotropic agents
- drug adverse effects of sedatives
Drug interactions
- agents that increase acetaminophen hepatotoxicity
- carbamazepine, hydantoin, barbiturates, chronic alcohol use, rifampin
- acetaminophen can elevate INR in patients takin warfarin
- naloxone is a direct opiate antagonist
- drug interaction(s) of acetaminophen in combination with GLP1-agonist
- drug interaction(s) of acetaminophen in combination with phenylephrine
- drug interaction(s) of benzodiazepine with opiates
- drug interaction(s) of Z-drugs with opiates
- drug interaction(s) of alcoholic beverage with opiates
- drug interaction(s) of pregabalin with opiates
- drug interaction(s) of gabapentin with opiates
- drug interaction(s) of alcoholic beverage with acetaminophen
- drug interaction(s) of ethanol with acetaminophen
Laboratory
Mechanism of action
- see acetaminohen
- see codeine
More general terms
Components
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ 2.0 2.1 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