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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:

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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