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Opioid (Narcotic Analgesics and Acetaminophen Systemic )

This monograph includes information on the following:

1) Acetaminophen and Codeine
2) Dihydrocodeine and Acetaminophen  
3) Hydrocodone and Acetaminophen 
4) Oxycodone and Acetaminophen
5) Pentazocine and Acetaminophen 
6) Propoxyphene and Acetaminophen 

Pharmacy Equivalent Name (PEN):
{02} Acetaminophen and Codeine
Co-codAPAP Hydrocodone and Acetaminophen
Co-hycodAPAP Oxycodone and Acetaminophen
Co-oxycodAPAP Propoxyphene napsylate and Acetaminophen
Co-proxAPAP

INN:
Acetaminophen— Paracetamol
Propoxyphene— Dextropropoxyphene

VA CLASSIFICATION
Primary: CN101

Note: Controlled substance classification—

Note: Controlled substances in the U.S. and Canada as follows:



Drug
U.S.
Canada
Acetaminophen and Codeine
Capsules; Tablets
III
N
Oral solution
IV
N
Oral suspension
IV
**
 
Dihydrocodeine and Acetaminophen
III
**
 
Hydrocodone and Acetaminophen
III
**
 
Oxycodone and Acetaminophen
II
N
Pentazocine and Acetaminophen
IV
**
 
Propoxyphene and Acetaminophen
IV
**
 
** Not commercially available in Canada.
Commonly used brand name(s): Acet Codeine 301; Acet Codeine 601; Acet-21; Acet-31; Allay3; Anexsia 5/5003; Anexsia 7.5/6503; Anolor DH 53; Atasol-151; Atasol-301; Atasol-81; Bancap-HC3; Capital with Codeine1; Cetaphen Extra Strength with Codeine1; Cetaphen with Codeine1; Co-Gesic3; Cotabs1; DHC plus2; Darvocet-N 1006; Darvocet-N 506; Dolacet3; Dolagesic3; Duocet3; E-Lor6; EZ III1; Empracet-301; Empracet-601; Emtec-301; Endocet4; Exdol-81; HY-PHEN3; Hyco-Pap3; Hycomed3; Hydrocet3; Hydrogesic3; Lenoltec with Codeine No.11; Lenoltec with Codeine No.21; Lenoltec with Codeine No.31; Lenoltec with Codeine No.41; Lorcet 10/6503; Lorcet Plus3; Lorcet-HD3; Lortab3; Lortab 10/5003; Lortab 2.5/5003; Lortab 5/5003; Lortab 7.5/5003; Margesic #31; Margesic-H3; Novo-Gesic C151; Novo-Gesic C301; Novo-Gesic C81; Oncet3; Oxycocet4; PMS-Acetaminophen with Codeine1; Panacet 5/5003; Panlor3; Percocet4; Percocet 10/6504; Percocet 2.5/3254; Percocet 5/3254; Percocet 7.5/5004; Percocet-Demi4; Phenaphen with Codeine No. 31; Phenaphen with Codeine No.41; Polygesic3; Propacet 1006; Pyregesic-C1; Roxicet4; Roxicet 5/5004; Roxilox4; Stagesic3; T-Gesic3; Talacen5; Triatec-301; Triatec-81; Triatec-8 Strong1; Tylenol with Codeine Elixir1; Tylenol with Codeine No.11; Tylenol with Codeine No.1 Forte1; Tylenol with Codeine No.21; Tylenol with Codeine No.31; Tylenol with Codeine No.41; Tylox4; Ugesic3; Vanacet3; Vendone3; Vicodin3; Vicodin ES3; Wygesic6; Zydone3.

Other commonly used names are:
APAP with codeine —Acetaminophen and Codeine
, Co-codAPAP —Acetaminophen and Codeine
, Co-hycodAPAP —Hydrocodone and Acetaminophen
, Co-oxycodAPAP —Oxycodone and Acetaminophen
, Co-proxAPAP — Propoxyphene napsylate and Acetaminophen
, Drocode and Acetaminophen —Dihydrocodeine and Acetaminophen
, Hydrocodone with APAP —Hydrocodone and Acetaminophen
, Oxycodone with APAP —Oxycodone and Acetaminophen
, Propoxyphene with APAP —Propoxyphene and Acetaminophen

Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).

Not commercially available in Canada.



Category:


Analgesic—
Note: Opioid agonist analgesics—Codeine, Dihydrocodeine, Hydrocodone, Oxycodone, and Propoxyphene.
Opioid agonist/antagonist analgesic—Pentazocine.



Indications

Accepted

Pain (treatment)—Indicated for the symptomatic relief of:
Mild to moderate pain—Pentazocine and acetaminophen; propoxyphene and acetaminophen.

Mild to severe pain (depending on the dose of codeine)—Acetaminophen and codeine.

Moderate to moderately severe pain—Dihydrocodeine and acetaminophen; hydrocodone and acetaminophen; oxycodone and acetaminophen.


Pharmacology/Pharmacokinetics

Acetaminophen—See Acetaminophen (Systemic).

Caffeine—See Caffeine (Systemic).

Codeine—See Opioid (Narcotic) Analgesics (Systemic).

Dihydrocodeine—Although dihydrocodeine is not specifically referenced, see Opioid (Narcotic) Analgesics (Systemic) for mechanism of action proposed for all opioid agonist analgesics.

Hydrocodone—See Opioid (Narcotic) Analgesics (Systemic).

Oxycodone—See Opioid (Narcotic) Analgesics (Systemic).

Pentazocine—See Opioid (Narcotic) Analgesics (Systemic).

Propoxyphene—See Opioid (Narcotic) Analgesics (Systemic).


Precautions to Consider

Acetaminophen—See Acetaminophen (Systemic).

Caffeine—See Caffeine (Systemic).

Codeine—See Opioid (Narcotic) Analgesics (Systemic).

Dihydrocodeine—Although dihydrocodeine is not specifically referenced, see Opioid (Narcotic) Analgesics (Systemic) for precautions that may apply to all opioid agonist analgesics.

