What is the safe dosage of Tylenol 3 (Acetaminophen and Codeine) with Impaired renal function (eGFR of 56)?

From the Guidelines

For an individual with an eGFR of 56, Tylenol 3 (acetaminophen with codeine) should be used with caution, with a recommended maximum dose of 1-2 tablets every 6 hours as needed for pain, not exceeding 6 tablets in 24 hours, as suggested by the most recent guidelines 1. When considering the use of Tylenol 3 in patients with moderate kidney impairment, it's essential to take into account the potential accumulation of the codeine component, which is partially cleared by the kidneys.

• The codeine component may accumulate in the system, leading to increased risk of side effects such as excessive drowsiness, confusion, or constipation.
• Total daily acetaminophen intake should not exceed 3000mg to reduce kidney and liver stress, as recommended by recent studies 1.
• Monitoring for side effects is crucial, and if pain persists, consultation with a healthcare provider is necessary to adjust the medication or dosing schedule based on the specific health situation.
• The use of opioids, including codeine, in patients with renal insufficiency requires caution, and alternative analgesics may be considered, as suggested by recent guidelines 1.
• It's also important to note that the safest nonopioid analgesic may be acetaminophen, and intravenous acetaminophen may be better absorbed until gut function has recovered postoperatively, as recommended by recent studies 1.

From the Research

Safe Use of Tylenol 3 with Renal Impairment

• Tylenol 3 is a combination of acetaminophen and codeine, an opioid analgesic.
• The safety of using Tylenol 3 in patients with renal impairment, specifically with an eGFR of 56, is a concern due to the potential for accumulation of toxic metabolites 2, 3, 4.
• Codeine, a component of Tylenol 3, is not recommended for use in patients with renal failure or dialysis due to the risk of neurotoxic symptoms from metabolite accumulation 2, 5, 4.

Alternative Opioids for Renal Impairment

• Opioids such as oxycodone and hydromorphone can be used with caution and close monitoring in patients with renal impairment, but may require dosage adjustments 2, 5, 4.
• Fentanyl and methadone are considered safer options for use in patients with renal impairment, but may still require careful monitoring 3, 6, 4.
• Buprenorphine may also be a suitable option, but its use in patients with severe renal impairment is not well studied 5.

Dosage Recommendations

• There is no specific dosage recommendation for Tylenol 3 in patients with an eGFR of 56, as codeine is generally avoided in renal impairment.
• If an opioid is necessary, dosage adjustments and close monitoring are recommended to minimize the risk of adverse effects 2, 5, 4.