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Acetaminophen and Diphenhydramine


Pronunciation

 (a seet a MIN oh fen & dye fen HYE dra meen)


U.S. Brand Names

 Anacin PM Aspirin Free [OTC] [DSC]; Excedrin® P.M. [OTC]; Goody's PM® Powder; Legatrin PM® [OTC]; Percogesic® Extra Strength [OTC]; Tylenol® PM Extra Strength [OTC]; Tylenol® Severe Allergy [OTC]


Synonyms

 Diphenhydramine and Acetaminophen


Generic Available

 Yes: Excludes powder


Use

 Aid in the relief of insomnia accompanied by minor pain


Adverse Reactions

 See individual agents.


Drug Interactions

Acetaminophen: Substrate (minor) of CYP1A2, 2A6, 2C8/9, 2D6, 2E1, 3A4; Inhibits CYP3A4 (weak)

Diphenhydramine: Inhibits CYP2D6 (moderate)

Also see individual agents.


Ethanol/Nutrition/Herb Interactions

 Ethanol: Excessive intake of ethanol may increase the risk of acetaminophen-induced hepatotoxicity. Avoid ethanol or limit to <3 drinks/day.


Pharmacodynamics/Kinetics

 See individual agents.


Dosage

 Oral: Adults: 50 mg of diphenhydramine HCl (76 mg diphenhydramine citrate) at bedtime or as directed by physician; do not exceed recommended dosage; not for use in children <12 years of age


Patient Education

 If you consume 3 or more alcoholic drinks per day, ask your prescriber whether you should take acetaminophen, other pain relievers, or fever reducers. Acetaminophen may cause liver damage.


Dental Health: Effects on Dental Treatment

 Key adverse event(s) related to dental treatment: Xerostomia (normal salivary flow resumes upon discontinuation).


Dental Health: Vasoconstrictor/Local Anesthetic Precautions

 No information available to require special precautions


Mental Health: Effects on Mental Status

 Drowsiness is common


Mental Health: Effects on Psychiatric Treatment

 Concurrent use with CNS depressant may result in additive CNS depression. MAO inhibitor may cause additive anticholinergic effects.


Dosage Forms

 [DSC] = Discontinued product

Caplet: Acetaminophen 500 mg and diphenhydramine hydrochloride 25 mg

Excedrin® P.M.: Acetaminophen 500 mg and diphenhydramine citrate 38 mg [contains benzoic acid]

Legatrin PM®: Acetaminophen 500 mg and diphenhydramine hydrochloride 50 mg

Percogesic® Extra Strength: Acetaminophen 500 mg and diphenhydramine hydrochloride 25 mg

Tylenol® PM Extra Strength: Acetaminophen 500 mg and diphenhydramine hydrochloride 25 mg

Tylenol® Severe Allergy: Acetaminophen 500 mg and diphenhydramine hydrochloride 12.5 mg

Gelcap (Tylenol® PM Extra Strength): Acetaminophen 500 mg and diphenhydramine hydrochloride 25 mg [contains benzyl alcohol]

Geltab: Acetaminophen 500 mg and diphenhydramine hydrochloride 25 mg

Excedrin® P.M.: Acetaminophen 500 mg and diphenhydramine citrate 38 mg [contains benzoic acid]

Tylenol® PM Extra Strength: Acetaminophen 500 mg and diphenhydramine hydrochloride 25 mg [contains benzyl alcohol]

Powder for oral solution (Goody's PM® Powder): Acetaminophen 500 mg and diphenhydramine citrate 38 mg

Tablet: Acetaminophen 500 mg and diphenhydramine hydrochloride 25 mg

Anacin® PM Aspirin-Free [DSC], Tylenol® PM Extra Strength: Acetaminophen 500 mg and diphenhydramine hydrochloride 25 mg

Excedrin® P.M.: Acetaminophen 500 mg and diphenhydramine citrate 38 mg [contains benzoic acid]


References

Barker JD Jr, de Carle DJ, and Anuras S, "Chronic Excessive Acetaminophen Use in Liver Damage," Ann Intern Med , 1977, 87(3):299-301.

Dionne RA, Campbell RA, Cooper SA, et al, "Suppression of Postoperative Pain by Preoperative Administration of Ibuprofen in Comparison to Placebo, Acetaminophen, and Acetaminophen Plus Codeine," J Clin Pharmacol , 1983, 23(1):37-43.

Licht H, Seeff LB, and Zimmerman HJ, "Apparent Potentiation of Acetaminophen Hepatotoxicity by Alcohol," Ann Intern Med , 1980, 92(4):511.

Mokhlesi B, Leikin JB, Murray P, et al, "Adult Toxicology in Critical Care: Part II: Specific Poisonings," Chest , 2003, 123(3):897-922.


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