Hydrocodone—See Opioid (Narcotic) Analgesics (Systemic).

Oxycodone—See Opioid (Narcotic) Analgesics (Systemic).

Pentazocine—See Opioid (Narcotic) Analgesics (Systemic).

Propoxyphene—See Opioid (Narcotic) Analgesics (Systemic).


Side/Adverse Effects
Acetaminophen—See Acetaminophen (Systemic).
Caffeine—See Caffeine (Systemic).
Codeine—See Opioid (Narcotic) Analgesics (Systemic).
Dihydrocodeine—Although dihydrocodeine is not specifically referenced, see Opioid (Narcotic) Analgesics (Systemic) for side/adverse effects that may occur with opioid agonist analgesics.
Hydrocodone—See Opioid (Narcotic) Analgesics (Systemic).
Oxycodone—See Opioid (Narcotic) Analgesics (Systemic).
Pentazocine—See Opioid (Narcotic) Analgesics (Systemic).
Propoxyphene—See Opioid (Narcotic) Analgesics (Systemic).



Overdose
For specific information on the agents used in the management of opioid (narcotic) analgesics and acetaminophen overdose, see:    • Acetylcysteine (Systemic) monograph;
   • Naloxone (Systemic) monograph; and/or
   • Vitamin K 1Phytonadione in Vitamin K (Systemic) monograph.


For more information on the management of overdose or unintentional ingestion, contact a Poison Control center (see Poison Control Center Listing ).

Treatment of overdose


For acetaminophen:
To decrease absorption—Emptying the stomach via induction of emesis or gastric lavage.

Removing activated charcoal (if used) by gastric lavage may be advisable. Although activated charcoal is recommended in cases of mixed drug overdose, it may interfere with absorption of orally administered acetylcysteine (antidote used to protect against acetaminophen-induced hepatotoxicity) and decrease its efficacy.

To enhance elimination—Instituting hemodialysis or hemoperfusion to remove acetaminophen from the circulation may be beneficial if acetylcysteine administration cannot be instituted within 24 hours following ingestion of a massive acetaminophen overdose. However, the efficacy of this treatment in preventing acetaminophen-induced hepatotoxicity is not known.

Specific treatment—Administering acetylcysteine. It is recommended that acetylcysteine administration be instituted as soon as possible after ingestion of an overdose has been reported, without waiting for the results of plasma acetaminophen determinations or other laboratory tests. Acetylcysteine is most effective if treatment is started within 10 to 12 hours after ingestion of the overdose; however, it may be of some benefit if treatment is started within 24 hours. See the package insert or Acetylcysteine (Systemic) for specific dosing guidelines for use of this product.

Monitoring—Determining plasma acetaminophen concentration at least 4 hours following ingestion of the overdose. Determinations performed prior to this time are not reliable for assessing potential hepatotoxicity. Initial plasma concentrations above 150 mcg per mL at 4 hours, 100 mcg per mL at 6 hours, 70 mcg per mL at 8 hours, 50 mcg per mL at 10 hours, 20 mcg per mL at 15 hours, 8 mcg per mL at 20 hours, or 3.5 mcg per mL at 24 hours postingestion indicate possible hepatotoxicity and the need for completing the full course of acetylcysteine treatment. If the initial determination indicates a plasma concentration below those listed at the times indicated, cessation of acetylcysteine therapy can be considered. However, some clinicians advise that more than one determination should be performed in order to ascertain peak absorption and half-life of acetaminophen prior to considering discontinuation of acetylcysteine.

Performing liver function tests (serum aspartate aminotransferase [AST or SGOT], serum alanine aminotransferase [ALT or SGPT], prothrombin time, and bilirubin) at 24-hour intervals for at least 96 hours postingestion if the plasma acetaminophen concentration indicates potential hepatotoxicity. If no abnormalities are detected within 96 hours, further determinations are not needed.

Monitoring renal and cardiac function and administering appropriate therapy as required.

Supportive care—Instituting supportive treatment, including maintaining fluid and electrolyte balance, correcting hypoglycemia, and administering vitamin K 1 (if prothrombin time ratio exceeds 1.5) and fresh frozen plasma or clotting factor concentrate (if prothrombin time ratio exceeds 3).



For opioid analgesics:
To decrease absorption—Emptying the stomach by induction of emesis or gastric lavage. However, treatment of respiratory depression or other potentially life-threatening adverse effects must take precedence.

Specific treatment—Administering the opioid antagonist naloxone. Larger doses of naloxone may be required to reverse the effects of pentazocine or propoxyphene than are required to antagonize the effects of other opioid analgesics. See the package insert or Naloxone (Systemic) for specific dosing guidelines for use of this product.

Monitoring—Continuing to monitor the patient (mandatory because the duration of action of the opioid analgesic may exceed that of naloxone) so that additional antagonist may be administered as needed. Alternatively, initial treatment may be followed by continuous intravenous infusion of naloxone, with the rate of infusion being adjusted according to patient response. The fact that naloxone may also antagonize the analgesic actions of opioid analgesics and may precipitate withdrawal symptoms in physically dependent patients must be kept in mind.

Supportive care—Establishing adequate respiratory exchange through provision of a patent airway and institution of assisted or controlled respiration.

Administration of intravenous fluids, vasopressors, and other supportive measures as needed. Patients in whom intentional overdose is known or suspected should be referred for psychiatric consultation.



Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Narcotic Analgesics and Acetaminophen (Systemic).

