This page was prepared by Tami Skinner, LPN Internet Nursing Guide
Michigan Nurses, Pediatrics, Respiratory, Home Health, Medical-Surgical, Long Term Care
http://www.nursefriendly.com/skinner/

Tylenol (Acetaminophine) + Codeine- Comparison or strength: Doctor's Guide: "Over-the-counter extra strength aspirin provides equivalent pain relief as acetaminophen plus codeine in relieving severe pain associated with tension headaches, researchers reported at the 20th scientific meeting of the American Pain Society. Pain relief reached statistical significance for both medications when compared with placebo among the 115 patients who were evaluated in the study, said Laureen MacEachern, Ph.D., senior associate director of research at Bayer, Inc., Morristown, New Jersey. Dr. MacEachern said that patients were selected if they had at least two tension headache but no more than 10 in the past month. Tension headaches are the head pain typically caused by mental stress. Dr. MacEachern said the severity was defined as pain so severe that it interfered with normal functioning and the patient felt "he had to take something for the pain."
http://www.docguide.com/news/content.nsf/news/F3E3EB12563066DF85256A360069B7C3?OpenDocument&id=48DDE4A73E09A969852568880078C249&count=10&highlight=0,tylenol,with,codeine

Pharmacokinetics of Tylenol with Codeine: Drug Infonet: "The behavior of the individual components is described below. Codeine: Codeine is readily absorbed from the gastrointestinal tract. It is rapidly distributed from the intravascular spaces to the various body tissues, with preferential uptake by parenchymatous organs such as the liver, spleen and kidney. Codeine crosses the blood-brain barrier, and is found in fetal tissue and breast milk. The plasma concentration does not correlate with brain concentration or relief of pain; however, codeine is not bound to plasma proteins and does not accumulate in body tissues. The plasma half-life is about 2.9 hours. The elimination of codeine is primarily via the kidneys, and about 90% of an oral dose is excreted by the kidneys within 24 hours of dosing. The urinary secretion products consist of free and glucuronide conjugated codeine (about 70%), free and conjugated norcodeine (about 10%), free and conjugated morphine (about 10%), normorphine (4%), and hydrocodone (1%). The remainder of the dose is excreted in the feces."
http://www.druginfonet.com/acetamin.htm#CLINICAL PHARMACOLOGY

Indication and use of Tylenol with Codeine: Health and Age: "INDICATIONS AND USAGE TYLENOL with Codeine tablets (acetaminophen and codeine phosphate tablets) are indicated for the relief of mild to moderately severe pain. TYLENOL with Codeine elixir (acetaminophen and codeine phosphate oral solution USP) is indicated for the relief of mild to moderate pain. CONTRAINDICATIONS TYLENOL with Codeine tablets or elixir (acetaminophen and codeine phosphate tablets and oral solution USP) should not be administered to patients who have previously exhibited hypersensitivity to any component."
http://www.healthandage.com/html/res/com/ConsDrugs/AcetaminophenandCodeinecd.html

Side effects of Tylenol with Codeine : Health Square: "Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Tylenol with Codeine. More common side effects may include: Dizziness, light-headedness, nausea, sedation, shortness of breath, vomiting Less common side effects may include: Abdominal pain, allergic reactions, constipation, depressed feeling, exaggerated feeling of well-being, itchy skin Rare side effects may include: Decreased breathing (when Tylenol with Codeine is taken at higher doses)"
http://www.healthsqr.com/newrx/TYL1466.HTM

Available forms of Tylenol with Codeine: Mayo Health: "These medicines are available in the following dosage forms: Oral Acetaminophen and Codeine Capsules (U.S.)Oral solution (U.S. and Canada)Oral suspension (U.S.)Tablets (U.S. and Canada)Acetaminophen, Codeine, and Caffeine Tablets (Canada)Dihydrocodeine, Acetaminophen, and Caffeine Capsules (U.S.)Hydrocodone and Acetaminophen Capsules (U.S.)Oral solution (U.S.)Tablets (U.S.)Oxycodone and Acetaminophen Capsules (U.S.)Oral solution (U.S.)Tablets (U.S. and Canada) and Acetaminophen Tablets (U.S.)Propoxyphene and Acetaminophen Tablets (U.S.)"
http://www.mayohealth.org/home?id=5.7.2&drugID=DR202392&drugName=TYLENOL%20WITH%20CODEINE%20ELIXIR

