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Acetaminophen/butalbital/caffeine Disease Interactions

There are 23 disease interactions with acetaminophen / butalbital / caffeine.

Major

Acetaminophen (applies to acetaminophen/butalbital/caffeine) alcoholism

Major Potential Hazard, High plausibility.

Chronic alcohol abusers may be at increased risk of hepatotoxicity during treatment with acetaminophen (APAP). Severe liver injury, including cases of acute liver failure resulting in liver transplant and death, has been reported in patients using acetaminophen. Therapy with acetaminophen should be administered cautiously, if at all, in patients who consume three or more alcoholic drinks a day. In general, patients should avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure. They should also be advised to seek medical attention if they experience signs and symptoms of liver injury such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice.

References

  1. Kaysen GA, Pond SM, Roper MH, Menke DJ, Marrama MA "Combined hepatic and renal injury in alcoholics during therapeutic use of acetaminophen." Arch Intern Med 145 (1985): 2019-23
  2. O'Dell JR, Zetterman RK, Burnett DA "Centrilobular hepatic fibrosis following acetaminophen-induced hepatic necrosis in an alcoholic." JAMA 255 (1986): 2636-7
  3. Seeff LB, Cuccherini BA, Zimmerman HJ, Adler E, Benjamin SB "Acetaminophen hepatotoxicity in alcoholics." Ann Intern Med 104 (1986): 399-404
  4. McClain CJ, Kromhout JP, Peterson FJ, Holtzman JL "Potentiation of acetaminophen hepatotoxicity by alcohol." JAMA 244 (1980): 251-3
  5. Kartsonis A, Reddy KR, Schiff ER "Alcohol, acetaminophen, and hepatic necrosis." Ann Intern Med 105 (1986): 138-9
  6. Prescott LF, Critchley JA "Drug interactions affecting analgesic toxicity." Am J Med 75 (1983): 113-6
  7. "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical PROD (2002):
  8. Whitcomb DC, Block GD "Association of acetaminopphen hepatotoxicity with fasting and ethanol use." JAMA 272 (1994): 1845-50
  9. Bonkovsky HL "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA 274 (1995): 301
  10. Nelson EB, Temple AR "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA 274 (1995): 301
  11. Zimmerman HJ, Maddrey WC "Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: analysis of instances of therapeutic misadventure." Hepatology 22 (1995): 767-73
View all 11 references
Major

Acetaminophen (applies to acetaminophen/butalbital/caffeine) liver disease

Major Potential Hazard, Moderate plausibility. Applicable conditions: Malnourished, Dehydration

Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease. Patients with hepatic impairment may be at increased risk of toxicity. Severe liver injury, including cases of acute liver failure and death, have been reported in patients using this drug. Clinical monitoring of hepatic function is recommended. Caution is advised if using acetaminophen in patients with chronic malnutrition or severe hypovolemia. Instruct patients to avoid drinking alcohol while taking acetaminophen-containing medications. Patients should be warned not to exceed the maximum recommended total daily dosage of acetaminophen (4 g/day in adults and children 12 years of age or older), and to read all prescription and over-the-counter medication labels to ensure they are not taking multiple acetaminophen-containing products, or check with a healthcare professional if they are unsure.

References

  1. "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical PROD (2002):
  2. "Product Information. Acetaminophen (acetaminophen)." Hikma Pharmaceuticals USA Inc. ORIG-1 (2022):
Major

Barbiturates (applies to acetaminophen/butalbital/caffeine) acute alcohol intoxication

Major Potential Hazard, High plausibility.

The use of barbiturates is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of barbiturates may be additive with those of alcohol. Severe respiratory depression and death may occur. Therapy with barbiturates should be administered cautiously in patients who might be prone to acute alcohol intake.

References

  1. Plaa GL "Acute toxicity of antiepileptic drugs." Epilepsia 16 (1975): 183-91
  2. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company PROD (2001):
  3. "Multum Information Services, Inc. Expert Review Panel"
  4. "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company PROD (2001):
  5. "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical PROD (2001):
  6. "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company PROD (2001):
  7. "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals PROD (2001):
  8. "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories PROD (2001):
View all 8 references
Major

Barbiturates (applies to acetaminophen/butalbital/caffeine) drug dependence

Major Potential Hazard, High plausibility. Applicable conditions: Drug Abuse/Dependence, Alcoholism

Barbiturates have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop, particularly after prolonged use of excessive dosages. Abrupt cessation and/or a reduction in dosage may precipitate withdrawal symptoms. In patients who have developed tolerance to a barbiturate, overdosage can still produce respiratory depression and death, and cross-tolerance usually will occur with other agents in the class. Addiction-prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance or medical supervision when treated with barbiturates. It may be prudent to refrain from dispensing large quantities of medication to these patients. After prolonged use or if dependency is suspected, withdrawal of barbiturates should be undertaken gradually using a dosage-tapering schedule.