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Before using this medication
»   Conditions affecting use, especially:
Sensitivity to acetaminophen or to opioid analgesic considered for use, history of

Pregnancy—Acetaminophen and opioid analgesics cross the placenta; regular use of opioids by pregnant women may cause physical dependence in the fetus and withdrawal symptoms in the neonate





Breast-feeding—Acetaminophen, codeine, and propoxyphene are distributed into breast milk





Use in children—Children up to 2 years of age are more susceptible to the effects of opioids, especially respiratory depression; also, children may be more likely to experience paradoxical CNS excitation during therapy






Use in the elderly—Geriatric patients are more susceptible to the effects of opioids, especially respiratory depression
Other medications, especially alcohol or other CNS depressants, monoamine oxidase inhibitors, tricyclic antidepressants, zidovudine, and naltrexone
Other medical problems, especially alcoholism (active or in remission), diarrhea caused by antibiotics or poisoning, asthma or other respiratory problems, hepatic disease, viral hepatitis, and severe inflammatory bowel disease

Proper use of this medication
» Importance of not taking more medication than the amount prescribed because of danger of overdose and habit-forming potential of opioid analgesics; also, acetaminophen may cause liver damage with long-term or high-dose use

» Not increasing dose if medication is less effective after a few weeks; checking with physician
Missed dose (if on scheduled dosing): Taking as soon as possible; not taking if almost time for next dose; not doubling doses

» Proper storage

Precautions while using this medication
Regular visits to physician to check progress during long-term or high-dose therapy

» Caution if other medications containing opioid analgesics or acetaminophen are used

» Avoiding use of alcohol or other central nervous system (CNS) depressants during therapy unless prescribed or otherwise approved by physician

Checking with your physician if you consume three or more alcohol-containing beverages per day; acetaminophen may increase the risk of liver damage

Not regularly taking aspirin or other salicylates or other nonsteroidal anti-inflammatory drugs concurrently, unless directed by physician or dentist

» Caution if dizziness, drowsiness, lightheadedness, or false sense of well-being occurs

Caution when getting up suddenly from a lying or sitting position

Lying down if nausea or vomiting, or dizziness or lightheadedness occurs

Caution if any kind of surgery (including dental surgery) or emergency treatment is required

Possible dryness of mouth; using sugarless gum or candy, ice, or saliva substitute for relief; checking with dentist if dry mouth continues for more than 2 weeks

» Checking with physician before discontinuing medication after prolonged use of high doses; gradual dosage reduction may be necessary to avoid withdrawal symptoms

» Suspected overdose: Getting emergency help at once


Side/adverse effects
Signs of potential side effects, especially respiratory depression or impairment; allergic reactions; confusion, convulsions, hallucinations, mental depression, or other signs of CNS toxicity; agranulocytosis; hepatotoxicity; hypertension; paradoxical CNS excitation, especially in children; renal function impairment; and thrombocytopenia


General Dosing Information
Opioid analgesics may depress respiration, especially in very young, elderly, very ill, or debilitated patients and those with respiratory problems. Lower doses may be required for these patients. However, elderly patients may also be more sensitive to the analgesic effects of these medications so that lower doses and/or longer dosing intervals may be sufficient to provide adequate analgesia.

Dosage of opioid analgesics should be individualized on the basis of the potency and duration of action of the specific agent used, the severity of pain, the condition of the patient, other medications given concurrently, and patient response.

Administration of acetaminophen concurrently with opioid analgesics provides additive analgesia and may permit lower doses of the opioid analgesic to be utilized.

Some clinicians recommend that patients in chronic severe pain receive opioid analgesics on a fixed dosage schedule in order that they remain free of pain rather than on an as needed basis after pain recurs.

Tolerance to many of the effects of opioid analgesics may develop with repeated administration. The first sign of tolerance is usually a decrease in the duration of effective analgesia. Patients who become tolerant to one of these agents may be partially cross-tolerant to the others.

If tolerance to the opioid analgesic component of the medication develops, more frequent dosing and/or an increase in dosage may be required. However, the analgesic efficacy of acetaminophen is subject to a ceiling effect; single doses larger than 1 gram may not provide additional therapeutic benefit. Also, for chronic use, the maximum recommended dose of acetaminophen is 2.6 grams per day; chronic ingestion of larger daily doses increases the risk of hepatotoxicity. Therefore, administration of supplemental opioid analgesic, or administration of an opioid analgesic and acetaminophen separately, may be required in order to achieve adequate analgesia in opioid-tolerant patients.

Psychological and physical dependence may occur with chronic administration of opioid analgesics; an abstinence syndrome may occur when these medications are discontinued. Gradual withdrawal may minimize the development of withdrawal symptoms following prolonged use.

ACETAMINOPHEN AND CODEINE

Summary of Differences


Category:
Codeine is an opioid agonist analgesic.



Indications:
Indicated for relief of mild to severe pain, depending on the dose of codeine.



Pharmacology/pharmacokinetics: For orally administered codeine :
Mechanism of action/effect: An opioid agonist analgesic; exerts agonist activity primarily at the mu receptor, but with usual doses is relatively weak.

Equivalence: 200 mg therapeutically equivalent to 10 mg of intramuscular morphine.

Protein binding: Very low.

Half-life: 2.5–4 hours

Biotransformation: Hepatic; about 10% demethylated to morphine.

Onset of action: 30–45 minutes.

Time to peak effect: 1–2 hours.

Duration of action (nontolerant patients only; decreases as tolerance develops during chronic therapy): 4 hours.

Elimination: Renal, 5–15% as unchanged codeine and 10% as unchanged or conjugated morphine.



Precautions:
Pregnancy—Codeine has been shown to cause delayed ossification in mice and increased resorptions in rats.

Breast-feeding—Codeine is distributed into breast milk.



Side/adverse effects:
Codeine is more likely than most other opioids to cause constipation, especially during chronic therapy.

Codeine has lower dependence liability and potential for abuse than most other opioid agonists with usual doses.

Withdrawal symptoms produced by codeine are less severe than those produced by stronger opioid agonist analgesics.



Oral Dosage Forms

ACETAMINOPHEN AND CODEINE PHOSPHATE CAPSULES USP

Usual adult dose
Analgesic
Oral, 1 or 2 capsules containing 325 mg of acetaminophen and 30 mg of codeine phosphate every four hours as needed; or

Oral, 1 capsule containing 325 mg of acetaminophen and 60 mg of codeine phosphate every four hours as needed.


Usual pediatric dose
Dosage must be individualized by the physician.

