acet
acetaminophen (oral, rectal)
(a-seet-a-min-oh-fen) acetaminophen,Abenol
(trade name),Acephen
(trade name),Acet
(trade name),APAP
(trade name),Artritol
(trade name),Aspirin Free Anacin
(trade name),Atasol
(trade name),Cetafen
(trade name),Feverall
(trade name),Fortolin
(trade name),Infantaire
(trade name),Little Fevers
(trade name),Mapap
(trade name),Nortemp Children's
(trade name),Ofirmev
(trade name),Pain-Eze
(trade name),Pediaphen
(trade name),Pediatrix
(trade name),Silapap
(trade name),Silapap Infant's
(trade name),Taminol
(trade name),Tempra
(trade name),Tylenol
(trade name),Valorin
(trade name)acetaminophen (intravenous)
,Ofirmev
(trade name)Classification
Therapeutic: antipyreticsPregnancy Category: C (intravenous)
Indications
- Mild pain,
- Fever.
- Mild to moderate pain,
- Moderate to severe pain with opioid analgesics,
- Fever.
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (analgesia and antipyresis)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | 0.5–1 hr | 1–3 hr | 3–8 hr† |
| Rect | 0.5–1 hr | 1–3 hr | 3–4 hr |
| IV‡ | within 30 min | 30 min | 4–6 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- agitation (↑ in children) (IV)
- anxiety (IV)
- headache (IV)
- fatigue (IV)
- insomnia (IV)
Respiratory
- atelectasis (↑ in children) (IV)
- dyspnea (IV)
Cardiovascular
- hypertension (IV)
- hypotension (IV)
Gastrointestinal
- hepatotoxicity (↑ doses) (life-threatening)
- constipation (↑ in children) (IV)
- ↑ liver enzymes
- nausea (IV)
- vomiting (IV)
Fluid and Electrolyte
- hypokalemia (IV)
Genitourinary
- renal failure (high doses/chronic use)
Hematologic
- neutropenia
- pancytopenia
Musculoskeletal
- muscle spasms (IV)
- trismus (IV)
Dermatologic
- acute generalized exanthematous pustulosis (life-threatening)
- stevens-johnson syndrome (life-threatening)
- toxic epidermal necrolysis (life-threatening)
- rash
- urticaria
Interactions
Drug-Drug interaction
Chronic high-dose acetaminophen (>2 g/day) may ↑ risk of bleeding with warfarin (INR should not exceed 4).Hepatotoxicity is additive with other hepatotoxic substances, including alcohol.Concurrent use of isoniazid, rifampin, rifabutin, phenytoin, barbiturates, and carbamazepine may ↑ the risk of acetaminophen-induced liver damage (limit self-medication); these agents will also ↓ therapeutic effects of acetaminophen.Concurrent use of NSAIDs may ↑ the risk of adverse renal effects (avoid chronic concurrent use).Propranolol ↓ metabolism and may ↑ effects.May ↓ effects of lamotrigine and zidovudine.Route/Dosage
Children ≤12 yr should not receive >5 PO or rectal doses/24 hr without notifying physician or other health care professional. No dosage adjustment needed when converting between IV and PO acetaminophen in adults and children ≥50 kgAvailability (generic available)
Nursing implications
Nursing assessment
- Assess overall health status and alcohol usage before administering acetaminophen. Patients who are malnourished or chronically abuse alcohol are at higher risk of developing hepatotoxicity with chronic use of usual doses of this drug.
- Assess amount, frequency, and type of drugs taken in patients self-medicating, especially with OTC drugs. Prolonged use of acetaminophen increases the risk of adverse renal effects. For short-term use, combined doses of acetaminophen and salicylates should not exceed the recommended dose of either drug given alone. Do not exceed maximum daily dose of acetaminophen when considering all routes of administration and all combination products containing acetaminophen.
- Pain: Assess type, location, and intensity prior to and 30–60 min following administration.
- Fever: Assess fever; note presence of associated signs (diaphoresis, tachycardia, and malaise).