References

  1. Boisse NR, Okamoto M "Physical dependence to barbital compared to pentobarbital. II. Tolerance characteristics." J Pharmacol Exp Ther 204 (1978): 507-13
  2. Gersema LM, Alexander B, Kunze KE "Major withdrawal symptoms after abrupt discontinuation of phenobarbital." Clin Pharm 6 (1987): 420-2
  3. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company PROD (2001):
  4. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  5. "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company PROD (2001):
  6. "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical PROD (2001):
  7. "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company PROD (2001):
  8. "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals PROD (2001):
  9. "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories PROD (2001):
View all 9 references
Major

Barbiturates (applies to acetaminophen/butalbital/caffeine) liver disease

Major Potential Hazard, High plausibility.

Barbiturates are extensively metabolized by the liver. The plasma clearance of barbiturates may be decreased and the half-lives prolonged in patients with impaired hepatic function. Therapy with barbiturates should be administered cautiously and initiated at reduced dosages in patients with liver disease. Barbiturates are not recommended for use in patients with cirrhosis, hepatic failure, hepatic coma, or other severe hepatic impairment.

References

  1. Alvin J, McHorse T, Hoyumpa A, et al. "The effect of liver disease in man on the disposition of phenobarbital." J Pharmacol Exp Ther 192 (1975): 224-35
  2. Kallberg N, Agurell S, Ericsson O, et al. "Quantitation of phenobarbital and its main metabolites in human urine." Eur J Clin Pharmacol 9 (1975): 161-8
  3. Whyte MP, Dekaban "Metabolic fate of phenobarbital: a quantitative study of p-hydroxyphenobarbital elimination in man." Drug Metab Dispos 5 (1977): 63-9
  4. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company PROD (2001):
  5. "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company PROD (2001):
  6. "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical PROD (2001):
  7. "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company PROD (2001):
  8. "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals PROD (2001):
  9. "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories PROD (2001):
View all 9 references
Major

Barbiturates (applies to acetaminophen/butalbital/caffeine) porphyria

Major Potential Hazard, High plausibility.

The use of barbiturates is contraindicated in patients with a history of porphyria. Barbiturates may exacerbate acute intermittent porphyria or porphyria variegata by inducing the enzymes responsible for porphyrin synthesis.

References

  1. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company PROD (2001):
  2. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  3. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):
  4. "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company PROD (2001):
  5. "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical PROD (2001):
  6. "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company PROD (2001):
  7. "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals PROD (2001):
  8. "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories PROD (2001):
View all 8 references
Major

Barbiturates (applies to acetaminophen/butalbital/caffeine) rash

Major Potential Hazard, High plausibility. Applicable conditions: Dermatitis - Drug-Induced

Skin eruptions may precede rare but potentially fatal barbiturate-induced reactions such as systemic lupus erythematosus and exfoliative dermatitis, the latter of which may be accompanied by hepatitis and jaundice. Therapy with barbiturates should be administered cautiously in patients with preexisting drug-induced dermatitis, since it may delay the recognition of a potential reaction to barbiturates. Barbiturate therapy should be withdrawn promptly at the first sign of a dermatologic adverse effect. However, cutaneous reactions may proceed to an irreversible stage even after cessation of medication due to the slow rate of metabolism and excretion of barbiturates. Patients should be advised to promptly report signs that may indicate impending development of barbiturate-related cutaneous lesions, including high fever, severe headache, stomatitis, conjunctivitis, rhinitis, urethritis, and balanitis. Rashes may be more likely to occur with phenobarbital and mephobarbital.

References

  1. Pelekanos J, Camfield P, Camfield C, Gordon K "Allergic rash due to antiepileptic drugs: clinical features and management." Epilepsia 32 (1991): 554-9
  2. Pagliaro L, Campesi G, Aguglia F "Barbiturate jaundice. Report of a case due to a barbital-containing drug, with positive rechallenge to phenobarbital." Gastroenterology 56 (1969): 938-43
  3. Shear NH, Spielberg SP "Anticonvulsant hypersensitivity syndrome. In vitro assessment of risk." J Clin Invest 82 (1988): 1826-32
  4. Stuttgen G "Toxic epidermal necrolysis provoked by barbiturates." Br J Dermatol 88 (1973): 291-3
  5. Fernandez de Corres L, Leanizbarrutia I, Munoz D "Eczematous drug reaction from phenobarbitone." Contact Dermatitis 11 (1984): 319
  6. Dourmishev AL, Rahman MA "Phenobarbital-induced pemphigus vulgaris." Dermatologica 173 (1986): 256-8
  7. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company PROD (2001):
  8. "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company PROD (2001):
  9. "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical PROD (2001):
  10. "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company PROD (2001):
  11. "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals PROD (2001):
  12. "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories PROD (2001):
View all 12 references
Major

Barbiturates (applies to acetaminophen/butalbital/caffeine) respiratory depression

Major Potential Hazard, High plausibility. Applicable conditions: Asphyxia, Pulmonary Impairment, Respiratory Arrest

Barbiturates may produce severe respiratory depression, apnea, laryngospasm, bronchospasm and cough, particularly during rapid intravenous administration. In usual hypnotic dosages, the degree of respiratory depression produced is similar to that which occurs during physiologic sleep, while at higher dosages, the rate, depth and volume of respiration may be markedly decreased. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with barbiturates should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are particularly important, and equipment for resuscitation should be immediately available if the parenteral route is used. Barbiturates, especially injectable formulations, should generally be avoided in patients with sleep apnea, hypoxia, or severe pulmonary diseases in which dyspnea or obstruction is evident.