Strength(s) usually available
U.S.—


325 mg of acetaminophen and 30 mg of codeine phosphate (Rx) [Phenaphen with Codeine No. 3{01} (D&C Yellow #10) (edible ink) (FD&C Blue #1) (FD&C Yellow #6) (gelatin) (magnesium stearate) (sodium starch glycolate) (stearic acid)]


325 mg of acetaminophen and 60 mg of codeine phosphate (Rx) [Phenaphen with Codeine No.4{01} (lactose) (cornstarch) (D&C Yellow #10) (edible ink) (FD&C Green #3 or Blue #1) (FD&C Yellow 6) ( gelatin) (magnesium stearate) ( sodium starch glycolate) (stearic acid)]

Canada—
Not commercially available.

Note: In Canada, Phenaphen with Codeine contains phenobarbital, aspirin, and codeine. See Barbiturates and Analgesics (Systemic).


Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight, light-resistant container.

Auxiliary labeling:
   • May cause drowsiness.
   • Avoid alcoholic beverages.
   • May be habit-forming.

Note: Controlled substance in the U.S.



ACETAMINOPHEN AND CODEINE PHOSPHATE ORAL SOLUTION {02} USP

Usual adult dose
Analgesic
Oral, 15 mL every four hours, as needed.


Usual pediatric dose
Analgesic
Children up to 3 years of age: Dosage has not been established.

Children 3 to 7 years of age: Oral, 5 mL three or four times a day, as needed.

Children 7 to 12 years of age: Oral, 10 mL three or four times a day, as needed.


Strength(s) usually available
U.S.—


120 mg of acetaminophen and 12 mg of codeine phosphate, per 5 mL (Rx) [Tylenol with Codeine Elixir{03} (alcohol 7% {03})][Generic]{04}

Canada—


160 mg of acetaminophen and 8 mg of codeine phosphate, per 5 mL (Rx) [PMS-Acetaminophen with Codeine{05} (alcohol 7%)] [Tylenol with Codeine Elixir{06} (alcohol 7%)]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight, light-resistant container. Protect from freezing.

Auxiliary labeling:
   • May cause drowsiness.
   • Avoid alcoholic beverages.
   • May be habit-forming.

Note: Controlled substance in the U.S. and Canada.



ACETAMINOPHEN AND CODEINE PHOSPHATE ORAL SUSPENSION {02} USP

Usual adult dose
See Acetaminophen and Codeine Phosphate Oral Solution USP.

Usual pediatric dose
See Acetaminophen and Codeine Phosphate Oral Solution USP.

Strength(s) usually available
U.S.—


120 mg of acetaminophen and 12 mg of codeine phosphate, per 5 mL (Rx) [Capital with Codeine{07}]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight, light-resistant container. {02} Protect from freezing.

Auxiliary labeling:
   • May cause drowsiness.
   • Avoid alcoholic beverages.
   • Shake well.
   • May be habit-forming.

Note: Controlled substance in the U.S.



ACETAMINOPHEN AND CODEINE PHOSPHATE TABLETS USP

Usual adult dose
Analgesic
Oral, 1 or 2 tablets containing 300 mg of acetaminophen and 15 or 30 mg of codeine phosphate every four hours as needed; or

Oral, 1 tablet containing 300 mg of acetaminophen and 60 mg of codeine phosphate every four hours as needed; or

Oral, 1 tablet containing 650 mg of acetaminophen and 30 mg of codeine phosphate every four hours as needed.


Usual pediatric dose
Dosage must be individualized by the physician.

Strength(s) usually available
U.S.—


300 mg of acetaminophen and 15 mg of codeine phosphate (Rx) [Tylenol with Codeine No.2{03} (sodium metabisulfite )][Generic]{04}


300 mg of acetaminophen and 30 mg of codeine phosphate (Rx) [Pyregesic-C{04}] [Tylenol with Codeine No.3{03} (sodium metabisulfite {03})][Generic]{04}


300 mg of acetaminophen and 60 mg of codeine phosphate (Rx) [Tylenol with Codeine No.4{03} (sodium metabisulfite {03})][Generic]{04}


650 mg of acetaminophen and 30 mg of codeine phosphate (Rx) [EZ III{04}] [Margesic #3{04}]

Canada—


300 mg of acetaminophen and 30 mg of codeine phosphate (Rx) [Acet Codeine 30{08} (scored)] [Empracet-30{09} ( scored)] [Emtec-30{10}] [Triatec-30{11}]


300 mg of acetaminophen and 60 mg of codeine phosphate (Rx) [Acet Codeine 60{08} (scored)] [Empracet-60{09}] [Lenoltec with Codeine No.4{12}] [Tylenol with Codeine No.4{06}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight, light-resistant container.

Auxiliary labeling:
   • May cause drowsiness.
   • Avoid alcoholic beverages.
   • May be habit-forming.

Note: Controlled substance in both the U.S. and Canada.



ACETAMINOPHEN, CODEINE PHOSPHATE, AND CAFFEINE TABLETS

Usual adult dose
Analgesic
Oral, 1 or 2 tablets every four hours as needed.


Usual pediatric dose
Dosage must be individualized by the physician.

Strength(s) usually available
U.S.—
Not commercially available.

Canada—


300 mg of acetaminophen, 8 mg of codeine phosphate, and 15 mg of caffeine (OTC) [Lenoltec with Codeine No.1{12}] [Novo-Gesic C8{13}] [Tylenol with Codeine No.1{06}][Generic] (may be scored){14}


300 mg of acetaminophen, 8 mg of codeine phosphate, and 30 mg of caffeine citrate (OTC) [Exdol-8{15} (scored)]


300 mg of acetaminophen, 15 mg of codeine phosphate, and 15 mg of caffeine (Rx) [Acet-2{16} (scored)] [Lenoltec with Codeine No.2{12}] [Novo-Gesic C15{13} (scored)] [Tylenol with Codeine No.2{06}]


300 mg of acetaminophen, 30 mg of codeine phosphate, and 15 mg of caffeine (Rx) [Acet-3{16} (scored)] [Lenoltec with Codeine No.3{12}] [Novo-Gesic C30{13} (scored)] [Tylenol with Codeine No.3{06}]


