Yes

Analgesic, Narcotic

Dental: Treatment of postoperative pain

Medical: Relief of mild to moderate pain

C-III; C-V

C

Hypersensitivity to acetaminophen, codeine phosphate, or similar compounds

Use with caution in patients with hypersensitivity reactions to other phenanthrene derivative opioid agonists (morphine, hydrocodone, hydromorphone, levorphanol, oxycodone, oxymorphone); tablets contain metabisulfite which may cause allergic reactions

>10%:

Central nervous system: Lightheadedness, dizziness, sedation

Gastrointestinal: Nausea, vomiting

Respiratory: Shortness of breath

1% to 10%:

Central nervous system: Euphoria, dysphoria

Dermatologic: Pruritus

Gastrointestinal: Constipation, abdominal pain

Miscellaneous: Histamine release

<1%: Palpitations, hypotension, bradycardia, peripheral vasodilation, increased intracranial pressure, antidiuretic hormone release, biliary tract spasm, urinary retention, miosis, respiratory depression, physical and psychological dependence

Refer to the Acetaminophen Toxicity Nomogram in the Appendix

Acetylcysteine 140 mg/kg orally (loading) followed by 70 mg/kg every 4 hours for 17 doses; therapy should be initiated based upon laboratory analysis suggesting high probability of hepatotoxic potential

Naloxone 2 mg I.V. (0.01 mg/kg for children) with repeat administration as necessary up to a total of 10 mg; can also be used to reverse the toxic effects of the opiate. Activated charcoal is effective at binding certain chemicals, and this is especially true for acetaminophen.

Increased toxicity: CNS depressants, phenothiazines, tricyclic antidepressants, guanabenz, MAO inhibitors (may also decrease blood pressure); effect of warfarin may be enhanced

Inhibits the synthesis of prostaglandins in the central nervous system and peripherally blocks pain impulse generation; produces antipyresis from inhibition of hypothalamic heat-regulating center; binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; causes cough supression by direct central action in the medulla; produces generalized CNS depression

Acetaminophen:

Onset: 1-3 hours

Duration: 3-4 hours

Serum half-life: 1-4 hours

Time to peak serum concentration: 0.5-2 hours

Codeine:

Onset (analgesia): Oral: 30-45 minutes

Duration: 4-6 hours

Serum half-life: 2.5-3.5 hours

Time to peak serum concentration: 1-2 hours

Doses should be adjusted according to severity of pain and response of the patient. Adult doses greater than or equal to 60 mg codeine fail to give commensurate relief of pain but merely prolong analgesia and are associated with an appreciably increased incidence of side effects. Oral:

Codeine: 0.5-1 mg codeine/kg/dose every 4-6 hours

Acetaminophen: 10-15 mg/kg/dose every 4 hours up to a maximum of 2.6 g/24 hours for children <12 years

3-6 years: 5 mL 3-4 times/day as needed of elixir

7-12 years: 10 mL 3-4 times/day as needed of elixir

>12 years: 15 mL every 4 hours as needed of elixir

Adults:

Antitussive: Based on codeine (15-30 mg/dose) every 4-6 hours

Analgesic: Based on codeine (30-60 mg/dose) every 4-6 hours

1-2 tablets every 4 hours to a maximum of 12 tablets/24 hours

Dosing adjustment in renal impairment: Refer to individual monographs for Acetaminophen and Codeine

May be taken with food

Relief of pain, respiratory and mental status, blood pressure, bowel function

Sedation is common; less commonly, codeine may produce euphoria or dysphoria

Codeine may produce physical and psychological dependence. Antipsychotics, tricyclic antidepressants, monoamine oxidase inhibitors, barbiturates, benzodiazepines, and anticonvulsants may increase the toxicity of codeine. Barbiturates and carbamazepine may increase the hepatotoxic potential of acetaminophen. Diminution of pain relief may occur with the SSRIs.

No information available to require special precautions

<1% of patients may experience dry mouth

See individual agents

Observe patient for excessive sedation, respiratory depression, constipation

Capsule:

#2: Acetaminophen 325 mg and codeine phosphate 15 mg (C-III)

#3: Acetaminophen 325 mg and codeine phosphate 30 mg (C-III)

#4: Acetaminophen 325 mg and codeine phosphate 60 mg (C-III)

Elixir: Acetaminophen 120 mg and codeine phosphate 12 mg per 5 mL with alcohol 7% (C-V)

Suspension, oral, alcohol free: Acetaminophen 120 mg and codeine phosphate 12 mg per 5 mL (C-V)

Tablet: Acetaminophen 500 mg and codeine phosphate 30 mg (C-III); acetaminophen 650 mg and codeine phosphate 30 mg (C-III)

Tablet:

#1: Acetaminophen 300 mg and codeine phosphate 7.5 mg (C-III)

#2: Acetaminophen 300 mg and codeine phosphate 15 mg (C-III)

#3: Acetaminophen 300 mg and codeine phosphate 30 mg (C-III)

#4: Acetaminophen 300 mg and codeine phosphate 60 mg (C-III)

Dionne RA, "New Approaches to Preventing and Treating Postoperative Pain," J Am Dent Assoc, 1992, 123(6):26-34.

Dionne RA, Campbell RA, Cooper SA, et al, "Suppression of Postoperative Pain by Preoperative Administration of Ibuprofen in Comparison to Placebo, Acetaminophen, and Acetaminophen Plus Codeine," J Clin Pharmacol, 1983, 23(1):37-43.

Forbes JA, Butterworth GA, Burchfield WH, et al, "Evaluation of Ketorolac, Aspirin, and an Acetaminophen-Codeine Combination in Postoperative Oral Surgery Pain," Pharmacotherapy, 1990, 10(6 Pt 2):77S-93S.

Gobetti JP, "Controlling Dental Pain," J Am Dent Assoc, 1992, 123(6):47-52.