When Can I give more Tylenol

~Mi Vida Loca~RN, ASN, RN · Jun 5, 2017

If it were me and my patient was maxing out on their Tylenol dosage for the day, I would think it's time to look at alternative medications because maybe the Tylenol is not working. Or adding something to it because the Tylenol is not working enough.

The max dose used to be 4 grams a day. So you could give 2 500mg every 6 hrs safely.(or whatever combination that didn't exceed that) They lowered the max safe dose to 3 grams a day. I don't recall if hospitals followed suit or if that was more for home usage. But would be the same principle.

So call your pharmacy and see if your hospital is on the 4 or 3 gram max dosage and it would be pretty simple to figure it out. Also keep in mind medications that have Tylenol in them. So if someone is getting Percocet for example, that's usually 325 mg per pill. So 2 Percocet would yield 650mg of Tylenol (again dosages vary I am just using what I see as the typical standard)

Also, when you say they are "maxing out" Are you stating they are exceeding the 3 or 4 grams in 24 hrs, or that they are using all that the doctor has ordered and still in pain? If the second is the case then again I would look back to alternate medications. If the first is what you mean, then you already have your answer. You already have maxed out.

Isakolistic · Jun 5, 2017

The EMR system that we use automatically tracks how much tylenol is administered in the last 24 hours, even if it is part of a combination med. If we attempt to give over the "max" of 4g in a 24 hour period, it will warn you with a popup that you need to override in order to give the medication. If your facility does not have an EMR with these kind of capabilities, the easiest way to determine this would be to contact the pharmacy or just check the EMR and add up their total for the past 24 hours. If they are at or near their "max", you may need to wait until a previously administered dose of tylenol "times out"; for example, if someone administered 1000 mg of tylenol at 0600 the previous day and they are at their max, you would need to wait until at least 0600 the next day to administer the next dose.

**NICU Guy, BSN, RN** · Jun 5, 2017

If you are maxing out a PRN pain med then it is time to talk to the doctor about something that will work better and longer lasting pain relief.

nurseyah · Jun 5, 2017

Hi everyone! Thanks for replying! Yes we are alerted when the pt is about to reach the max of APAP for that day via the EMR (Epic). I was thinking the same as a previous poster that looking in another pain reliever would be beneficial if the pt maxes out of APAP. I see Ofirmev prescribed every 6 hours scheduled AND prn Norco and I am like the pt's not going to be able to take anymore APAP if they take the Orfirmev as prescribed. I believe the max in our hospital is still 4grams which I thought was strange as it has been lowered to 3 grams or maybe that's for outpatient settings.

MunoRN, RN · Jun 5, 2017

I don't understand why your coworkers are calling pharmacy to see when a patient can get more acetaminophen, you add up the cumulative dose of APAP over the last 24 hours and make sure it stays below the set limit (the FDA recommends

If the patient has good pain control on a maximum dose of acetaminophen then there is no reason to change things up, generally patients should be maxed out on acetaminophen before adding opiates, which is one reason why opiates often come already combined with acetaminophen.