How to Take Your Medicine: 
Acetaminophen-Codeine 

    How you take a drug can be very important to both its effectiveness and 
safety. Sometimes it can be almost as important as what you take. Timing, 
what you eat and when you eat, proper dose, and many other factors can mean 
the difference between feeling better, staying the same, or even feeling
worse. This drug information page is intended to help you make your 
treatment work as effectively as possible. It is important to note, however,
that this is only a guideline. You should talk to your doctor about how and 
when to take any prescribed drugs.
    This installment in a series of articles on commonly prescribed drugs is
about acetaminophen-codeine combinations. 
    One of the most widely prescribed drugs and the most commonly prescribed
pain reliever in the United States, acetaminophen-codeine is a combination
of two medicines: acetaminophen, a pain remedy commonly found in such drugs 
as over-the-counter Tylenol; and codeine, a narcotic (morphine-like drug) 
that acts as a painkiller.
    More than 28.5 million prescriptions for acetaminophen-codeine
combinations were filled in 1989 in American drugstores.

Conditions These Drugs Treat
    The medication is prescribed for many different kinds of pain, ranging
from migraine headaches and broken bones or sprains to dental or
post-surgical pain. It is also sometimes prescribed to reduce coughing. 

How to Take 
    Take this medicine only as directed by your physician or dentist. Do not
take for a longer time than your doctor has prescribed. This drug is a
narcotic and may be habit-forming. Even if the drug is not relieving the
pain as well as you think it should, do not increase the dose without 
checking with your doctor or dentist. 

Missed Doses
    If you are taking this drug on a regular schedule and skip a dose, take 
it as soon as you remember. If it is nearly time for your next dose, skip 
the missed dose and get back on your regular dosing schedule. Do not double 
doses.

Relief of Symptoms
    Relief of the pain usually begins 15 to 30 minutes after taking the drug
and lasts up to four hours. Although scientists aren't exactly sure how 
acetaminophen-codeine works, they think codeine relieves pain by acting at
special sites (receptors) in the brain that react to the body's natural 
painkillers (endorphins). 

Side Effects and Risks
    Because this drug contains a narcotic, unconsciousness or death may 
result from a large overdose. Signs of overdose include seizures
(convulsions), nausea or vomiting, nervousness or restlessness, weakness, 
dizziness or drowsiness, pupils of eyes narrowed to a pinpoint, confusion,
and slowed breathing. If any of the signs occurs, get emergency help
immediately.
    Common side effects include lightheadedness or feeling faint, unusual 
tiredness, nausea, or drowsiness. Therefore, caution is necessary when
driving or using machines.
    Nausea may occur after the first couple of doses. Lie down until it 
passes. These side effects usually go away; however, check with your doctor 
if they don't go away or become bothersome. 
    Less commonly, you may also experience constipation, increased sweating,
loss of appetite, restlessness, nightmares or unusual dreams, and trouble 
sleeping. 
    Check with your doctor as soon as possible if you experience any of the 
following: bloody or cloudy urine, frequent urge to urinate, mental 
depression, pale stools, ringing or buzzing in ears, skin rash, or yellow 
eyes or skin. 
    The acetaminophen in this medicine does not mix well with some
medications that contain aspirin or other salicylates. Let your doctor know 
what other medications you may be taking. 
    After you stop taking the medicine, your body may take a while to 
adjust; you may have body aches, diarrhea, trouble sleeping, weakness, or 
rapid heartbeat. Check with your doctor if you experience these or other
symptoms. 

Precautions and Warnings
    Alcohol and medicines that depress the central nervous system will add
to the effects of this medication. Drinking alcohol also makes adverse
effects of acetaminophen on the liver more likely. For both these reasons,
don't drink alcohol with this medicine. Other drugs that may intensify
acetaminophen-codeine effects include antihistamines, sedatives,
tranquilizers or sleep medicines, other prescription pain medications,
barbiturates (sedatives), seizure medicine, depression medications, and 
muscle relaxers. Check with your doctor if you are taking these medications.
    Although there have been no reports of birth defects caused by this 
medicine, prolonged use during the last three months of pregnancy may cause 
the fetus to become addicted. Acetaminophen-
codeine may also cause breathing problems in newborns if taken just before
or during delivery. Animal studies have shown that this drug may cause
slower development of bones in the fetus. Acetaminophen-codeine is in 
pregnancy category C, indicating that animal studies show that the drug has 
some harmful effects on animal fetuses but that there has been no research
in humans. The drug should be used by pregnant women only if the potential
benefits justify the potential risk.
    Breathing problems may occur in children under 2. Unusual excitement or 
restlessness is more likely to occur in children than adults. 
    People over 65 are especially sensitive to the effects of narcotics.
They may be at greater risk for breathing problems. 

Before Taking This Medicine 
    Before you take this drug, let your physician know if you have any of 
the following medical problems: 
* impaired liver or kidney function 
* underactive thyroid 
* brain disease or head injury
* history of convulsions
* heart disease 
* emphysema, asthma, or chronic lung diseases 
* gallbladder disease or gallstones 
    Also inform your doctor if you are now taking or have taken within the
last two weeks the class of antidepressants known as MAO inhibitors, which
includes such brand names such as Furoxone, Marplan, Eutonyl, or Nardil. n

--Judy Folkenberg 
Common Brand Names

Acetaco 
Aceta with Codeine
Capital with Codeine
Empracet with Codeine 
Myapap with Codeine 
Phenaphen with Codeine
Proval
Tylaprin with Codeine 
Tylenol with Codeine
Ty-Pap with Codeine 
Ty-Tab with Codeine