From the Research
For hemodialysis patients, Tylenol #3 (acetaminophen with codeine) should be dosed cautiously with reduced frequency, with a recommended approach of administering 1 tablet (300 mg acetaminophen/30 mg codeine) every 6-8 hours as needed for pain, with a maximum daily acetaminophen dose of 2000-3000 mg, as suggested by the most recent and highest quality study 1.
Key Considerations
- The dose of Tylenol #3 should be reduced and administered with caution in hemodialysis patients due to the potential for accumulation of codeine metabolites, which can lead to opioid toxicity 2, 1.
- Acetaminophen is primarily metabolized by the liver, but codeine requires renal clearance of its metabolites, which is impaired in dialysis patients 2.
- After hemodialysis sessions, a supplemental dose may be required as both acetaminophen and codeine are partially removed during dialysis 3, 4.
- Regular assessment of pain control and side effects is essential, with dose adjustments made based on individual response, and alternative analgesics like non-opioid options should be considered when appropriate to minimize opioid-related complications in this vulnerable population 1.
Monitoring and Precautions
- Monitor for signs of opioid toxicity, including excessive sedation, respiratory depression, and confusion, as codeine and its metabolites can accumulate in renal failure 2, 1.
- Avoid extended-release formulations and consider alternative analgesics when possible to minimize opioid-related complications 1.
- Hemodialysis can remove both acetaminophen and codeine, and the dose may need to be adjusted accordingly 3, 4.