Tylenol with Codeine- Dosage: Nurses PDR: "Dosage- Tablets, Capsules Analgesia. Adults, individualized, usual: 1-2 No. 2 or No. 3 Tablets or No. 3 Capsules q 2-4 hr as needed for pain. Or, 1 No. 4 Tablet or Capsule q 4 hr as required. Maximum 24-hr dose is 360 mg codeine phosphate and 4,000 mg acetaminophen. Pediatric: Dosage equivalent to 0.5 mg/kg codeine. Elixir Analgesia. Adults, individualized, usual: 15 mL q 4 hr as needed; pediatric, 7-12 years: 10 mL t.i.d.-q.i.d.; 3-6 years: 5 mL t.i.d.-q.i.d. Special Concerns: Use with caution during lactation. Safety has not been determined in children less than 3 years of age. May be habit-forming due to the codeine component."
http://www.nursespdr.com/members/database/archives/tylenolwithcodeineelixirortablets.html

Tylenol with Codeine drug interactions, contraindications, warnings: University of Iowa Nursing: "Taking acetaminophen and alcohol together can destroy a pateint's liver. Be sure and educate your patients to this cold, hard reality. Codeine is able to produce physiological drug dependence similar to morphine dependence. Tolerance, psychological dependence and physiological dependence can occur with recurrent administration. Codeine also impairs mental alertness and physical coordination. Pregnancy category C. Use only during pregnancy if the potential benefits warrants the potential risk to the fetus. Drug interactions: An additive effect of CNS depression can occur with other narcotic analgesics, anti psychotics, anti anxiety agents, or other CNS depressants such as alcohol. The dose of one or both agents should be decreased. The use of anti cholinergics with codeine can produce paralytic ileus."
http://www.nursing.uiowa.edu/sites/adultpain/Narcs/TyCodtt.htm

Overdose S/S and treatment for Tylenol with Codeine: Rx List: "Signs and Symptoms: In acute acetaminophen overdosage, dose-dependent, potentially fatal hepatic necrosis is the most serious adverse effect. Renal tubular necrosis, hypoglycemic coma, and thrombocytopenia may also occur. In adults, hepatic toxicity has rarely been reported with acute overdoses of less than 10 grams and fatalities with less than 15 grams. Importantly, young children seem to be more resistant than adults to the hepatotoxic effect of an acetaminophen overdose. Despite this, the measures outlined below should be initiated in any adult or child suspected of having ingested an acetaminophen overdose. Serious overdose with codeine is characterized by respiratory depression (a decrease in respiratory rate and/or tidal volume, Cheyne-Stokes respiration, cyanosis), extreme somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, and sometimes bradycardia and hypotension. In severe overdosage, apnea, circulatory collapse, cardiac arrest, and death may occur. Toxicity from codeine poisoning includes the opiod triad of: pinpoint pupils, depression of respiration, and loss of consciousness. Convulsions may occur."
http://www.rxlist.com/cgi/generic/acetcod_od.htm

Special Considerations: Tylenol with Codeine for the Geriatric patient: Age Net: "Tylenol with Codeine is used for the relief of mild to moderate pain. It is a narcotic analgesic, and is an acceptable form of therapy when narcotic analgesic use is indicated. The duration of action of Codeine may be prolonged in elderly people. Also, elderly people may experience greater analgesic effects compared to younger adults. This drug inhibits pain impulse generation, can lower fever, and can suppress coughing.Since hepatotoxicity and the effectiveness of Tylenol may be increased, the following drugs should be used with caution when taken concomitantly: barbiturates, Carbamazepine, hydantoins, Rifampin, Sulfinpyrazone, phenothiazines, alcohol, CNS depressants, tricyclic antidepressants, Guanabenz, MAO inhibitors (i.e. Nardil, Parnate)."
http://agenet.agenet.com/?Url=link.asp?DOC/1311

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