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Acetaminophen, Aspirin, and Caffeine


Pronunciation

 (a seet a MIN oh fen, AS pir in, & KAF een)


U.S. Brand Names

 Excedrin® Extra Strength [OTC]; Excedrin® Migraine [OTC]; Fem-Prin® [OTC]; Genaced™ [OTC]; Goody's® Extra Strength Headache Powder [OTC]; Goody's® Extra Strength Pain Relief [OTC]; Pain-Off [OTC]; Vanquish® Extra Strength Pain Reliever [OTC]


Synonyms

 Aspirin, Acetaminophen, and Caffeine; Aspirin, Caffeine and Acetaminophen; Caffeine, Acetaminophen, and Aspirin; Caffeine, Aspirin, and Acetaminophen


Generic Available

 Yes


Use

 Relief of mild to moderate pain; mild to moderate pain associated with migraine headache


Pregnancy Risk Factor

 D


Adverse Reactions

 See individual agents.


Drug Interactions

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

Aspirin: Substrate (minor) of CYP2C8/9

Caffeine: Substrate of CYP1A2 (major), 2C8/9 (minor), 2D6 (minor), 2E1 (minor), 3A4 (minor); Inhibits CYP1A2 (weak), 3A4 (moderate)

Also see individual monographs for Acetaminophen and Aspirin.


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:

Analgesic:

Based on acetaminophen component:

Mild to moderate pain: 325-650 mg every 4-6 hours as needed; do not exceed 4 g/day

Mild to moderate pain associated with migraine headache: 500 mg/dose (in combination with 500 mg aspirin and 130 mg caffeine) every 6 hours while symptoms persist; do not use for longer than 48 hours

Based on aspirin component:

Mild to moderate pain: 325-650 mg every 4-6 hours as needed; do not exceed 4 g/day

Mild to moderate pain associated with migraine headache: 500 mg/dose (in combination with 500 mg acetaminophen and 130 mg caffeine) every 6 hours; do not use for longer than 48 hours

Product labeling:

Excedrin® Extra Strength, Excedrin® Migraine: Children >12 years and Adults: 2 doses every 6 hours (maximum: 8 doses/24 hours)

Note: When used for migraine, do not use for longer than 48 hours

Goody's® Extra Strength Headache Powder: Children >12 years and Adults: 1 powder, placed on tongue or dissolved in water, every 4-6 hours (maximum: 4 powders/24 hours)

Goody's® Extra Strength Pain Relief Tablets: Children >12 years and Adults: 2 tablets every 4-6 hours (maximum: 8 tablets/24 hours)

Vanquish® Extra Strength Pain Reliever: Children >12 years and Adults: 2 tablets every 4 hours (maximum: 12 tablets/24 hours)


Dental Health: Effects on Dental Treatment

 No significant effects or complications reported


Dental Health: Vasoconstrictor/Local Anesthetic Precautions

 No information available to require special precautions


Mental Health: Effects on Mental Status

 May cause anxiety, insomnia, and excitability


Mental Health: Effects on Psychiatric Treatment

 Effects of CNS depressants may be lessened by caffeine component


Dosage Forms

Caplet:

Excedrin® Extra Strength, Excedrin® Migraine: Acetaminophen 250 mg, aspirin 250 mg, and caffeine 65 mg

Vanquish® Extra Strength Pain Reliever: Acetaminophen 194 mg, aspirin 227 mg, and caffeine 33 mg

Geltab (Excedrin® Extra Strength, Excedrin® Migraine): Acetaminophen 250 mg, aspirin 250 mg, and caffeine 65 mg

Powder (Goody's® Extra Strength Headache Powder): Acetaminophen 260 mg, aspirin 520 mg, and caffeine 32.5 mg [contains lactose]

Tablet:

Excedrin® Extra Strength, Excedrin® Migraine, Genaced™, Pain-Off: Acetaminophen 250 mg, aspirin 250 mg, and caffeine 65 mg

Fem-Prin®: Acetaminophen 194.4 mg, aspirin 226.8 mg, and caffeine 32.4 mg

Goody's® Extra Strength Pain Relief: Acetaminophen 130 mg, aspirin 260 mg, and caffeine 16.25 mg


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.

Desjardins PJ, Cooper SA, Gallegos TL, et al, "The Relative Analgesic Efficacy of Propiram Fumarate, Codeine Aspirin, and Placebo in Post-Impaction Dental Pain," J Clin Pharmacol , 1984, 24(1):35-42.

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.

Forbes JA, Butterworth GA, Burchfield WH, et al, "Evaluation of Ketorolac, Aspirin, and an Acetaminophen-Codeine Combination in Postoperative Oral Surgery Pain," Pharmacotherapy , 1990, 10(6 Pt 2):77S-93S.

Forbes JA, Keller CK, Smith JW, et al, "Analgesic Effect of Naproxen Sodium, Codeine, a Naproxen-Codeine Combination and Aspirin on the Postoperative Pain of Oral Surgery," Pharmacotherapy , 1986, 6(5):211-8.

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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