Tylenol IV - page 4

by Adri_RN 27,477 Views | 38 Comments

Ok, so the other day I receive a post op on our floor with an order for Tylenol 500 mg IV q8h x2. I thought the doc had written the order by mistake.... IV? So I call him to clarify, and he tells me yes, administer it via IVPB.... Read More


  1. 2
    Quote from pumpkin455
    I have seen it come on the scene in the last 3 months. I work in Ortho and a bunch of our surgeons have deemed it "the miracle drug". We typically give 1000 mg Q6 x 24 hours post op- so that puts pts right at their 4G limit for 24 hours.
    Also one thing we have learned is that- per our pharmacy, the only IV fluid it is compatible with is normal saline, otherwise it must have its own tubing.
    Not so sure I'm convinced of its effectiveness yet, I really think Toradol is the way to go for a non-narcotic pain med.
    Toradol is great; unfortunately, it's also contraindicated in several instances (renal failure, hx of ulcers, hx of abnormal bleeding, age 65 or older). Many patients can't take NSAIDS of any kind for those reasons, so the IV APAP certainly makes a wonderful alternative. Also, a patient could receive BOTH the Toradol and the APAP, which has the potential to reduce the need for narcotic medication even more.
    CCRNDiva and pumpkin455 like this.
  2. 0
    I saw it used in the UK on my friend when I was over there visiting about 3-4 yrs ago I was amazed and the RN's said they thought it worked very well
  3. 0
    Quote from nozyrozy40
    The new MDD of acetaminophen is 3 grams/24hr.
    I did not know that!! Thank you for sharing...I will have to see if our pharmacy is aware!
  4. 1
    Quote from cherrybreeze
    Toradol is great; unfortunately, it's also contraindicated in several instances (renal failure, hx of ulcers, hx of abnormal bleeding, age 65 or older). Many patients can't take NSAIDS of any kind for those reasons, so the IV APAP certainly makes a wonderful alternative. Also, a patient could receive BOTH the Toradol and the APAP, which has the potential to reduce the need for narcotic medication even more.
    Ketorolac (TORADOL) isn't contraindicated in all of those cases. You should reduce dose from 30mg to 15mg when the pt has elevated renal numbers, or delayed creatinine clearance. It also is not contraindicated in pts with abnormal bleeding any more than aspirin or other NSAIDs are. Perhaps the article that ortho surgeons keep citing as a reason to not give Ketorolac should be read a little closer. One time dosing does not increase bleeding risk appreciably.

    In my practice I use ketorolac in almost all ortho and gyn cases. It has a pain relief equivalency of 6-8mg morphine. I reduce the dose with older pts and those w renal compromise. Renal failure I hold it.

    Ofirmev is a decent substitute when ketorolac is not used, but it is quite expensive right now.
    Altra likes this.
  5. 0
    Quote from Phishininau
    Ketorolac (TORADOL) isn't contraindicated in all of those cases. You should reduce dose from 30mg to 15mg when the pt has elevated renal numbers, or delayed creatinine clearance. It also is not contraindicated in pts with abnormal bleeding any more than aspirin or other NSAIDs are. Perhaps the article that ortho surgeons keep citing as a reason to not give Ketorolac should be read a little closer. One time dosing does not increase bleeding risk appreciably.

    In my practice I use ketorolac in almost all ortho and gyn cases. It has a pain relief equivalency of 6-8mg morphine. I reduce the dose with older pts and those w renal compromise. Renal failure I hold it.

    Ofirmev is a decent substitute when ketorolac is not used, but it is quite expensive right now.
    I understand all of that. I can also understand a doc choosing NOT to use it, rather than using a decreased dose, if there is risk present to any degree. I did state that there are patients that can't use ANY type of NSAID for those reasons, not just Toradol.

    I don't know what you are referring to when you mention "the article that ortho surgeons keep citing;" I was speaking from my experience (and the info that prints up, from our pharmacists, when any order for ketorolac is entered).

    It doesn't just have to be a substitute, the two can be used together. Yes, it's expensive, but that's another risk vs. reward scenario.
  6. 0
    Quote from cherrybreeze
    I understand all of that. I can also understand a doc choosing NOT to use it, rather than using a decreased dose, if there is risk present to any degree. I did state that there are patients that can't use ANY type of NSAID for those reasons, not just Toradol.

    I don't know what you are referring to when you mention "the article that ortho surgeons keep citing;" I was speaking from my experience (and the info that prints up, from our pharmacists, when any order for ketorolac is entered).

    It doesn't just have to be a substitute, the two can be used together. Yes, it's expensive, but that's another risk vs. reward scenario.
    I'm aware that ofirmev doesn't have to be a substitute. I was trying to offer an example in that if you want NSAID coverage and you believe the increased bleeding risk mantra with relation to single dose ketorolac. In my practice I use both occasionally, but usually stick to one NSAID.
  7. 0
    Quote from AirforceRN
    I believe the Brits have been using IV acetaminophen for some time...I haven't used it before but anything that can decrease my suppository count can only be good in my books.
    Yep, UK been using it for several years. When I had Gastric Bypass in 2005 by surgeon used it IV for the first 24 hours as well as PCA for 12 hours and I hardly used the PCA as pain was so well controlled with the IV Paracetamol (UK version of Tylenol)
  8. 0
    Quote from Phishininau
    I'm aware that ofirmev doesn't have to be a substitute. I was trying to offer an example in that if you want NSAID coverage and you believe the increased bleeding risk mantra with relation to single dose ketorolac. In my practice I use both occasionally, but usually stick to one NSAID.
    I have no idea what you just said. I read it three times, and it's not making sense.
  9. 0
    Quote from Phishininau
    I'm aware that ofirmev doesn't have to be a substitute. I was trying to offer an example in that if you want NSAID coverage and you believe the increased bleeding risk mantra with relation to single dose ketorolac. In my practice I use both occasionally, but usually stick to one NSAID.
    My understanding is that the main concern is not related to bleeding but to thrombus formation, causing either MI or stroke, I think the FDA warning might be a little broad in this case since it lumps Cox selective and unselective into the same group, but I agree there's enough evidence to be concerned in general, but not enough to definitively say what the risks are with each type.

    Not sure what you mean "stick to one NSAID", acetaminophen is not an NSAID.


Top