II. Indications

  1. Pain
  2. Fever (>102 F or Fever at bedtime)

III. Efficacy: Rheumatologic conditions

  1. Scheduled dosing much more effective than prn
  2. Tylenol 1000 mg qid is as effective as Tylenol #3

IV. Dosing: Children

  1. Avoid overdosage of the Acetaminophen component at all cost (err on the side of underdosage)
  2. Acetaminophen
    1. Well hydrated child: 15 mg/kg every 4 to 6 hours
    2. Dehydration risk: 10 mg/kg every 4 to 6 hours
    3. Dosing by age
      1. Age >2 months (5 kg): 80 mg per dose
      2. Age >4 months (6.5 kg): 100 mg per dose
      3. Age >6 months (8 kg): 120 mg per dose
      4. Age >12 months (10 kg): 160 mg per dose
      5. Age >2 years (13 kg): 200 mg per dose
      6. Age >3 years (15 kg): 240 mg per dose
      7. Age >5 years (19 kg): 280 mg per dose
    4. Maximum
      1. Do not exceed 75 mg/kg/day (up to 4 grams per day)

V. Dosing: Adults

  1. Regular Dose: 650 mg orally every 4 to 6 hours prn
  2. Higher Dose (Osteoarthritis)
    1. Regular Strength Tablet (325 mg)
      1. Take 975 mg (3 tablets) PO every 6 hours
    2. Extra-Strength Tablet (500 mg)
      1. Take 1000 mg (2 tablets) PO every 6 hours
  3. Maximum: 4 grams per day
    1. Do not exceed 12 regular strength tablets (325 mg)
    2. Do not exceed 8 extra-strength tablets (500 mg)

VI. Pharmacokinetics

  1. Similar potency and time-effect curve to Aspirin
  2. Duration: 4 hours

VII. Preparations

  1. Chewable: 80 mg
  2. Elixir: 160 per 5 ml
  3. Dropper: 80 mg per 0.8 ml
  4. Suppository: 120 mg, 325 mg, 650 mg
  5. Tablet
    1. Regular strength: 325 mg
    2. Extra-Strength: 500 mg
  6. Combination agents with Opioids
    1. Vicodin or Lortab (Acetaminophen with Hydrocodone)
    2. Percocet (Acetaminophen with Oxycodone)
  7. Combination agents - miscellaneous
    1. Excedrin Migraine (Acetaminophen with Aspirin and Caffeine)
    2. Sudafed PE (Acetaminophen with Diphenhydramine and Phenylephrine)

IX. Safety: Pregancy

  1. FDA Pregnancy Category B
  2. May be associated with increased risk of ADHD in children with prolonged regular use (>6 weeks)
    1. However Acetaminophen association with ADHD is very weak, and without any evidence of causality (observational study)
    2. Cooper (2014) JAMA Pediatr 168(4):306-307 [PubMed]
  3. Untreated fever over 101 F is also associated with increased fetal risks in pregnancy (and NSAIDs present additional risks)
    1. Dreier (2014) Pediatrics 133(3): e674-88 [PubMed]

X. Precautions

  1. Dehydration predisposes to overdosage
  2. Never exceed maximum daily dosage (hepatotoxicity)

XI. References

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Cost: Medications

acetaminophen (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
ACETAMINOPHEN 120 MG SUPPOS Generic OTC $0.24 each
ACETAMINOPHEN 160 MG/5 ML LIQ Generic OTC $0.01 per ml
ACETAMINOPHEN 325 MG TABLET Generic OTC $0.01 each
ACETAMINOPHEN 500 MG CAPLET Generic OTC $0.02 each
ACETAMINOPHEN 500 MG SOFTGEL Generic OTC $0.04 each
ACETAMINOPHEN 500 MG TABLET Generic OTC $0.02 each
ACETAMINOPHEN 650 MG SUPPOS Generic OTC $0.31 each
ACETAMINOPHEN ER 650 MG TABLET Generic OTC $0.06 each
ACETAMINOPHEN PM CAPLET Generic OTC $0.04 each
ACETAMINOPHEN-COD #2 TABLET Generic $0.11 each
ACETAMINOPHEN-COD #3 TABLET Generic $0.12 each
ACETAMINOPHEN-COD #4 TABLET Generic $0.22 each
ACETAMINOPHEN-CODEINE 120 MG-12 MG/5 ML SOLUTION Generic $0.02 per ml
ACETAMINOPHEN-DIPHENHYDRAMINE 500 MG-25 MG TABLET Generic OTC $0.04 each

