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Pronunciation:

(a seet a MIN oh fen, eye soe me THEP teen, & dye KLOR al FEN a zone)

U.S. Brand Names:

I.D.A.; Midrin®; Migrin-A

Synonyms:

Acetaminophen, Dichloralphenazone, and Isometheptene; Dichloralphenazone, Acetaminophen, and Isometheptene; Dichloralphenazone, Isometheptene, and Acetaminophen; Isometheptene, Acetaminophen, and Dichloralphenazone; Isometheptene, Dichloralphenazone, and Acetaminophen

Generic Available:

Yes

Use:

Relief of migraine and tension headache

Restrictions:

C-IV

Lactation:

Excretion in breast milk unknown/use caution

Contraindications:

Hypersensitivity to acetaminophen, isometheptene, dichloralphenazone, or any component of the formulation; glaucoma; severe renal disease; hypertension; organic heart disease; hepatic disease; MAO inhibitor therapy

Adverse Reactions:

Frequency not defined.

Central nervous system: Transient dizziness

Dermatological: Rash

Drug Interactions:

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

Decreased effect: Barbiturates, carbamazepine, hydantoins, rifampin, sulfinpyrazone may decrease the analgesic effect of acetaminophen; cholestyramine may decrease acetaminophen absorption (separate dosing by at least 1 hour)

Increased toxicity: Barbiturates, carbamazepine, hydantoins, isoniazid, rifampin, sulfinpyrazone may increase the hepatotoxic potential of acetaminophen; chronic ethanol abuse increases risk for acetaminophen toxicity; effect of warfarin may be enhanced

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.

Dosage:

Oral: Adults:

Migraine headache: 2 capsules to start, followed by 1 capsule every hour until relief is obtained (maximum: 5 capsules/12 hours)

Tension headache: 1-2 capsules every 4 hours (maximum: 8 capsules/24 hours)

Patient Education:

Breast-feeding precaution: Consult prescriber if breast-feeding.

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 drowsiness or dizziness

Mental Health: Effects on Psychiatric Treatment:

Contraindicated with MAO inhibitor

Dosage Forms:

Capsule: Acetaminophen 325 mg, isometheptene mucate 65 mg, dichloralphenazone 100 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.

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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