Acetaminophen

Aka: Acetaminophen, Acetaminophen with codeine, Lortab, Roxicet, Tylenol, Tylenol with codeine, Tylenol #3, Paracetamol

1. Indications
   1. Pain
   2. Fever
      1. Temperature >102 degrees Fahrenheit
      2. Fever at bedtime
2. Efficacy: Acetaminophen with codeine
   1. See Narcotic Analgesics for efficacy studies
   2. Codeine adds side effects but no benefit to Tylenol
   3. Tylenol and NSAIDs are as effective as Tylenol #3
3. Efficacy: Rheumatologic conditions
   1. Scheduled dosing much more effective than prn
   2. Tylenol 1000 mg qid is as effective as Tylenol #3
4. Dosing: Children
   1. Acetaminophen
      1. Well hydrated child: 15 mg/kg every 4 to 6 hours
      2. Dehydration risk: 10 mg/kg every 4 to 6 hours
      3. Dosing by age
         1. Age >2 months (5 kg): 80 mg per dose
         2. Age >4 months (6.5 kg): 100 mg per dose
         3. Age >6 months (8 kg): 120 mg per dose
         4. Age >12 months (10 kg): 160 mg per dose
         5. Age >2 years (13 kg): 200 mg per dose
         6. Age >3 years (15 kg): 240 mg per dose
         7. Age >5 years (19 kg): 280 mg per dose
      4. Maximum: 90 mg/kg/day (to 4 grams per day)
   2. Acetaminophen with Hydrocodone (Lortab Elixir)
      1. Components per 15 ml
         1. Hydrocodone 7.5 mg
         2. Acetaminophen 500 mg
      2. Dosing
         1. Age 2-3 years (12-15 kg or 27-34 lbs)
            1. Dose: 3.75 ml (0.75 tsp)
         2. Age 4-6 years (16-22 kg or 35-50 lbs)
            1. Dose: 5 ml (1 tsp)
         3. Age 7-9 years (23-31 kg or 51-69 lbs)
            1. Dose: 7.5 ml (1.5 tsp)
         4. Age 10-13 years (35-45 kg or 70-100 lbs)
            1. Dose: 10 ml (2.0 tsp)
   3. Oxycodone
      1. Dose: 0.05 to 0.15 mg/kg/dose every 4-6 hours up to 5 mg/dose
   4. Acetaminophen with Oxycodone (Roxicet)
      1. Components
         1. Oxycodone 5 mg/5ml
         2. Acetaminophen 325 mg/5 ml
      2. Dosing
         1. Base on Oxycodone dose of 0.05 to 0.15 mg/kg/dose every 4-6 hours up to 5 mg/dose
   5. Acetaminophen with codeine Elixir (not recommended)
      1. Risk of Opioid induced respiratory depression and other overdose adverse effects (especially in children)
         1. Deaths in children have occurred with codeine Analgesics following Tonsillectomy and adenoidectomy
         2. Resulted in FDA black box warning in 2013
         3. (2013) Presc Lett 20(4): 21
         4. FDA Drug Safety Communication
            1. http://www.fda.gov/Drugs/DrugSafety/ucm339112.htm
      2. Components
         1. Acetaminophen (120 mg/5ml Elixir)
         2. Codeine (12 mg/5ml Elixir)
      3. Dosing
         1. Age 3 to 6 years: 5 ml/dose every 4 hours prn
         2. Age 7 to 12 years: 10 ml/dose every 4 hours prn
5. Dosing: Adults
   1. Regular Dose: 650 mg PO every 4 to 6 hours prn
   2. Higher Dose (Osteoarthritis)
      1. Regular Strength Tablet (325 mg)
         1. Take 975 mg (3 tablets) PO every 6 hours
      2. Extra-Strength Tablet (500 mg)
         1. Take 1000 mg (2 tablets) PO every 6 hours
   3. Maximum: 4 grams per day
      1. Do not exceed 12 regular strength tablets (325 mg)
      2. Do not exceed 8 extra-strength tablets (500 mg)
6. Pharmacokinetics
   1. Similar potency and time-effect curve to Aspirin
   2. Duration: 4 hours
7. Preparations
   1. Chewable: 80 mg
   2. Elixir: 160 per 5 ml
   3. Dropper: 80 mg per 0.8 ml
   4. Suppository: 120 mg, 325 mg, 650 mg
   5. Tablet
      1. Regular strength: 325 mg
      2. Extra-Strength: 500 mg
8. Adverse Effects: Hepatotoxicity
   1. See Acetaminophen Toxicity
9. Precautions
   1. Dehydration predisposes to overdosage
   2. Never exceed maximum daily dosage (hepatotoxicity)
10. References
    1. (2000) Med Lett Drugs Ther 42(1085):73-8
    2. (1996) Med Lett Drugs Ther 38:5
    3. Katzung (1989) Basic and Clinical Pharmacology