Does anyone know if IV Tylenol is any better than PO Tylenol?
Does anyone know if IV Tylenol is any better than PO Tylenol?
FDA has approved the IV form, Omfirmev but we don't yet have it on formulary. It has a definite opioid sparing effect (and lower PONV likely due to less opioid). I haven't seen anything comparing the clinical efficacy of IV to PO. The Medical Letter has a summary on Omfirmev. Peak serum levels are 70% higher with IV vs PO with onset of analgesia at 10 minutes, peak at 1 hour and last 4-6 hours. These likely outperform PO route. PR pharmacokinetics are unreliable, so IV route would definitely be preferred. Wholesale cost is $10.75, within a dollar of ketorolac. I plan on using it when available and I wonder if combining it with ketorolac will have additive opioid-sparing effect.
Yeah, I can't imagine anyone's gonna use this is people who could take PO (or even PR) unless there was some other absorption issue.
How many people here use PO acetaminophen preop? I'm guessing not many.
what ever happened to good ole per rectum?
I've used it on most patients i've seen through the OR.
IMHO it a has a pretty weak effect. Patients are so variable in respect to pain (eg post-op thoracotomies barely using any morphine ) that it would be hard to notice it's effect: if there are studies on opiod sparring i haven't seen them.
What has been studied is the post-op plasma level between PO and iv and due to slower GI transit times the peak PO level is about half the iv.
Agree w/ sevo85288; anecdotally, this stuff works better than my expectations for it. I started using it specifically when the po route is unavailable, and/or the sturgeons have forbidden ketorolac.
As others have said, IV administration offers several advantages in terms of PK, i.e. shorter Tmax (i.e. more rapid onset), higher Cmax, and greater time above MEAC in the CNS (the site of action).
My initial reaction was: great, but what about the liver? Because iv route avoids 1st-pass metabolism, the liver sees about 2-fold LESS APAP initially, so iv route may in fact be safer. The mean Cmax after 1gm iv is about 29mg/L, whereas the threshold for potential hepatotoxicity which is about 150mg/L.
Could you please provide a link or source to your last sentence. Thanks
Could you please provide a link or source to your last sentence. Thanks