Acetaminophen with Codeine

 

Acetaminophen with codeine is a well-known prescription pain reliever marketed as a generic or under brand names of Tylenol with Codeine or Capital with Codeine. There is also a number associated with each product that indicates the amount of codeine in the product; #3 is most common and contains 30 mg of codeine in each tablet.  This medication can be used alone or in combination with other pain management medications, although it is usually not used in combination with other acetaminophen medications.

 

In the body, pain is a sensation produced through many different signals and pathways interpreted by the brain. Prostaglandins and opioid receptors are two components that contribute to the feeling of a signal being interpreted as pain. Acetaminophen with codeine consists of two medications that target different pathways in the body to achieve a greater decrease of a patient’s pain. The mechanism of action for acetaminophen is not well understood, but it is thought to decrease the formation of prostaglandins. If prostaglandins are not produced, the patient feels less pain. When codeine is ingested, the body converts the medication into morphine, which can bind to opioid receptors in the body. This blocks pain signals from being transmitted, and the brain does not receive the signal to process into the feeling of pain.

Acetaminophen with Codeine


What are the Uses of acetaminophen with codeine?

The FDA approves this medication for the management of mild to moderately severe pain, although this medication is usually reserved as a secondary option for pain therapy due to the potential for abuse.

Acetaminophen with codeine is also reserved for pain management where opioid use is appropriate. There is clinical research to support the use of it in cancer patients suffering from significant pain as well, although this is not typically the first line of treatment for pain due to cancer therapy.

 

While acetaminophen with codeine effectively inhibits many levels of pain, there are cases where the use of this medication may not be appropriate due to medical characteristics of the patient. This medication is not approved for use in children 12 years of age or younger. A treating physician may decide against the use of this medication in patients experiencing significant respiratory distress or severe bronchial asthma. A physician may also seek other therapy options in patients who experienced a previous allergic reaction to either acetaminophen or codeine. Lastly, patients taking Monoamine Oxidase Inhibitors (MAOI) can experience drug interactions with acetaminophen with codeine and would likely benefit from alternate pain medications.

 

An adult prescribed acetaminophen with codeine will typically take a tablet containing 300 – 1000 mg of acetaminophen with 30 – 60 mg codeine every 4 hours. The patient should not exceed 4000 mg acetaminophen or 360 mg of codeine in a 24-hour period. After taking a dose, the patient will know if the medication is working through a noticeable decrease in his or her chronic pain. Acetaminophen with codeine is a medication used on an as-needed basis; if the patient stops experiencing pain then the medication should be discontinued.

 

Acetaminophen with codeine can be taken with or without food, although the patient should take note to drink plenty of fluids to avoid constipation. If the patient experiences an upset stomach, taking the medication with food can aid in discomfort. Patients should not take two doses at a time or take an extra dose if a previous one is missed.

 

Patients should expect to feel physically better when taking this medication as a result of a decrease in overall pain. The regular use of this medication may aid in the management of chronic pain or acute, severe pain typically experienced after a medical procedure allowing the patient to continue activities of daily life. While this medication helps manage pain, it does not cure the underlying cause of pain in the body. This can lead to a dependence on acetaminophen with codeine for chronic pain due to the recurrence of pain once the dose is excreted from the body.

 

Common side effects of taking this medication are sweating, nausea, vomiting, and dizziness or fatigue. To prevent nausea, the patient can plan to take the medication after meals to ease the effects on the gastrointestinal tract. If the patient experiences dizziness or fatigue, he or she may take caution to taking doses at times when cognition is not required, such as before bedtime.

 

A more serious, but rare side effects of acetaminophen with codeine is serotonin syndrome, which is characterized by agitation, increased reflexes and an increase in body temperature. If a patient believes they are experiencing symptoms of serotonin syndrome, it should be discontinued and the patient should contact their physician or pharmacist for suggestions on alternate pain treatments.

 

Lastly, patients taking acetaminophen with codeine should take care to avoid suddenly discontinuing the medication. Acetaminophen with codeine contains an opioid, which is normally tapered over a period of time to prevent withdrawal symptoms.

About Dr. Peter J. Rice

Dr. Peter J. Rice is a professor of Pharmacology emeritus at the East Tennessee State University Quillen College of Medicine and Professor of Clinical Pharmacy at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. --------------------------------------------------------------------------He received his BS in pharmacy from Northeastern University, PhD in pharmacology from the Ohio State University and PharmD from the University of Kentucky. He is a Board Certified Pharmacotherapy Specialist and practices in the ambulatory care and community pharmacy settings. Professor Rice is the author of Understanding Drug Action: An introduction to pharmacology (APhA, 2014) and is a fellow of the American Pharmacists Association. --------------------------He welcomes interesting medication questions and suggestions for future columns.