Last updated on December 28th, 2023
Introduction
In this article, you’ll learn about Acetaminophen / Paracetamol (Tylenol) nursing implications and patient teachings. Also, its dosage, indication, contraindications, interactions, and side effects.
Acetaminophen is a popular OTC medicine used to relieve mild to moderate pain and fever across the life span. Acetaminophen is a para-aminophenol derivative which also known as Paracetamol. It is not an NSAID because does not include any anti-inflammatory properties.
Acetaminophen is the generic name and adopted by the United States while Paracetamol is the international non-proprietary name. The most popular name for this drug outside of the United States is paracetamol. Tylenol is another well-known brand name for acetaminophen.
Basically, acetaminophen is the generic name, paracetamol is the international non-proprietary name, and Tylenol is one of its brand names.
Generic Name: Acetaminophen (Paracetamol)
Brand Names: Tylenol, Abenol (CAN), Acephen, Actimol Children’s (CAN), Actimol infant (CAN), Altenol, Aminofen, Apra, Atasol (CAN), Cetafen, Calpol, Dolono, Febrol, Genapap, Genebs, Mapap, Panadol, Pediaphen (CAN), Pyrecot, Pyrigesic, Redutemp, Silapap, Tylenol 8-hr Arthritis Pain Caplets, Uphamol.
Acetaminophen Class and Category
Pharmacologic class: Non-salicylate, para-aminophenol derivative.
Therapeutic class: nonopioid analgesic; antipyretic
Pregnancy category: B
Acetaminophen Dosage
- Adults: PO: 325-650mg q4-8h PRN. Rectal suppository: 650mg q.i.d. IV: 1g q6h or 650 mg q4h PRN. Maximum dose: 4 g/day in divided doses.
- Children: PO: 10 – 15 mg/kg q4-8h PRN. Maximum dose: 75 mg/kg/day.
Acetaminophen Pharmaco*kinetics and Pharmacodynamics
Route | Onset | Peak | Duration |
IV | rapid | 0.5 – 2 hr | 3 – 4 hr |
PO | 10 – 30 min | 30 – 60 min | 3 – 5 hr |
Rectal | unknown | unknown | 4 – 6 hr |
Absorption: Acetaminophen/paracetamol is quickly and effectively absorbed in the GI tract when taken orally. Rectal absorption varies.
Distribution: Protein binding is 20%–50%.
Metabolism: Hepatic.
Half-life: 1 – 4 hr
Excretion: The kidneys eliminate inactive substances through urine.
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Acetaminophen Mechanism of Action
Antipyretic: Acetaminophen has a direct effect on the hypothalamic temperature-regulating center by decreasing prostaglandin E2 synthesis.
Analgesic: Acetaminophen inhibits cyclooxygenase, preventing prostaglandin synthesis and thereby reducing pain sensation.
What are the indications of acetaminophen?
Acetaminophen/paracetamol (Tylenol) indications include:
- To relieve mild to moderate pain
- To reduce fever
- To relive dysmenorrhea
- To alleviate dental pain
- To alleviate headaches
- To relieve myalgia
What are the contraindications of acetaminophen?
The contraindications of acetaminophen/paracetamol (Tylenol) are:
- Hypersensitivity to acetaminophen
- Severe hepatic or renal disease
Caution: pregnancy, breastfeeding, geriatric patients, anemia, active renal or hepatic disease, G6PD deficiency, chronic alcoholism.
Acetaminophen Interactions
Acetaminophen/paracetamol interactions include:
- Acetaminophen’s action of onset is slowed by anticholinergics.
- Acetaminophen has a decreased therapeutic effect and a higher risk of hepatotoxicity when combined with barbiturates, carbamazepine, hydantoins, isoniazid, rifampin, or sulfinpyrazone.
- Dasatinib and imatinib may increase the risk of hepatotoxicity.
- Oral contraceptives reduce effectiveness of acetaminophen.
- May elevate serum ALT, AST, bilirubin, K+, and prothrombin levels.
Herbal/food interactions
- St. John’s wort increases risk of hepatotoxicity
- Alcohol consumption increases risk of hepatotoxicity
What are acetaminophen side effects?
