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Narcotic Analgesics and Acetaminophen (Systemic)

  • Category: Analgesic 

  • Brand Names U.S.: Allay4, Anexsia4, Anolor 4, Bancap-HC4, Capital with Codeine1, Co-Gesic4, Darvocet7, DHCplus3, Dolacet4, Dolagesic4, Duocet4, E-Lor7, Endocet5, EZ III1, Hycomed4, Hyco-Pap4, Hydrocet4, Hydrogesic4, HY-PHEN4, Lorcet4, Lortab4, Margesic4, Oncet4, Panacet4, Panlor4, Percocet5, Phenaphen1, Polygesic4, Propacet 1007, Pyregesic-C1, Roxicet5, Roxilox5, Stagesic4, Talacen6, T-Gesic4, Tylenol1, Tylox5, Ugesic4, Vanacet4, Vendone4, Vicodin4, Wygesic7, Zydone4
  • Brand Names Canada: Acet1, Atasol2, Cetaphen2, Cotabs2, Empracet1, Emtec-301, Endocet5, Exdol-82, Lenoltec1, Novo-Gesic2, Oxycocet5, Percocet5, PMS-Acetaminophen with Codeine1, Roxicet5, Triatec2, Tylenol with Codeine Elixir1, Tylenol2
  • Other commonly used names: APAP with codeine, Co-codAPAP, Co-hycodAPAP, Co-oxycodAPAP, Co-proxAPAP, Drocode, acetaminophen, and caffeine, Hydrocodone with APAP, Oxycodone with APAP, Propoxyphene with APAP

1Acetaminophen and Codeine · 2Acetaminophen, Codeine, and Caffeine · 3Dihydrocodeine, Acetaminophen, and Caffeine · 4Hydrocodone and Acetaminophen · 5Oxycodone and Acetaminophen · 6Pentazocine and Acetaminophen · 7Propoxyphene and Acetaminophen

Description: Combination medicines containing narcotic analgesics and are used to relieve pain. A narcotic analgesic and acetaminophen used together may provide better pain relief than either medicine used alone. In some cases, relief of pain may come at lower doses of each medicine. Narcotic analgesics act in the central nervous system (CNS) to relieve pain. Many of their side effects are also caused by actions in the CNS. When narcotics are used for a long time, your body may get used to them so that larger amounts are needed to relieve pain. This is called tolerance to the medicine. Also, when narcotics are used for a long time or in large doses, they may become habit-forming (causing mental or physical dependence). Physical dependence may lead to withdrawal symptoms when you stop taking the medicine. Acetaminophen does not become habit-forming when taken for a long time or in large doses, but it may cause other unwanted effects, including liver damage, if too much is taken. In the U.S., these medicines are available only with your medical doctor's or dentist's prescription. In Canada, some acetaminophen, codeine, and caffeine combinations are available without a prescription.

Other Medications: It is always important that your prescribing physician be aware of any other medications you are taking -- both prescriptions meds and OTC's. Before taking narcotic analgesics and acetaminophen be especially careful to discuss it with your doctor if you are also taking any of the following: 
  • Carbamazepine (Tegretol)--Propoxyphene may increase the blood levels of carbamazepine, which increases the chance of serious side effects
  • Central nervous system (CNS) depressants or
  • Monoamine oxidase (MAO) inhibitors (furazolidone [Furoxone], isocarboxazid [e.g., Marplan], pargyline [Eutonyl], phenelzine [Nardil], procarbazine [Matulane], tranylcypromine [Parnate]) (taken currently or within the past 2 weeks) or
  • Tricyclic antidepressants (amitriptyline [Elavil], amoxapine [Asendin], clomipramine [Anafranil], desipramine [Pertofrane], doxepin [Sinequan], imipramine [Tofranil], nortriptyline [Aventyl], protriptyline [Vivactil], trimipramine [Surmontil])--Taking these medicines together with a narcotic analgesic may increase the chance of serious side effects
  • Naltrexone (Trexan)--Naltrexone keeps narcotic analgesics from working to relieve pain; people taking naltrexone should take pain relievers that do not contain a narcotic
  • Zidovudine (AZT, Retrovir)--Acetaminophen may increase the blood levels of zidovudine, which increases the chance of serious side effects

Potential Side Effects of This Medicine:

Get emergency help immediately if any of the following symptoms of overdose occur: cold, clammy skin; confusion (severe); convulsions (seizures); diarrhea; dizziness (severe); drowsiness (severe); increased sweating; low blood pressure; nausea or vomiting (continuing); nervousness or restlessness (severe); pinpoint pupils of eyes; shortness of breath or unusually slow or troubled breathing; slow heartbeat; stomach cramps or pain; weakness (severe)