325 mg of acetaminophen, 8 mg of codeine phosphate, and 15 mg of caffeine (OTC) [Cetaphen with Codeine{17}]


325 mg of acetaminophen, 8 mg of codeine phosphate, and 30 mg of caffeine citrate (OTC) [Atasol-8{18} (scored)] [Cotabs{19}] [Triatec-8{11}]


325 mg of acetaminophen, 15 mg of codeine phosphate, and 30 mg of caffeine citrate (Rx) [Atasol-15{18} (scored)]


325 mg of acetaminophen, 30 mg of codeine phosphate, and 30 mg of caffeine citrate (Rx) [Atasol-30{18} (scored)]


500 mg of acetaminophen, 8 mg of codeine phosphate, and 15 mg of caffeine (OTC) [Cetaphen Extra Strength with Codeine{20}] [Tylenol with Codeine No.1 Forte{06}][Generic]{21}


500 mg of acetaminophen, 8 mg of codeine phosphate, and 30 mg of caffeine citrate (OTC) [Triatec-8 Strong{11}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer.

Auxiliary labeling:
   • May cause drowsiness.
   • Avoid alcoholic beverages.
   • May be habit-forming.

Note: Controlled substance in Canada.



DIHYDROCODEINE AND ACETAMINOPHEN

Summary of Differences



Category:
Dihydrocodeine is an opioid agonist analgesic.



Indications:
Indicated for relief of moderate to moderately severe pain.



Oral Dosage Forms

DIHYDROCODEINE BITARTRATE, ACETAMINOPHEN, AND CAFFEINE CAPSULES

Usual adult dose
Analgesic
Oral, 2 capsules every four hours.


Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—


16 mg of dihydrocodeine bitartrate, 356.4 mg of acetaminophen, and 30 mg of caffeine (Rx) [DHC plus{22} (croscarmellose sodium ) (FD&C Blue #1) ( FD&C Green #3) (gelatin) ( silica gel) (silicon dioxide) ( sodium lauryl sulfate) (cornstarch) (titanium dioxide) ( zinc stearate )]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a tight, light-resistant container, unless otherwise specified by manufacturer.

Auxiliary labeling:
   • May cause drowsiness.
   • Avoid alcoholic beverages.
   • May be habit-forming.

Note: Controlled substance in the U.S.



HYDROCODONE AND ACETAMINOPHEN

Summary of Differences


Category:
Hydrocodone is an opioid agonist analgesic.



Indications:
Indicated for relief of moderate to moderately severe pain.



Pharmacology/pharmacokinetics: For orally administered hydrocodone :
Mechanism of action/effect: An opioid agonist analgesic; exerts agonist activity primarily at the mu receptor.

Half-life: 3.8 hours

Onset of action: 10–30 minutes.

Time to peak effect: 30–60 minutes.

Duration of action (nontolerant patients only; decreases as tolerance develops during chronic therapy): 4–6 hours.



Precautions:
Pregnancy—Hydrocodone teratogenic in animals in very high doses.

Breast-feeding—Not known whether hydrocodone is distributed into breast milk.



Side/adverse effects:
Hydrocodone is more likely than most other opioids to cause side effects associated with histamine release.



Oral Dosage Forms

HYDROCODONE BITARTRATE AND ACETAMINOPHEN CAPSULES

Usual adult dose
Analgesic
Oral, one capsule every four to six hours, as needed. Dosage may be increased to two capsules every six hours if necessary.


Usual adult prescribing limits
Analgesic
Eight capsules per 24 hours.


Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—


5 mg of hydrocodone bitartrate and 500 mg of acetaminophen (Rx) [Allay{04}] [Anolor DH 5{04}] [Bancap-HC{23}] [Dolacet{04}] [Dolagesic{04}] [Hycomed{04}] [Hyco-Pap{24}] [Hydrocet{25}] [Hydrogesic{04}] [Lorcet-HD{26}] [Margesic-H{04}] [Panlor{04}] [Polygesic{04}] [Stagesic{04}] [T-Gesic{04}] [Ugesic{21}] [Vendone{04}] [Zydone{04} (FD&C Yellow 6)]{11}[Generic]{04}

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer.

Auxiliary labeling:
   • May cause drowsiness.
   • Avoid alcoholic beverages.
   • May be habit-forming.

Note: Controlled substance in the U.S.



HYDROCODONE BITARTRATE AND ACETAMINOPHEN ORAL SOLUTION

Usual adult dose
Analgesic
Oral, 5 to 15 mL every four to six hours as needed.


Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—


2.5 mg of hydrocodone bitartrate and 167 mg of acetaminophen per 5 mL (Rx) [Lortab{27} (alcohol 7%) ( citric acid) (ethyl maltol) ( glycerin, methylparaben) (propylene glycol) ( propylparaben) (saccharin sodium ) ( sorbitol solution) ( sucrose) (D&C Yellow #10) ( FD&C Yellow #6)]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a tight, light-resistant container, unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • May cause drowsiness.
   • Avoid alcoholic beverages.
   • May be habit-forming.

Note: Controlled substance in the U.S.



HYDROCODONE BITARTRATE AND ACETAMINOPHEN TABLETS {02} USP

Usual adult dose
Analgesic
Oral, 1 or 2 tablets containing 2.5 mg of hydrocodone bitartrate and 500 mg of acetaminophen every four to six hours; or

Oral, 1 tablet containing 5 mg of hydrocodone bitartrate and 500 mg of acetaminophen every four to six hours as needed, with dosage being increased to 2 tablets every six hours if necessary; or

Oral, 1 tablet containing 7.5 mg of hydrocodone bitartrate and 650 mg of acetaminophen every four to six hours as needed, with dosage being increased to 2 tablets every six hours if necessary; or

Oral, 1 tablet containing 7.5 mg of hydrocodone bitartrate and 750 mg of acetaminophen every four to six hours as needed; or

Oral, 1 tablet containing 10 mg of hydrocodone bitartrate and 650 mg of acetaminophen every four to six hours as needed {33}.


Usual adult prescribing limits
Up to 40 mg of hydrocodone bitartrate and 4 grams of acetaminophen in twenty-four hours.

Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—


2.5 mg of hydrocodone bitartrate and 500 mg of acetaminophen (Rx) [Lortab 2.5/500{27} (scored)][Generic]{04}


5 mg of hydrocodone bitartrate and 500 mg of acetaminophen (Rx) [Anexsia 5/500{28} (scored)] [Co-Gesic{29} ( scored)] [Duocet{04} (scored)] [HY-PHEN{04} ( scored)] [Lortab 5/500{27} (scored)] [Oncet{04}] [Panacet 5/500{04} (scored)] [Vanacet{04}] [Vicodin{30} (scored)][Generic]{04}


7.5 mg of hydrocodone bitartrate and 500 mg of acetaminophen (Rx) [Lortab 7.5/500{06} (scored)][Generic]{04}


7.5 mg of hydrocodone bitartrate and 650 mg of acetaminophen (Rx) [Anexsia 7.5/650{28} (scored)] [Lorcet Plus{31} (scored)][Generic]{04}


7.5 mg of hydrocodone bitartrate and 750 mg of acetaminophen (Rx) [Vicodin ES{32} (scored)][Generic]{04}


10 mg of hydrocodone bitartrate and 500 mg of acetaminophen (Rx) [Lortab 10/500{33} (scored) ( colloidal silicon dioxide) (croscarmellose sodium ) (crospovidone) (microcrystalline cellulose) (povidone) ( pregelatinized starch) (stearic acid) (FD&C Red #27 Lake) (FD&C Red #30 Lake)]


10 mg of hydrocodone bitartrate and 650 mg of acetaminophen (Rx) [Lorcet 10/650{33} (scored) ( colloidal silicon dioxide) (croscarmellose sodium ) (crospovidone) (microcrystalline cellulose) (povidone) ( pregelatinized starch) (stearic acid) (FD&C Blue #1 Lake)]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F). Store in a tight, light-resistant container. {02}

Auxiliary labeling:
   • May cause drowsiness.
   • Avoid alcoholic beverages.
   • May be habit-forming.

Note: Controlled substance in the U.S.



OXYCODONE AND ACETAMINOPHEN

Summary of Differences


Category:
Oxycodone is an opioid agonist analgesic.



Indications:
Indicated for relief of moderate to moderately severe pain.



Pharmacology/pharmacokinetics: For orally administered oxycodone :
Mechanism of action/effect: An opioid agonist analgesic. Has agonist activity primarily at the mu receptor.

Equivalence: 30 mg via oral administration therapeutically equivalent to 10 mg of intramuscular morphine.

Half-life: 2–3 hours

Time to peak effect: 1 hour.

Duration of action (nontolerant patients only; duration decreases as tolerance develops during chronic therapy): 3–4 hours.

Elimination: Renal.



Precautions:
Breast-feeding—Not known whether oxycodone is distributed into breast milk.



Oral Dosage Forms

OXYCODONE AND ACETAMINOPHEN CAPSULES USP

Usual adult dose
Analgesic
Oral, 1 capsule every four to six hours as needed.


Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—


5 mg of oxycodone hydrochloride and 500 mg of acetaminophen (Rx) [Roxilox{04}] [Tylox{34} (sodium metabisulfite)][Generic]{04}

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight, light-resistant container.

Auxiliary labeling:
   • May cause drowsiness.
   • Avoid alcoholic beverages.
   • May be habit-forming.

Note: Controlled substance in the U.S.



OXYCODONE AND ACETAMINOPHEN ORAL SOLUTION

Usual adult dose
Analgesic
Oral, 5 mL every four to six hours as needed.


Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—


5 mg of oxycodone hydrochloride and 325 mg of acetaminophen per 5 mL (Rx) [Roxicet{35} (alcohol 0.4%) ( edetic acid) (saccharin)]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • May cause drowsiness.
   • Avoid alcoholic beverages.
   • May be habit-forming.

Note: Controlled substance in the U.S.



OXYCODONE AND ACETAMINOPHEN TABLETS USP

Usual adult dose
Oral, 1 to 2 tablets every four to six hours as needed.

Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—


2.5 mg of oxycodone hydrochloride and 325 mg of acetaminophen [Percocet 2.5/325 (colloidal silicon dioxide) (croscarmellose sodium) (crospovidone) ( microcrystalline cellulose) (povidone) (pregelatinized corn starch) (stearic acid)]{45}


5 mg of oxycodone hydrochloride and 325 mg of acetaminophen (Rx) [Endocet{04}] [Percocet 5/325{36} (scored) ( colloidal silicon dioxide) (croscarmellose sodium ) (crospovidone)] [Roxicet{35} (scored )][Generic]{04}


5 mg of oxycodone hydrochloride and 500 mg of acetaminophen (Rx) [Roxicet 5/500{35} (scored)][Generic]{04}


7.5 mg of oxycodone hydrochloride and 500 mg of acetaminophen [Percocet 7.5/500 (colloidal silicon dioxide) (croscarmellose sodium) (crospovidone) ( microcrystalline cellulose) (povidone) (pregelatinized corn starch) (stearic acid)]{46}


10 mg of oxycodone hydrochloride and 650 mg of acetaminophen [Percocet 10/650 (colloidal silicon dioxide) (croscarmellose sodium) (crospovidone) ( microcrystalline cellulose) (povidone) (pregelatinized corn starch) (stearic acid)]{46}

Canada—


2.5 mg of oxycodone hydrochloride and 325 mg of acetaminophen (Rx) [Percocet-Demi{37} (double-scored)]


5 mg of oxycodone hydrochloride and 325 mg of acetaminophen (Rx) [Endocet{38} (scored)] [Oxycocet{39} ( scored)] [Percocet{37} (scored)] [Roxicet{40} ( scored)]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight, light-resistant container.

Auxiliary labeling:
   • May cause drowsiness.
   • Avoid alcoholic beverages.
   • May be habit-forming.

Note: Controlled substance in both the U.S. and Canada.



PENTAZOCINE AND ACETAMINOPHEN

Summary of Differences


Category:
Pentazocine is an opioid agonist/antagonist analgesic.