Acetaminophen / paracetamol (Tylenol) side effects / adverse reactions include:
- Anorexia
- Nausea and vomiting
- Abdominal pain
- Agitation
- Rash
- Insomnia
- Oliguria
- Urticaria
- Elevated liver enzymes,
- Hypoglycemia
- Life-threatening adverse effects: hemorrhage, hepatotoxicity, hemolytic anemia, agranulocytosis, leukopenia, thrombocytopenia, seizures, coma, death.
Black Box Warning! |
Acetaminophen injection has been linked to acute liver failure. There is a risk of severe liver damage. |
Acetaminophen Nursing Implications [Nursing Considerations]
Acetaminophen/paracetamol (Tylenol) nursing considerations are divided into nursing assessment, interventions, and evaluation.
Acetaminophen (tylenol) nursing assessment
- Obtain detailed medical and drug related history including hypersensitivity, possible drug-drug and drug-food interactions.
- Monitor vital signs
- Assess the severity of pain including location, characteristics such as radiating, relieving and aggravating factors, onset, duration.
- Monitor LFTs, RFTs, and CBC with long-term acetaminophen therapy.
Acetaminophen (tylenol) nursing diagnosis
- Risk for injury related to adverse effects.
- Acute pain or chronic pain (indication)
- Hyperthermia (indication)
- Deficient knowledge related to drug’s mechanism of action and adverse effects.
Acetaminophen (tylenol) nursing interventions/ actions
- Monitor vital signs.
- Ensure total acetaminophen dose does not exceed 4g/day.
- Reassess pain and body temperature after one hours of administering the acetaminophen.
- Determine LFTs, RFTs, and CBC with high doses or overdose of acetaminophen.
- Monitor serum acetaminophen level with long-term therapy (normal range: 10–30 mcg/mL, toxic level: more than 200 mcg/mL).
- Store suppositories at temperatures below 26.6°C (80°F).
IV administration considerations
- Administer parenteral acetaminophen over 15 minutes (dilution is not required).
- For pediatrics, draw the required dose to a syringe and infuse via syringe pump over 15 minutes.
- Use the medication within 6 hours of puncturing the protective seal of the vial or after transferring the content.
- Closely observe for air in the IV tubing to prevent air embolism.
Evaluation
Evaluate the effectiveness of the drug: to relieve pain; to reduce fever; taking recommended daily dose without any side effects.
Pregnancy/breastfeeding considerations for acetaminophen/paracetamol (tylenol)
- Use with caution during pregnancy and breastfeeding. Because it crosses placenta and excretes in breastmilk.
- Acetaminophen should not be used for long-term during pregnancy and lactation without consulting a physician.
What is the patient teaching for acetaminophen?
The nurse should discuss the following points during the acetaminophen/paracetamol (Tylenol) patient teaching.
- Teach the patient how to recognize adverse effects (eg; bleeding, easy bruising, and malaise) and interactions.
- Advise the patient not to exceed recommended daily dose (4g/day).
- Instruct the patient to store medication out of reach of children.
- Teach the caretaker how to measure and administer accurate dose for infants and children.
- Explain to the patient that acetaminophen can cause both female and male fertility problems.
Treatment of Overdose
- Determine serum acetaminophen level
- Gastric lavage
- Administer acetylcysteine as prescribed
- Observe for bleeding
Conclusion
To sum up, acetaminophen, paracetamol, and Tylenol are essentially the same drug. Acetaminophen is the generic name, paracetamol is the international non-proprietary name, and Tylenol is just one of the many brand names.
Furthermore, you learned about acetaminophen/paracetamol (Tylenol) nursing implications (aka nursing considerations), and patient teaching in this article. In addition, you’ve learned about acetaminophen’s mechanism of action, pharmaco*kinetics, dosage, indications, nursing diagnoses, contraindications, and side effects.
Recommended Readings & Reference
Kee, J., Hayes, E., & McCuistion, L. (2015). PHARMACOLOGY A Patient-Centered Nursing Process Approach (8th ed.). Elsevier Inc/Saunders.
Kizior, R., & Hodgson, K. (2021). SAUNDERS NURSING DRUG HANDBOOK 2021. Elsevier Inc.
Jones & Bartlett Learning. (2021). Nurse’s Drug Handbook (20th ed.). Jones & Bartlett Learning, LLC.
Skidmore-Roth, L. (2021). MOSBY’S 2021 NURSING DRUG REFERENCE (34th ed.). Elsevier Inc.