chapter 1

AZ Listing of Drugs

A
COMBINATION DRUG

Acetaminophen and Codeine phosphate

(ah - SE AT - a h - M IN - o hfen, KO H -deen )
CLASSIFICATION(S): Non-narcotic/narcotic analgesic combination PREGNANCY CATEGORY: C Rx: Tylenol with Codeine, Vopac, C-III
SEE ALSO ACETAMINOPHEN AND CODEINE PHOSPHATE.

sion of pain impulses and therefore analgesia. Pharmacokinetics Both are well absorbed after PO. Acet1 aminophen, plasma t /2: 14 hr; codeine 1 plasma t /2 : 2.53 hr. Acetaminophen is metabolized mainly in the liver and excreted in the urine. Codeine is metabolized in the liver and excreted in the urine. CONTRAINDICATIONS Renal insufficiency, anemia. Those with cardiac or pulmonary disease are more susceptible to acetaminophen toxicity. During labor when delivery of a premature infant is expected. Hypersensitivity to any component of the product. SPECIAL CONCERNS Tablets contain sodium metabisulfite that may cause allergic-type reactions including anaphylaxis and life-threatening or less severe asthmatic episodes in susceptible individuals. Use with caution in the elderly, debilitated, in those with severe hepatic or renal impairment, hypothyroidism, Addisons disease, and prostatic hypertrophy or urethral stricture. Acetaminophen toxicity, including serious liver damage and apoptosis, may occur with doses not far beyond labeled dosing. Consult a provider before use if more than three alcoholic drinks per day are consumed. Clinically significant amounts of codeine may appear in breast milk in individuals abusing codeine. Safety and efficacy of the tablets have not been determined in children. Safety and efficacy of the elixir (oral solution) has not been determined in children 3 years of age and younger.
IV = Intravenous

USES Relief of mild to moderately severe pain. CONTENT Each Tylenol with Codeine No. 3 Tablet contains: Acetaminophen (non-narcotic analgesic), 300 mg and Codeine phosphate (narcotic analgesic), 30 mg. Each Tylenol with Codeine No. 4 Tablet contains Acetaminophen, 300 mg, and Codeine phosphate, 60 mg. Each 5 mL of Tylenol with Codeine Elixir (oral solution) contains: Acetaminophen, 120 mg and Codeine phosphate, 12 mg. Each Vopac Capsule contains Acetaminophen, 650 mg and Codeine phosphate, 30 mg. ACTION/KINETICS Action Acetaminophen may cause analgesia by inhibiting CNS prostaglandin synthesis. The mechanism of morphine is believed to involve decreased permeability of the cell membrane to sodium, which results in diminished transmis-

C = see color insert

H = Herbal

E = sound alike drug

ACETAMINOPHEN/CODEINE PHOSPHATE
Adults: /22 tablets q 4 hr, up to 6 tablets per day.
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SIDE EFFECTS Most Common Lightheadedness, dizziness, sedation, shortness of breath, N&V, respiratory depression (high doses of codeine). See Acetaminophen and Narcotic Analgesics for a complete list of possible side effects. Codeine can produce drug dependence of the morphine type and thus has the potential to be abused. Psychological and physical dependence, as well as tolerance, can result upon repeated use. OD OVERDOSE MANAGEMENT
SEE ALSO ACETAMINOPHEN AND NARCOTIC ANALGESICS.

NURSING CONSIDERATIONS
ADMINISTRATION/STORAGE 1. Adult doses of codeine higher than 60 mg do not give commensurate relief of pain but do prolong analgesia and are associated with a significant increase in the incidence of side effects. 2. Store tablets from 1530C (5986F). Dispense in a tight, light-resistant container. ASSESSMENT 1. List reasons for therapy, onset, duration, characteristics of symptoms; rate pain level, list other drugs trialed/outcome. 2. Assess CBC, renal and LFTs; for hypothyroidism, CAD, BPH, asthma, seizuresmay preclude therapy or require lower dosage. 3. With cough, determine co-morbidities, fever, change in sputum color/ amount, leukocytosis, need for CXR/ ATX. CLIENT/FAMILY TEACHING 1. Take as directed with full glass of water. May take with food/milk if GI upset. 2. Do not drive/perform activities that require mental alertness until drug effects realized; may cause dizziness, drowsiness. 3. For constipation, increase fluid and fiber intake to offset. 4. Store away from bedside; out of reach of children. Do not exceed prescribed dose. 5. Do not stop suddenly with prolonged use, may cause withdrawal. 6. Keep all F/U visits to assess response and for adverse SE. OUTCOMES/EVALUATE Control of pain/cough

DRUG INTERACTIONS See also Acetaminophen and Narcotic Analagesics. Anticholinergics / Possible paralytic ileus CNS Depressants (other narcotic analgesics, antipsychotics, antianxiety drugs, alcohol) / Additive CNS depression HOW SUPPLIED See Content. DOSAGE ELIXIR (ORAL SOLUTION) Mild to moderately severe pain. Adults: 15 mL (360 mg acetaminophen and 36 mg codeine phosphate) q 4 hr. Children, 712 years of age: 10 mL (240 mg acetaminophen and 24 mg codeine phosphate) 34 times per day. Children, 36 years of age: 5 mL (120 mg acetaminophen and 12 mg codeine phosphate) 34 times per day. TABLETS Mild to moderately severe pain. Adults, acetaminophen: 2001,000 mg is the single dose range; maximum daily dose: 4,000 mg. Adults, codeine: 1560 mg is the single dose range; maximum daily dose: 360 mg. Doses may be repeated q 4 hr. TABLETS (VOPAC) Mild to moderately severe pain.

Bold Italic = life threatening side effect

= black box warning

W = Available in Canada