Ontology: Acetaminophen (C0000970)

Definition (NCI_NCI-GLOSS) A drug that reduces pain and fever (but not inflammation). It belongs to the family of drugs called analgesics.
Definition (NCI) A p-aminophenol derivative with analgesic and antipyretic activities. Although the exact mechanism through which acetaminophen exert its effects has yet to be fully determined, acetaminophen may inhibit the nitric oxide (NO) pathway mediated by a variety of neurotransmitter receptors including N-methyl-D-aspartate (NMDA) and substance P, resulting in elevation of the pain threshold. The antipyretic activity may result from inhibition of prostaglandin synthesis and release in the central nervous system (CNS) and prostaglandin-mediated effects on the heat-regulating center in the anterior hypothalamus.
Definition (MSH) Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage.
Definition (CSP) analgesic antipyretic derivative of acetanilide; weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D000082
SnomedCT 384977007, 264317002, 387517004, 90332006
LNC LP14712-1, MTHU003399
English Acetamidophenol, Acetaminophen, Acetominophen, Hydroxyacetanilide, p-Acetamidophenol, p-Hydroxyacetanilide, Paracetamol, N-Acetyl-p-aminophenol, Acetamide, N-(4-hydroxyphenyl)-, N-(4-Hydroxyphenyl)acetanilide, PARACETAMOL, 4-Hydroxyacetanilide, N-(4-Hydroxyphenyl)acetamide, acetaminophen, ACETAMINOPHEN, 4-hydroxyacetanilide, acetaminophen (medication), analgesics acetaminophen, APAP, Paracetamol - chemical, Acetaminophen [Chemical/Ingredient], paracetamol, Paracetamol (substance), Paracetamol - chemical (substance), Paracetamol product, Acetaminophen (product), Acetaminophen (substance), Acetaminophen product, ACMP
Swedish Acetaminofen
Czech acetaminofen, paracetamol
Finnish Parasetamoli
Italian Idrossiacetanilide, Acetaminofenolo, Paracetamolo, N-acetile-p-amminofenolo, N-(4-idrossifenil)acetanilide, p-Acetaminofenolo, p-Idrossiacetanilide, Acetominofene, Acetaminofene
Russian ATSETAMIDOFENOL, ATSETAMINOFEN, PARATSETAMOL, GIDROKSIATSETANILID, АЦЕТАМИДОФЕНОЛ, АЦЕТАМИНОФЕН, ГИДРОКСИАЦЕТАНИЛИД, ПАРАЦЕТАМОЛ
Japanese ピリナジン, ピレチノール, N-アセチルアミノフェノール, ヒドロキシアセトアニリド, アニルーメ, アセトアミドフェノール, オキシアセトアニリド, アフロギス, カロナール, アルピニー, パラセタモール, アセトアミノフェノール, アンヒバ, コカール, リングルサット, アスペイン, タイレノール, アセフェン, サールツー, アセトアミノフェン, カルポール, ドリプラン, キオフィーバ
Spanish paracetamol, acetaminofeno (producto), paracetamol (producto), Acetaminofén, paracetamol (sustancia), Acetaminofeno, acetaminofeno (sustancia), acetaminofeno, Paracetamol, Acetamidofenol, Hidroxiacetanilida
Croatian ACETAMINOFEN
French 4-Hydroxyacétanilide, Paracétamol, Acétaminophène, p-Hydroxyacétanilide
Polish Paracetamol, Acetaminofen
Norwegian Acetaminophen, Paracetamol
German Acetamidophenol, Acetaminophen, Azetaminophen, Hydroxyacetanilid, Paracetamol
Portuguese Paracetamol, Acetamidofenol, Acetaminofen, Hidroxiacetanilida

Ontology: Tylenol (C0699142)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D000082
Italian Tylenol
English tylenol, Tylenol
Czech Tylenol