- Lab Test Considerations: Evaluate hepatic, hematologic, and renal function periodically during prolonged, high-dose therapy.
- May alter results of blood glucose monitoring. May cause falsely ↓ values when measured with glucose oxidase/peroxidase method, but probably not with hexokinase/G6PD method. May also cause falsely ↑ values with certain instruments; see manufacturer’s instruction manual.
- Increased serum bilirubin, LDH, AST, ALT, and prothrombin time may indicate hepatotoxicity.
If overdose occurs, acetylcysteine (Acetadote) is the antidote.
Potential Nursing Diagnoses
Acute pain (Indications)Risk for imbalanced body temperature (Indications)
Implementation
- Do not confuse Tylenol with Tylenol PM.
- To prevent fatal medication errors ensure dose in milligrams (mg) and milliliters (mL) is not confused; dosing is based on weight for patients under 50 kg; programming of infusion pump accurate; and total daily dose of acetaminophen from all sources does not exceed maximum daily limits.
- When combined with opioids do not exceed the maximum recommended daily dose of acetaminophen.
- Oral: Administer with a full glass of water.
- May be taken with food or on an empty stomach.
Intravenous Administration
- Intermittent Infusion: For 1000 mg dose, insert vented IV set through septum of 100 mL vial; may be administered without further dilution. For doses <1000 mg, withdraw appropriate dose from vial place in a separate empty, sterile container for IV infusion. Place small volume pediatric doses up to 60 mL in a syringe and administer via syringe pump. Solution is clear and colorless; do not administer solutions that are discolored of contain particulate matter. Administer within 6 hrs of breaking vial seal.
- Rate: Infuse over 15 min. Monitor end of infusion in order to prevent air embolism, especially if acetaminophen is primary infusion.
- Y-Site Compatibility: buprenorphine, butorphanol, D5W, dexamethasone, D10W, D5/LR, D5/0.9% NaCl, diphenhydramine, dolasetron, droperidol, fentanyl, granisetron, heparin, hydrocortisone, hydromorphone, ketorolac, LR, lidocaine, lorazepam, mannitol, meperidine, methylprednisolone, metoclopraminde, midazolam, morphine, nalbuphine, 0.9% NaCl, ondansetron, potassium chloride, prochlorperazine, sufentanil
- Y-Site Incompatibility: chlorpromazine, diazepam
- Additive Incompatibility: Do not mix with other medications.
Patient/Family Teaching
- Advise patient to take medication exactly as directed and not to take more than the recommended amount. Chronic excessive use of >4 g/day (2 g in chronic alcoholics) may lead to hepatotoxicity, renal or cardiac damage. Adults should not take acetaminophen longer than 10 days and children not longer than 5 days unless directed by health care professional. Short-term doses of acetaminophen with salicylates or NSAIDs should not exceed the recommended daily dose of either drug alone.
- Advise patient to avoid alcohol (3 or more glasses per day increase the risk of liver damage) if taking more than an occasional 1–2 doses and to avoid taking concurrently with salicylates or NSAIDs for more than a few days, unless directed by health care professional.
- Advise patient to discontinue acetaminophen and notify health care professional if rash occurs
- Inform patients with diabetes that acetaminophen may alter results of blood glucose monitoring. Advise patient to notify health care professional if changes are noted.
- Caution patient to check labels on all OTC products. Advise patients to avoid taking more than one product containing acetaminophen at a time to prevent toxicity.
- Advise patient to consult health care professional if discomfort or fever is not relieved by routine doses of this drug or if fever is greater than 39.5°C (103°F) or lasts longer than 3 days.
- Pediatric: Advise parents or caregivers to check concentrations of liquid preparations. All OTC single ingredient acetaminophen liquid products now come in a single concentration of 160 mg/5 mL. Errors have resulted in serious liver damage. Have parents or caregivers determine the correct formulation and dose for their child (based on the child's age/weight), and demonstrate how to measure it using an appropriate measuring device.
Evaluation/Desired Outcomes
- Relief of mild to moderate pain.
- Reduction of fever.