Indications:
Indicated for relief of moderate pain.



Pharmacology/pharmacokinetics: For orally administered pentazocine :
Mechanism of action/effect: An opioid agonist/antagonist analgesic.

Agonist—Has agonist activity at the kappa and sigma receptors.

Antagonist—Has antagonist activity at the mu receptor; may precipitate withdrawal symptoms in patients who are physically dependent on mu receptor agonists.

Equivalence: 180 mg therapeutically equivalent to 10 mg of intramuscular morphine.

Protein binding: Moderate.

Half-life: 2–3 hours

Onset of action: 15–30 minutes.

Time to peak effect: 60–90 minutes.

Duration of action (nontolerant patients only; decreases as tolerance develops during chronic therapy): 3 hours.

Elimination— Renal, 5–23% as unchanged pentazocine, and biliary.



Precautions:
Pregnancy—Studies in animals have not shown that pentazocine causes adverse effects on the fetus.

Breast-feeding—Not known whether pentazocine is distributed into breast milk.

Drug interactions and/or related problems—

May partially antagonize effects of opioid agonist analgesics.

May cause withdrawal symptoms if given to a patient physically dependent on an opioid agonist.

Medical considerations/contraindications—

Precaution in patients who are physically dependent on an opioid agonist.

Precaution in patients with acute myocardial infarction.



Side/adverse effects:
Although effects occur rarely, pentazocine more likely than butorphanol or nalbuphine to cause subjective and psychotomimetic effects characteristic of sigma receptor agonists.

Respiratory depression subject to a “ceiling effect,” after which the depth of respiratory depression does not increase with dose.

Pentazocine has less dependence liability and potential for abuse than opioid agonists.

Pentazocine produces withdrawal symptoms that are less severe than those produced by opioid agonist analgesics.



Oral Dosage Forms

PENTAZOCINE HYDROCHLORIDE AND ACETAMINOPHEN TABLETS

Usual adult dose
Analgesic
Oral, 1 tablet every four hours.


Usual adult prescribing limits
Up to 6 tablets daily.

Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—


650 mg of acetaminophen and 25 mg of pentazocine base (Rx) [Talacen{41} (scored) (colloidal silicon dioxide ) (FD&C Blue #1) ( gelatin) (microcrystalline cellulose) (potassium sorbate) (pregelatinized starch) (sodium lauryl sulfate) ( sodium metabisulfite) ( sodium starch glycolate ) (stearic acid)]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a tight, light-resistant container, unless otherwise specified by manufacturer.

Auxiliary labeling:
   • May cause drowsiness.
   • Avoid alcoholic beverages.
   • May be habit-forming.

Note: Controlled substance in the U.S.



PROPOXYPHENE AND ACETAMINOPHEN

Summary of Differences


Category:
Propoxyphene is an opioid agonist analgesic.



Indications:
Indicated for relief of mild to moderate pain.



Pharmacology/pharmacokinetics: For orally administered propoxyphene :
Mechanism of action/effect: An opioid agonist analgesic; has agonist activity primarily at the mu receptor.

Equivalence: Dose therapeutically equivalent to 10 mg of intramuscular morphine too toxic to administer.

Protein binding: High.

Biotransformation: Metabolite norpropoxyphene is toxic.

Half-life:

Propoxyphene—6–12 hours

Norpropoxyphene—30–36 hours

Onset of action: 15–60 minutes.

Time to peak concentration: 2–2.5 hours.

Peak plasma concentration: 0.05–0.1 mcg per mL.

Time to peak effect: 2 hours.

Duration of action (nontolerant patients only; decreases as tolerance develops during chronic therapy): 4–6 hours.

Elimination: Renal, < 10% as unchanged propoxyphene; biliary.



Precautions:
Pregnancy—Studies in animals have not shown that propoxyphene causes adverse effects on the fetus.

Breast-feeding—Propoxyphene is distributed into breast milk.

Drug interactions and/or related problems—Risk of convulsions if overdose of propoxyphene administered to amphetamine-treated patients.

May increase effects of coumarin- or indanedione-derivative anticoagulants.

Concurrent use with carbamazepine not recommended because may decrease carbamazepine metabolism, leading to increased risk of toxicity.

Laboratory value alterations—May cause liver function test abnormalities.



Side/adverse effects:
Propoxyphene may be more likely than most opioid analgesics to cause convulsions.

Hepatotoxicity has been reported with propoxyphene.

Propoxyphene has less dependence liability and potential for abuse than other opioid agonists with usual doses.

Propoxyphene produces withdrawal symptoms that are less severe than those produced by stronger opioid agonist analgesics.



Oral Dosage Forms

PROPOXYPHENE HYDROCHLORIDE AND ACETAMINOPHEN TABLETS USP

Usual adult dose
Analgesic
Oral, 1 tablet every four hours, as needed.


Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—


65 mg of propoxyphene hydrochloride and 650 mg of acetaminophen (Rx) [E-Lor{04}] [Wygesic{42} (scored)][Generic]{04}

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.

Auxiliary labeling:
   • May cause drowsiness.
   • Avoid alcoholic beverages.
   • May be habit-forming.

Note: Controlled substance in the U.S.



PROPOXYPHENE NAPSYLATE AND ACETAMINOPHEN TABLETS USP

Usual adult dose
Analgesic
Oral, 2 tablets containing 50 mg of propoxyphene napsylate and 325 mg of acetaminophen every four hours, as needed; or

Oral, 1 tablet containing 100 mg of propoxyphene napsylate and 650 mg of acetaminophen every four hours, as needed.


Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—


50 mg of propoxyphene napsylate and 325 mg of acetaminophen (Rx) [Darvocet-N 50{43}][Generic]{04}


100 mg of propoxyphene napsylate and 650 mg of acetaminophen (Rx) [Darvocet-N 100{43} ( cellulose) (cornstarch) (FD&C Yellow #6) (magnesium stearate ) (stearic acid) (titanium dioxide)] [Propacet 100{04}][Generic]{04}

Canada—
Not commercially available.

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.

