Coordination of meds question

[DHnurse]

What is your opinion? Tylenol and Vicodin ordered for pain. Tylenol 650 mg given. One hour later, pain is at the same level or increasing. Would you give the Vicodin? Both contain acetaminophen so I know I need to stop Tylenol once I begin administering Vicodin (don't want to exceed 4 grams is 24 hours) Is it too early for Vicodin? Thank you.

[fab4fan]

When was the Vicodin last given? Is this going to be the first dose of Vicodin? If it is, I would go ahead and give it. Even so, you'll have to watch the acet. If the pt is going to need multiple doses of pain meds it may be better for the pt to get an opioid that doesn't contain acet. (e.g. Dilaudid, OxyIR, MSIR).

[DHnurse]

It will be the first dose. The doctor ordered Vicodin but said to try Tylenol first. Thanks for your answer

[teeituptom, BSN, RN]

ask him if he would prefer Vicoproffen

[Dave ARNP]

I think the better idea here would be to use a medication other than Tylenol.

Since you've not said what you're treating, it's kinda hard for me to speculate. I will say that the first thing generally done here would be start a COX-2 agent, (I prefer Celebrex) and use Vicodin PRN. Ideally, 400mg of Celebrex to start, then 200mg QD, with Vicodin PRN.

If you'll elaborate a little more on the source of pain you're trying to treat, I can make a few more suggestions for you to take to his MD.

-Dave

[teeituptom, BSN, RN]

Im sure dilaudid would work just fine

[DHnurse]

My patient has Multiple Myeloma, Arthritis, Hypertension, Gout and DM. So far, she has only taken Vicodin once. Tylenol works for now but I want to be prepared. There will come a time when Tylenol is not enough. Thanks