Acetaminophen with codeine

III Significant but less abuse and dependency potential than that of schedule I and II agents. They may contain limited quantities of certain narcotics. Aspirin with codeine Acetaminophen with codeine... 

High-dose NSAIDs and the combination of aspirin or acetaminophen with butalbital or, rarely, codeine, are effective options. The use of butalbital and codeine combinations should be avoided when possible. 

Catalytic reduction of codeine gives dihydrocodeine and Oppenauer oxidation (a ketone such as acetone and an aluminum alkoxide, the ketone being reduced to an alcohol) gives hydrocodone. Hydrocodone can also be prepared directly from codeine with a metal catalyst, which isomerizes the allylic alcohol to a ketone. Codeine is prepared by methylation of morphine, which is isolated from the opium poppy. Hydrocodone is more potent than codeine. Acetaminophen is a mild analgesic and is discussed in Section 8. 

Tylenol with codeine acetaminophen Tablets, liquid Relief of acute pain of mild-to-moder-ate intensity... 

Codeine/acetaminophen (generic, Tylenol with Codeine, others)... 

A survey published in 2001 shows that primary care physicians would much rather prescribe Schedule III pain relievers—such as acetaminophen with codeine—for chronic pain not due to cancers. Thirty-five percent of the 161 doctors responding to the mailed survey stated they would never prescribe Schedule II opioids to be used around-the-clock by patients in persistent pain. Those who would be willing to give the Schedule II drugs were those who also indicated a lower degree of concern about... 

Acetaminophen can interact with other drugs, both in good and bad ways. For example, hospitals often combine acetaminophen with the narcotic pain reliever codeine (CoTylenol ) to treat more severe pain. Caffeine can increase the effectiveness of acetaminophen similarly to the way it does with aspirin. Brand names that use a combination of aspirin, caffeine, and acetaminophen include Excedrin and Vanquish . Combining these ingredients for their additive effects also reduces the dose needed for each one and thereby reduces the risk of side effects. However, there are a few drugs that should not be mixed with acetaminophen. These include anticonvulsants and alcohol, both of which increase the risk of liver damage. 

SCHEDULE II Certain barbiturates, cocaine, codeine, codeine + acetaminophen (depends on dose and formulation), fentanyl (depends on dose), hydrocodone, hydromorphone, meperidine, methadone, morphine (depends on combination with other pain relievers), oxycodone, propoxyphene... 

The opioid analgesics of choice for use in the elderly are listed in Box 7-3. For treatment of moderate to severe pain, an effective opioid regimen consists of a combination of acetaminophen with 15 to 60 mg codeine or acetaminophen with 5 to 30 mg oxycodone. Acetaminophen combinations with hydrocodone are also frequently used. If pain persists, an alternative opioid analgesic should be selected. Adjuvants such as caffeine may enhance the analgesic activity of the opioid. 

ACETAMINOPHEN AND ACETAMINOPHEN WITH CODEINE PHOSPHATE (N-Acetyl-P-Aminophenol, APAP, Acephen, Anacin-3, Bromo-Seltzer, Datril, Datril 500, Tempra, Tylenol, Valadol, Valorin)... 

Ko, C.Y. Marziani, F.C. Janicki, C.A. H -performance liquid chromatographic assay of codeine in acetaminophen with codeine dosage forms. J.Pharm.Sci., 1980, 69, 1081-1084... 

Toms L, Derry S, Moore RA, McQuay HJ (2(X)9) Single dose oral paracetamol (acetaminophen) with codeine for postoperative pain in adults. Cochrane Database Syst Rev (1) CD001547 DOI 10.1002/14651858.CD001547.pub2... 

Drendel AL, Gorelick MH, Weisman SJ, Lyon R, Brousseau DC, Kim MK (2009) A randomized clinical trial of ibuprofen versus acetaminophen with codeine for acute pediatric arm fracture pain. Ann Emerg Med 54(4) 553-560... 

Friedman AP, DiSerio FJ. Symptomatic treatment of chronically recurring tension headache a placebo-controlled multicenter investigation of Fioricet and acetaminophen with codeine. Clin Jher 1987 10 69-81. 

Severe pain should be treated with an opioid such as morphine, hydromorphone, methadone, or fentanyl. Moderate pain can be treated effectively in most cases with a weak opioid such as codeine or hydrocodone, usually in combination with acetaminophen. Meperidine should be avoided owing to its relatively short analgesic effect and its toxic metabolite, normeperidine. Normeperidine may accumulate with repeated dosing and can lead to central nervous system side effects including seizures. 

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