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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