Admin Tyl and Vicodin w/ in 4 hr

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During report tonight the oncoming nurse told me tyl and vicodin cannot be admin w/in 4 hrs of each other. The order reads Tyl 650 mg 1 po q4/prn/pain and the vicodin order reads Vicodin 5/500 1 or 2 po prn q4/prn/pain. There is nothing in the MARS that says one must wait 4 hrs between doses. I took the vicodin order myself from the MD. He didn't mention anything about waiting. I am a new nurse and the oncoming has been a nurse forever. Is she correct? If so, why isn't it specified in any pt's MARS? I know there is a daily limit for acetiminophen (sp?) dosing. How much/d?

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During report tonight the oncoming nurse told me tyl and vicodin cannot be admin w/in 4 hrs of each other. The order reads Tyl 650 mg 1 po q4/prn/pain and the vicodin order reads Vicodin 5/500 1 or 2 po prn q4/prn/pain. There is nothing in the MARS that says one must wait 4 hrs between doses. I took the vicodin order myself from the MD. He didn't mention anything about waiting. I am a new nurse and the oncoming has been a nurse forever. Is she correct? If so, why isn't it specified in any pt's MARS? I know there is a daily limit for acetiminophen (sp?) dosing. How much/d?

Vicodin 5/500 is 5mg hydrocodone and 500 mg acetominophen. The maxium daily dose of tylenol is 2000mg over this dosage increases the chance of hepatic dysfunction. If you administer a vicodin 500mg it is close to the 650mg dose of tylenol PRN order.

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So she can have 2 vicodin and 3 tyl/d max so as not to exceed the 2000mg/d. She has been getting over the 2000mg/d for at least a wk now between the 3 shifts. This lady is 91 yrs old. Should I ask the MD about the daily limit allowed for this pt?

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I would take the order to mean that she can have up to 650mg acetaminophen q4 hrs, whether it be Tylenol or Vicodin. Therefore, if she had Vicodin, I don't believe she would be able to have Tylenol for another four hours, and vice versa. However, if she is consistently requiring more than the recommended daily dose of acetaminophen, maybe the doctor needs to prescribe something different for pain, as this doesn't seem to be effective for her. If for some reason the doc can't or won't do that, sometimes they will raise the max daily dose to 4000mg (depending on the pt. and her medical condition). You need to be careful not to go over the max prescribed dose -- you could be opening yourself up for trouble. I would discuss this pts. pain management with the doctor -- there are many other options for pain relief meds. Good luck!

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Sorry, I just reread your original post, and realized the order says she can have one or two Vicodin every four hours, meaning that she can have up to 1000mg acet. In this case, she could technically receive Vicodin and Tylenol within four hours of each other, as long as you didn't go over the 1000mg. However, giving her that much in that short of a period of time would mean she would have to wait longer between doses so as not to exceed the daily limit. My advice, talk to the doctor. Apparently, she is not receiving adequate pain relief.

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Specializes in medical, telemetry, IMC.

the max. daily dose of acetaminophen is 4000mg.

http://www.drugs.com/acetaminophen.html

does that lady request pain medicine that often? what kind of pain does she have?

if she request pain medicine around the clock i wouldn't even bother with the tylenol and just give her the vicodin q4 hours (and make sure not to go over the daily limit) and talk to the md to see if something else can be ordered to control the pain.

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She recently fractured a rib. She doesn't like to take the vicodin d/t N but occ does. I offered the pt vicodin bc I had given her tyl 1 1/2 hrs earlier and couldn't admin more tyl for awhile. When I told the oncoming I gave her tyl at 2030 and she was still c/o pain that I offered the pt a vicodin but she refused. That's when the oncoming nurse informed me I couldn't give tyl and vicodin together in a 4 hr period. I disagreed w/ her in spite of her yrs of exp.

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Nothing was mentioned about the mg/d limit. She just told me I couldn't give both w/in a 4 hr period. I said, "Well, the orders don't say that" and she said it should.

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Gotta go bed, ladies, but will check for more replies tomorrow. Thanks for the GREAT feedback! That's why I love allnurses.com!:jester:

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Specializes in Emergency.

The other option would be to see if one can get an order for just the narcotic component of the Vicodin- hydrocodone.

Most generally one should not be giving a repeat dose of acetomiophen in any form with in 4 hrs of a prior dose at the minimum and 6 hrs preferably. There are recent studies that show chronic use of it in low doses is causing liver damage. To this extent alot of facilities are dropping the max a patient can recieve in 24hrs down from 4,000mg to 3,000 and even less as apparently one prior poster had mentioned 2000mg as a max.

Rj

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Our ER docs often order Tylenol 325mg along with 1 tab of Vicodin...one each.

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If I were you I would question the doctors order. I have taken vicodin and was instructed by the physician that NO acetaminopen could be taken as long as I was taking the vicodin (and I am much younger than your pt.) I was told that I could take ibuprofen with the vicodin every 4 hours. Example vicodin then wait 2 hours and have ibuprofen then wait 2 hours and have vicodin. If your pt. is taking vicodin 2 q 4 hrs. then she is getting her daily max of acetaminophen. Also ibuprofen is a NSAID and may do more for her pain than acetaminophen.

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