Product Details

Acetaminophen with Codeine Phosphate

A to Z Drug Facts

Acetaminophen with Codeine Phosphate

Action
Indications
Contraindications
Route/Dosage
Interactions
Lab Test Interferences
Adverse Reactions
PrecautionsPatient Care Considerations
Administration/Storage
Assessment/Interventions
Patient/Family Education

(ass-cet-ah-MEE-noe-fen with KOE-deen FOSS-fate)Tylenol with Codeine, Margesic, Phenaphen with Codeine,  Acet Codeine, Empracet-30, Empracet-60, Emtec-30, Lenoltec No. 4, PMS-Acetaminophen with Codeine, Rounox with Codeine 15, Rounox with Codeine 30, Rounox with Codeine 60, Triatec-30, Tylenol with Codeine Elixir, Tylenol with Codeine No. 4Class: Narcotic analgesic combination

 Action Inhibits synthesis of prostaglandins; binds to opiate receptors in CNS and peripherally blocks pain impulse generation; produces antipyresis by direct action on hypothalamic heat-regulating center; causes cough suppression by direct central action in medulla; may produce generalized CNS depression; does not have significant anti-inflammatory or antiplatelet effects.

 Indications Relief of mild-to-moderate pain; analgesic-antipyretic therapy in presence of aspirin allergy, hemostatic disturbances, bleeding diatheses, upper GI disease and gouty arthritis.

 Contraindications Hypersensitivity to codeine phosphate or similar compounds.

 Route/Dosage

Tylenol No. 2 equals 15 mg codeine, 300 mg acetaminophen. Tylenol No. 3 equals 30 mg codeine, 300 mg acetaminophen. Tylenol No. 4 equals 60 mg codeine, 300 mg acetaminophen. Max adult dose: Codeine equals 360 mg/day; acetaminophen equals 4 g/day.

TABLETS

ADULTS: PO Usually 1 to 2 tablets q 4 hr (varies according to product). CHILDREN < 12 YR: PO 0.5 to 1 mg codeine/kg/dose q 4 to 6 hr; 10 to 15 mg acetaminophen/kg/dose q 4 hr to max of 2.6 g/24 hr.

ELIXIR

CHILDREN > 12 YR: PO 15 ml q 4 hr prn. CHILDREN 7 to 12 YR: PO 10 ml tid to qid prn. CHILDREN 3 to 6 YR: PO 5 ml tid to qid prn.

 Interactions

Carbamazepine, hydantoins, sulfinpyrazone: May result in increased risk of hepatotoxicity. Cimetidine: Effects of codeine may be enhanced, increasing toxicity. CNS depressants (eg, barbiturates, ethyl alcohol, other narcotics): May result in additive CNS depressant effects and toxicity. Tricyclic antidepressants, phenothiazines: May cause additive CNS depressant effects and toxicity.

 Lab Test Interferences With Chemstrip bG, Dextrostix, and Visidex II home blood glucose systems, drug may cause false decrease in mean glucose values. False-positive results may occur in urinary 5-hydroxy-indoleacetic acid test.

 Adverse Reactions

CV: Flushing. CNS: Lightheadedness; dizziness; sedation; euphoria; insomnia; disorientation; uncoordination. DERM: Pruritus. GI: Nausea; vomiting; dry mouth; constipation; abdominal pain. RESP: Dyspnea; respiratory depression; decreased cough reflex. OTHER: Histamine release.

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Sulfite sensitivity: Caution is needed with sulfite sensitive patients; some commercial preparations contain sodium bisulfite. Hepatic impairment: Acetaminophen intake must be limited to £ 2 g/day.

PATIENT CARE CONSIDERATIONS

 

 Administration/Storage

• Give with food or milk if GI distress occurs.
• Store in airtight, light-resistant container at room temperature.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note pulmonary or hepatic disease, alcoholism, head injury, Addison's disease, hypothyroidism, or previous addiction to narcotic drugs.
• Assess baseline level of pain before administration.
• Take vital signs before administration. Withhold dose if respiratory rate is < 12 breaths/min (< 20 in children) and notify physician.
• Consider related factors that may lower pain threshold, such as anxiety, fear, boredom, or environmental stressors.
• Assess cough for productiveness and effectiveness; auscultate for rales.
• Administer scheduled dose before pain becomes severe.
• Use the following adjunctive pain relief measures: Massage, emotional support, diversion.
• If visual acuity is decreased by pupil constriction, keep room well lit during waking hours.
• Assess therapeutic effectiveness 1 hr after administration of dose based on patient's report of relief. Do not rely on objective signs.
• Reassess respiratory rate, depth and rhythm after each dose. Notify physician if rate is < 10 breaths/min or breathing is shallow.
• Assess for dizziness, sedation, euphoria, or confusion.
• Monitor for urinary retention or constipation.
• Monitor the following special-risk patients carefully: Elderly, debilitated, those with increased intracranial pressure, pulmonary disease or conditions involving hypoxia or hypercapnia, history of drug dependence.
• Record degree and duration of pain relief. Notify physician if therapy is ineffective.
• Record any adverse or unusual reactions.
• If drowsiness or sedation occurs, institute safety precautions.
• Provide diet high in fiber; increase fluids to 2 to 3 L unless contraindicated.
• If constipation occurs, notify physician.
• Encourage patient to void q 3 to 4 hr.

OVERDOSAGE: SIGNS & SYMPTOMS Blood dyscrasias, respiratory depression, hepatic damage (may occur up to several days after overdose)

 Patient/Family Education

• Caution patient that drug dependency or tolerance may result from long-term use.
• Instruct patient not to discontinue medication abruptly after long-term regular use.
• Caution patient to avoid intake of alcohol and other CNS depressants without consulting physician.
• Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness.
• Instruct patient to notify physician if the following signs/symptoms occur: Persistence or recurrence of pain before next scheduled dose; difficulty breathing; blurred vision; increased drowsiness; severe nausea; vomiting; urinary retention; or yellowing of skin, sclera or gums.
• Warn patient that orthostatic hypotension may occur; instruct patient to change positions slowly and to sit or lie down if symptoms occur.
• Explain that diaphoresis is a common side effect and does not indicate a problem.
• Warn patient that constipation may occur. Advise patient to increase dietary fiber and fluids unless contraindicated.
• Caution patient against taking otc medications that contain acetaminophen.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts