From the Research
For patients with COPD, Tylenol 3 (acetaminophen with codeine) should be used cautiously at the lowest effective dose for the shortest duration possible, typically not exceeding 1 tablet (containing 300mg acetaminophen and 30mg codeine) every 6 hours, with a maximum of 2000mg acetaminophen and 120mg codeine daily. This recommendation is based on the potential for codeine to worsen respiratory function in COPD patients, as highlighted in various studies 1, 2. The most recent and highest quality study on opioid use in COPD patients suggests that opioids can be beneficial for breathlessness in certain patients, but this study focused on morphine rather than codeine 3. Given the potential risks, non-opioid alternatives like regular acetaminophen alone should be considered first for pain management in COPD, as suggested by the American Thoracic Society Clinical Practice Guideline 4. If Tylenol 3 is necessary, patients should be monitored closely for increased shortness of breath, drowsiness, or confusion, which may indicate respiratory depression. Key considerations include the patient's age, severity of COPD, and presence of other respiratory depressants, which can increase the risk of adverse effects. Overall, the goal is to balance the need for effective pain management with the potential risks associated with opioid use in COPD patients.