Daily Maximum Tylenol Dosage Lowered - page 2

McNeil Consumer Healthcare has announced it is lowering the maximum daily dose instructions for Extra Strength Tylenol to six pills a day (3,000 mg) to reduce the risk of acetaminophen overdose. ... Read More

  1. by   SummitRN
    Quote from CloudySky
    Wow very interesting. I've never heard this. Do you have a reference? We were taught they were synergistic.

    Glad they lowered the max dose and that more ppl are aware of the dangers.
    I'm not thinking there is goinng to be a NEJM article on how oxy/apap was done for patent extension. Otoh I could be full of it.

    I read a study showing synergy. I thought it was weak. Ill look for it.
  2. by   Flo.
    What does patient extension mean?
  3. by   MKS8806
    I'm just curiuos.....I'm on the nursing council for my unit and I sent out an email regarding this and how we might have to adjust our standing orders for meds and talk to our doctors about this. I got an email back from another council member saying that we lowered our max dosage to 3250/24 hrs and our population is generally healthy and doesn't take tylenol for long periods of time. In our standing orders we have Tylenol ES 1-2 tabs q4-6hrs prn and Norco 5/325mg 1-2 tabs q4hrs prn. We have some patients that take their Norco 2 every 4 hours. This is getting them 12 tabs in 24 hours, which equals 3900mg of APAP.....should I push this further? What kind of implications could we be looking at if we are not changing our standards to match the FDA?
    ps - I work on a L&D/postpartum unit.
  4. by   rnmi2004
    That's great... now how about making regular strength acetaminophen readily available? I don't know if it's just my area of the country, but it is very difficulty to find the 325mg APAP. Maybe if more people were using the lower dose, there'd be fewer dead livers.
  5. by   wooh
    Not long ago our formulary was changed to reflect the new standards. Our standard doses of hydrocodone/codeine/whatever mixed with tylenol was all changed to lower percentages of tylenol. For example, instead of 5/500, we're using 5/325. Makes it a LOT easier to keep the daily total of tylenol down.
    Not noticing much of a problem with pain relief with the change. My problem has been getting fevers down. The lower doses of tylenol just aren't cutting it.
  6. by   xtxrn
    I've seen too many kids (usually some heartbroken teenage girl) OD on Tylenol, not expecting their LFTs to go nuts a couple of days later....OR that they'd have to take 17 doses of Mucomyst orally to minimize the chance of liver failure. We all assume that OTCs are benign medications-- and even if we, in the medical field, have a bit more respect for them, the general public does not. It's going to take more than a new label to minimize risk....
  7. by   divaRN*
    the thing is patients rarely know tylenol is in vicodin, percocet etc. maybe if they were taking 2 pills (one tylenol the other oxycodone/ hydrocodone) they would be more aware of tylenol intake. i get the whole potential for abuse with straight oxycodone, but if someone wants to OD they will OD with whatever they can get their hands on. they wont care if it is a bottle of oxycodone or a bottle of percocet.
  8. by   Havin' A Party!
    Thought this was to be changed two years ago.
  9. by   ozoneranger
    One case-control study of patients with end-stage renal disease suggested that long term consumption of acetaminophen may significantly increase the risk of ESRD particularly in patients taking more than two pills per day.

    This research was conducted on 1,700 women, and spanned 11 years. Overall, it showed that 10% of the women experienced a decline in their kidney function, indicating that their kidneys were being harmed by acetaminophen .
    Women who took between 1,500 and 9,000 tablets over their lifetimes raised their risk of kidney impairment by 64%, and women who took more than 9,000 tablets increased their risk even further.
    It is estimated that over-the-counter painkillers are responsible for killing over 40,000 Americans each year -- that includes aspirin, acetaminophen, and other painkillers.

    Chronic pain patients, especially the elderly with RA are prescribed vicoden for years on end are finding themselves in chronic renal failure.
    Codeine itself has a weak binding affinity to mu-opioid receptors, 5% to 10% of codeine is converted into morphine, which has a high binding affinity to mu-opioid receptors. Conversion of codeine to morphine occurs in the liver via cytochrome P450, some drugs may interfere with the effectiveness of codeine (ie) certain SSRIs (also converted via cytochrome P450) decrease the analgesic effect of codeine.

    While codeine alone is not as effective, especially went taken with SSRI's, combining acetaminophen with codeine appears to have long term detrimental effects which, in part, could be avoided by removing acetaminophen from the equation.

    Though the folks at Johnson & Johnson don't want to hear that....