Home Drug Guide Acetaminophen and Codeine Phosphate

Drug Guide

Generic Name

Acetaminophen and Codeine Phosphate

Brand Names Codrix, Capital And Codeine, Empracet W/ Codeine Phosphate #3, Empracet W/ Codeine Phosphate #4, Phenaphen W/ Codeine No. 2, Phenaphen W/ Codeine No. 3, Phenaphen W/ Codeine No. 4, Tylenol W/ Codeine No. 1, Tylenol W/ Codeine No. 2, Tylenol W/ Codeine No. 3, Tylenol W/ Codeine No. 4, Tylenol W/ Codeine, Proval #3, Phenaphen-650 W/ Codeine, Papa-deine #3, Papa-deine #4

Classification

Therapeutic: Analgesic, Antitussive

Pharmacological: Opioid analgesic with non-opioid analgesic

FDA Approved Indications

  • Moderate to severe pain
  • Cough suppression

Mechanism of Action

Codeine is converted in the liver to morphine, which binds to opioid receptors in the brain and spinal cord to reduce the perception of pain and suppress cough. Acetaminophen works centrally to inhibit pain and reduce fever.

Dosage and Administration

Adult: As prescribed, generally q4-6h as needed, not to exceed daily maximums.

Pediatric: Use with caution; dosing based on weight and age, typically under strict medical supervision.

Geriatric: Adjust dose based on renal/hepatic function, monitor for sedation and respiratory depression.

Renal Impairment: Adjust dose accordingly; may require dose reduction or increased dosing interval.

Hepatic Impairment: Use with caution; acetaminophen metabolism may be impaired, increasing risk of toxicity.

Pharmacokinetics

Absorption: Rapidly absorbed from gastrointestinal tract.

Distribution: Widely distributed, crosses the blood-brain barrier.

Metabolism: Metabolized in the liver; codeine via CYP2D6 to morphine, acetaminophen via conjugation.

Excretion: Excreted primarily in the urine.

Half Life: Approximately 2-4 hours for acetaminophen; 3-4 hours for codeine.

Contraindications

  • Known hypersensitivity to acetaminophen or codeine.
  • Respiratory depression, including severe asthma.
  • Children under 12 years (especially for codeine due to risk of severe respiratory depression).

Precautions

  • Use with caution in hepatic impairment, respiratory impairment, or in elderly. Monitor for signs of opioid toxicity and hepatotoxicity. Container warning for children due to toxicity risk.

Adverse Reactions - Common

  • Drowsiness (Common)
  • Dizziness (Common)
  • Nausea (Common)

Adverse Reactions - Serious

  • Respiratory depression (Rare)
  • Hepatotoxicity (due to acetaminophen overdose) (Rare)
  • Hypersensitivity reactions including rash (Uncommon)

Drug-Drug Interactions

  • CNS depressants, other opioids, benzodiazepines, alcohol, fluconazole, zidovudine.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor pain relief, respiratory status, liver function, and signs of opioid toxicity.

Diagnoses:

  • Risk for respiratory depression
  • Impaired comfort

Implementation: Administer with food or milk to minimize gastrointestinal upset; monitor for adverse effects.

Evaluation: Assess pain relief, respiratory function, and liver enzymes regularly.

Patient/Family Teaching

  • Do not operate machinery or drive until effects are known.
  • Avoid alcohol and CNS depressants.
  • Report signs of allergic reaction, severe dizziness, difficulty breathing.
  • Use only as prescribed; do not exceed recommended dosage.

Special Considerations

Black Box Warnings:

  • Respiratory depression and death in children due to codeine metabolism variability.
  • Risk of hepatotoxicity due to acetaminophen overdose.

Genetic Factors: CYP2D6 polymorphisms can affect codeine metabolism, leading to variable effects.

Lab Test Interference: May interfere with liver function tests.

Overdose Management

Signs/Symptoms: Nausea, vomiting, sweating, pallor, confusion, hypotension, liver failure, respiratory depression.

Treatment: Administer naloxone for respiratory depression; supportive care; activated charcoal if ingestion is recent; monitor liver function.

Storage and Handling

Storage: Store in a tight container at room temperature away from moisture and heat.

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.