Check with your doctor as soon as possible if any of the following side effects occur: black, tarry stools; bloody or cloudy urine; confusion; dark urine; difficult or painful urination; fast, slow, or pounding heartbeat; frequent urge to urinate; hallucinations (seeing, hearing, or feeling things that are not there); increased sweating; irregular breathing or wheezing; mental depression; pain in lower back and/or side (severe and/or sharp); pale stools; pinpoint red spots on skin; redness or flushing of face; ringing or buzzing in ears; skin rash, hives, or itching; sore throat and fever; sudden decrease in amount of urine; swelling of face; trembling or uncontrolled muscle movements; unusual bleeding or bruising; unusual excitement (especially in children); yellow eyes or skin

These side effects usually do not need medical attention, but check with your doctor if any of them continue or are bothersome: dizziness, lightheadedness, or feeling faint; drowsiness; nausea or vomiting; unusual tiredness or weakness; blurred or double vision or other changes in vision; constipation (more common with long-term use and with codeine or meperidine); dry mouth; false sense of well-being; general feeling of discomfort or illness; headache; loss of appetite; nervousness or restlessness; nightmares or unusual dreams; trouble in sleeping

Although not all of the side effects listed above have been reported for all of these combination medicines, they have been reported for at least one of them. However, since all of the narcotic analgesics are very similar, any of the above side effects may occur with any of these medicines.

    • If you are taking this medicine for an extended period, or in high doses, your doctor should check your progress at regular intervals.
    • Check the labels of all nonprescription and prescription medicines you now take. If any contain acetaminophen or a narcotic be especially careful, since taking them while taking this medicine may lead to overdose.
    • The narcotic analgesic in this medicine will add to the effects of alcohol and other CNS depressants. Also, there may be a greater risk of liver damage if you drink three or more alcoholic beverages while you are taking acetaminophen. Do not drink alcoholic beverages, and check with your medical doctor or dentist before taking any of the medicines listed above, while you are using this medicine .
    • Too much use of the acetaminophen in this combination medicine together with certain other medicines may increase the chance of unwanted effects. If your doctor directs you to take these medicines together on a regular basis, follow his or her directions carefully. However, do not take this medicine together with any of the following medicines for more than a few days, unless your doctor has directed you to do so and is following your progress:
      • Aspirin or other salicylates
      • Diclofenac (e.g., Voltaren)
      • Diflunisal (e.g., Dolobid)
      • Etodolac (e.g., Lodine)
      • Fenoprofen (e.g., Nalfon)
      • Floctafenine (e.g., Idarac)
      • Flurbiprofen, oral (e.g., Ansaid)
      • Ibuprofen (e.g., Motrin)
      • Indomethacin (e.g., Indocin)
      • Ketoprofen (e.g., Orudis)
      • Ketorolac (e.g., Toradol)
      • Meclofenamate (e.g., Meclomen)
      • Mefenamic acid (e.g., Ponstel)
      • Nabumetone (e.g., Relafen)
      • Naproxen (e.g., Naprosyn)
      • Oxaprozin (e.g., Daypro)
      • Phenylbutazone (e.g., Butazolidin)
      • Piroxicam (e.g., Feldene)
      • Sulindac (e.g., Clinoril)
      • Tenoxicam (e.g., Mobiflex)
      • Tiaprofenic acid (e.g., Surgam)
      • Tolmetin (e.g., Tolectin)
    • Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert and clearheaded. Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem.
    • Nausea or vomiting may occur, especially after the first couple of doses. This effect may go away if you lie down for a while. However, if nausea or vomiting continues, check with your medical doctor or dentist. Lying down for a while may also help relieve some other side effects, such as dizziness or lightheadedness, that may occur.
    • Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine.
    • If you think you or someone else may have taken an overdose of this medicine, get emergency help at once. Taking an overdose of this medicine or taking alcohol or CNS depressants with this medicine may lead to unconsciousness or death. Signs of overdose of narcotics include convulsions (seizures), confusion, severe nervousness or restlessness, severe dizziness, severe drowsiness, shortness of breath or troubled breathing, and severe weakness. Signs of severe acetaminophen overdose may not occur until several days after the overdose is taken.

    Other Medical Conditions: --As with any medication, your doctor should be aware of all health conditions you may have. Be sure to keep your doctor updated of your medical history, especially:
    • Alcohol and/or other drug abuse ( or history of)
    • Brain disease or head injury 
    • Colitis 
    • Convulsions (seizures)
    • Emotional problems or mental illness 
    • Emphysema, asthma, or other chronic lung disease 
    • Enlarged prostate or problems with urination 
    • Gallbladder disease or gallstones
    • Heart disease
    • Hepatitis or other liver disease 
    • Kidney disease 
    • Underactive thyroid

    Material on this page is for informational purposes only,
    and should not be construed as medical advice.
    Always consult your physician regarding medications.



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