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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