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acetaminophen (N-acetyl-p-aminophenol)

(a seet a min' a fen)


Suppositories:
Abenol (CAN), Acephen, Children's FeverAll
Oral:
Aceta, Apacet, Atasol (CAN), Genapap, Genebs, Liquiprin, Mapap, Panadol,
Tapanol, Tempra, Tylenol

Pregnancy Category B

Drug classes
Antipyretic
Analgesic (nonopioid)

Therapeutic actions
Antipyretic: Reduces fever by acting directly on the hypothalamic heat-regulating center
to cause vasodilation and sweating, which helps dissipate heat.
Analgesic: Site and mechanism of action unclear.

Indications
• Analgesic-antipyretic in patients with aspirin allergy, hemostatic disturbances,
bleeding diatheses, upper GI disease, gouty arthritis
• Arthritis and rheumatic disorders involving musculoskeletal pain (but lacks
clinically significant antirheumatic and anti-inflammatory effects)
• Common cold, flu, other viral and bacterial infections with pain and fever
• Unlabeled use: prophylactic for children receiving DPT vaccination to reduce
incidence of fever and pain

Contraindications and cautions


• Contraindicated with allergy to acetaminophen.
• Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy,
lactation.

Available forms
Suppositories—80, 120, 125, 300, 325, 650 mg; chewable tablets—80 mg; tablets—160,
325, 500, 650 mg; caplets—160, 500, 650 mg; gelcaps—650 mg; capsules—325,
500 mg; elixir—80 mg/2.5 mL, 80 mg/5 mL, 120 mg/5 mL, 160 mg/5 mL; liquid—
160 mg/5 mL, 500 mg/15 mL; solution—80 mg/1.66 mL, 100 mg/mL; drops—80 mg/0.8
mL; sprinkle capsules—80, 160 mg

Dosages
ADULTS
PO or PR
By suppository, 325–650 mg q 4–6 hr or PO, 1,000 mg tid to qid. Do not exceed 4 g/day.
PEDIATRIC PATIENTS
PO or PR
Doses may be repeated 4–5 times/day; do not exceed five doses in 24 hr; give PO or by
suppository.

Age Dosage (mg)


0–3 mo 40
4–11 mo 80
1–2 yr 120
2–3 yr 160
4–5 yr 240
6–8 yr 320
9–10 yr 400
11 yr 480

Pharmacokinetics
Route Onset Peak Duration
Oral Varies 0.5–2 hr 3–4 hr

Metabolism: Hepatic; T1/2: 1–3 hr


Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CNS: Headache
• CV: Chest pain, dyspnea, myocardial damage when doses of 5–8 g/day are
ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr
• GI: Hepatic toxicity and failure, jaundice
• GU: Acute kidney failure, renal tubular necrosis
• Hematologic: Methemoglobinemia—cyanosis; hemolytic anemia—hematuria,
anuria; neutropenia, leukopenia, pancytopenia, thrombocytopenia, hypoglycemia
• Hypersensitivity: Rash, fever

Interactions
Drug-drug
• Increased toxicity with long-term, excessive ethanol ingestion
• Increased hypoprothrombinemic effect of oral anticoagulants
• Increased risk of hepatotoxicity and possible decreased therapeutic effects with
barbiturates, carbamazepine, hydantoins, rifampin, sulfinpyrazone
• Possible delayed or decreased effectiveness with anticholinergics
• Possible reduced absorption of acetaminophen with activated charcoal
• Possible decreased effectiveness of zidovudine
Drug-lab test
• Interference with Chemstrip G, Dextrostix, and Visidex II home blood glucose
measurement systems; effects vary

Nursing considerations
Assessment
• History: Allergy to acetaminophen, impaired hepatic function, chronic
alcoholism, pregnancy, lactation
• Physical: Skin color, lesions; T; liver evaluation; CBC, liver and renal function
tests

Interventions
• Do not exceed the recommended dosage.
• Consult physician if needed for children < 3 yr; if needed for longer than 10 days;
if continued fever, severe or recurrent pain occurs (possible serious illness).
• Avoid using multiple preparations containing acetaminophen. Carefully check all
OTC products.
• Give drug with food if GI upset is noted.
• Discontinue drug if hypersensitivity reactions occur.
• Treatment of overdose: Monitor serum levels regularly, N-acetylcysteine should
be available as a specific antidote; basic life support measures may be necessary.

Teaching points
• Do not exceed recommended dose; do not take for longer than 10 days.
• Take the drug only for complaints indicated; it is not an anti-inflammatory agent.
• Avoid the use of other over-the-counter preparations. They may contain
acetaminophen, and serious overdosage can occur. If you need an over-the-
counter preparation, consult your health care provider.
• Report rash, unusual bleeding or bruising, yellowing of skin or eyes, changes in
voiding patterns.

Adverse effects in Italics are most common; those in Bold are life-threatening.

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