Auxiliary labeling:
   • May cause drowsiness.
   • Avoid alcoholic beverages.
   • May be habit-forming.

Note: Controlled substance in the U.S.




Revised: 05/21/2001



References

Note: All references used in the development and earlier revisions of this monograph have not yet been incorporated into the computer database and, therefore, are not listed below. Citations for information not yet referenced in the monograph will be provided upon request.

  1. Acetaminophen and Codeine (Phenaphen with Codeine, Robins). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 2010.
  1. The United States pharmacopeia. The national formulary. USP 22nd revision (January 1, 1990). NF 17th ed (January 1, 1990). Rockville, MD: The United States Pharmacopeial Convention, Inc., 1990 (Seventh supplement, 1992): 3009-11, 3058.
  1. Acetaminophen and Codeine (Tylenol with Codeine, McNeil). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 1473-4.
  1. Red book 1995. Montvale, NJ: Medical Economics Company, 1995: 110, 125, 127-31, 218, 224, 225, 228, 238, 272, 313, 355, 360, 378, 394, 398, 405, 424, 429, 455, 458, 459.
  1. Acetaminophen and Codeine (PMS Acetaminophen with Codeine, Pharmascience). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 1033.
  1. Acetaminophen and Codeine formulations (Tylenol with Codeine, McNeil). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 1380-1.
  1. Acetaminophen and Codeine (Capital with Codeine, Carnrick). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 841.
  1. Acetaminophen and Codeine (Acet Codeine, Pharmascience). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 16.
  1. Acetaminophen and Codeine (Empracet, B.W.). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 437.
  1. Acetaminophen and Codeine (Emtec-30, Technilab). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 437.
  1. Acetaminophen and Codeine formulations (Triatec, Trianon). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 1351.
  1. Acetaminophen and Codeine formulations (Lenoltec with Codeine, Technilab). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 680-1.
  1. Acetaminophen, Codeine, and Caffeine (Novo-Gesic C, Novopharm). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 902.
  1. Acetaminophen, Codeine, and Caffeine (Generic, Stanley). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 16.
  1. Acetaminophen, Codeine, and Caffeine (Exdol-8, Frosst). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 468.
  1. Acetaminophen, Codeine, and Caffeine (Acet-2/Acet-3, Pharmascience). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 16.
  1. Acetaminophen, Codeine, and Caffeine (Cetaphen with Codeine, Wampole). In: Krogh CME, editor. Self-Medication Product Information. Volume 2, 4th edition. Canadian Pharmaceutical Association, 1993: 208.
  1. Acetaminophen, Codeine, and Caffeine (Atasol-8/-15/-30, Horner). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 120.
  1. Acetaminophen, Codeine, and Caffeine (Cotabs, Pharmavite). In: Krogh CME, editor. Self-Medication Product Information. Volume 2, 4th edition. Canadian Pharmaceutical Association, 1993: 209.
  1. Acetaminophen, Codeine, and Caffeine (Cetaphen Extra Strength with Codeine, Wampole). In: Krogh CME, editor. Self-Medication Product Information. Volume 2, 4th edition. Canadian Pharmaceutical Association, 1993: 209.
  1. Acetaminophen and Codeine (Generic, WestCan). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 471.
  1. Dihydrocodeine, Acetaminophen, and Caffeine (DHC Plus, Purdue Frederick). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 1932.
  1. Hydrocodone and Acetaminophen (Bancap-HC, Forest). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 1025.
  1. Hydrocodone and Acetaminophen (Hyco-Pap, Lunsco). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 1376.
  1. Hydrocodone and Acetaminophen (Hydrocet, Carnrick). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 842-3.
  1. Hydrocodone and Acetaminophen (Lorcet-HD, UAD). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 2513.
  1. Hydrocodone and Acetaminophen (Lortab, Whitby). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 2631-2.
  1. Hydrocodone and Acetaminophen (Anexsia, Boehringer Mannheim). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 648-9.
  1. Hydrocodone and Acetaminophen (Co-Gesic, Central). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 852.
  1. Hydrocodone and Acetaminophen (Vicodin, Knoll). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 1241-2.
  1. Hydrocodone and Acetaminophen (Lorcet Plus, UAD). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 2514.
  1. Hydrocodone and Acetaminophen (Vicodin E.S., Knoll). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 1242-3.
  1. Hydrocodone and Acetaminophen (Lorcet 10/650, UAD). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 2514-5.
  1. Oxycodone and Acetaminophen (Tylox, McNeil). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 1474-5.
  1. Oxycodone and Acetaminophen (Roxicet, Roxane). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 2138.
  1. Oxycodone and Acetaminophen (Percocet, DuPont). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 957-8.
  1. Oxycodone and Acetaminophen (Percocet, Percocet-Demi, DuPont). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 1005.
  1. Oxycodone and Acetaminophen (Endocet, Endo). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 438-9.
  1. Oxycodone and Acetaminophen (Oxycocet, Technilab). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 973-4.
  1. Oxycodone and Acetaminophen (Roxicet, Boehringer Ingelheim). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 29th ed. Ottawa: Canadian Pharmaceutical Association, 1994: 1164-5.
  1. Pentazocine and Acetaminophen (Talacen, Sanofi Winthrop). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 2230-2.
  1. Propoxyphene Hydrochloride and Acetaminophen (Wygesic, Wyeth Ayerst). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 2755-6.
  1. Propoxyphene Napsylate and Acetaminophen (Darvocet-N, Lilly). In: PDR Physicians" desk reference. 49th ed. 1995. Montvale, NJ: Medical Economics Data Production Company, 1995: 1320-2.
  1. Lortab package insert (UCB Pharma—US), Rec 2/97, Rev 5/96.
  1. Product Information: Percocet®, oxycodone and acetaminophen (2.5/325 and 5/325 tablets) Endo Laboratories, Pennsylvania (PI revised 5/1999) PI reviewed 3/2001
  1. Product Information: Percocet®, oxycodone and acetaminophen (7.5/500 and 10/650 tablets) Endo Laboratories, Pennsylvania (PI revised 5/1999) PI reviewed 3/2001
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