References

  1. Plaa GL "Acute toxicity of antiepileptic drugs." Epilepsia 16 (1975): 183-91
  2. Lund A, Gormsen H "The role of antiepileptics in sudden death in epilepsy." Acta Neurol Scand 72 (1985): 444-6
  3. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company PROD (2001):
  4. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  5. "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company PROD (2001):
  6. "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical PROD (2001):
  7. "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company PROD (2001):
  8. "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals PROD (2001):
  9. "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories PROD (2001):
View all 9 references
Major

CNS stimulants (applies to acetaminophen/butalbital/caffeine) cardiac disease

Major Potential Hazard, Moderate plausibility. Applicable conditions: Hypertension, Hyperthyroidism, Heart Disease, Pheochromocytoma, Peripheral Arterial Disease

Many CNS stimulants are contraindicated in patients with significant cardiovascular impairment such as uncompensated heart failure, severe coronary disease, severe hypertension (including that associated with hyperthyroidism or pheochromocytoma), cardiac structural abnormalities, serious arrhythmias, etc. Sudden death has been reported in patients with structural cardiac abnormalities or other serious cardiac disease who are treated with CNS stimulants at the recommended dosages for attention deficit hyperactivity disorder; use of these agents should be avoided in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, coronary artery disease, or other serious cardiac disease. Additionally, stroke, myocardial infarction, chest pain, syncope, arrhythmias, and other symptoms have been reported in adults under treatment. A careful assessment of the cardiovascular status should be done in patients being considered for treatment. This includes family history, physical exam, and further cardiac evaluation (EKG and echocardiogram). Patients who develop symptoms should have a detailed cardiac evaluation and if needed, treatment should be suspended.

References

  1. "Product Information. Provigil (modafinil)." Cephalon, Inc PROD (2001):
  2. "Product Information. Dopram (doxapram)." West Ward Pharmaceutical Corporation PROD (2001):
  3. "Product Information. Dexedrine (dextroamphetamine)." SmithKline Beecham PROD (2001):
  4. "Product Information. Didrex (benzphetamine)." Pharmacia and Upjohn PROD (2001):
  5. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  6. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  7. "Product Information. Concerta (methylphenidate)." Alza (2002):
  8. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
  9. "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
  10. "Product Information. Nuvigil (armodafinil)." Cephalon Inc (2007):
  11. "Product Information. Phendimetrazine Tartrate SR (phendimetrazine)." Sandoz Inc (2012):
  12. "Product Information. Phentermine Hydrochloride (phentermine)." Tagi Pharma Inc (2019):
  13. "Product Information. Desoxyn (methamphetamine)." Recordati Rare Diseases Inc SUPPL-38 (2023):
View all 13 references
Major

CNS stimulants (applies to acetaminophen/butalbital/caffeine) hypertension

Major Potential Hazard, Moderate plausibility.

CNS stimulants increase blood pressure and heart rate; the use of some agents may be contraindicated in patients with severe/uncontrolled hypertension. Caution should be used when administering to patients with preexisting high blood pressure (even mild hypertension) and other cardiovascular conditions. All patients under treatment should be regularly monitored for potential tachycardia and hypertension.

References

  1. "Product Information. Provigil (modafinil)." Cephalon, Inc PROD (2001):
  2. "Product Information. Dopram (doxapram)." West Ward Pharmaceutical Corporation PROD (2001):
  3. "Product Information. Dexedrine (dextroamphetamine)." SmithKline Beecham PROD (2001):
  4. "Product Information. Didrex (benzphetamine)." Pharmacia and Upjohn PROD (2001):
  5. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  6. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  7. "Product Information. Concerta (methylphenidate)." Alza (2002):
  8. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
  9. "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
  10. "Product Information. Nuvigil (armodafinil)." Cephalon Inc (2007):
  11. "Product Information. Phendimetrazine Tartrate SR (phendimetrazine)." Sandoz Inc (2012):
  12. "Product Information. Phentermine Hydrochloride (phentermine)." Tagi Pharma Inc (2019):
  13. "Product Information. Desoxyn (methamphetamine)." Recordati Rare Diseases Inc SUPPL-38 (2023):
View all 13 references
Major

CNS stimulants (applies to acetaminophen/butalbital/caffeine) psychiatric disorders

Major Potential Hazard, Moderate plausibility. Applicable conditions: Psychosis, Depression

The use of CNS stimulants can cause psychotic symptoms, suicidal ideation, and aggression, and can exacerbate symptoms of behavior disturbance and thought disorder; CNS stimulants may induce a manic or mixed episode in patients with bipolar disorder. Psychiatric symptoms have been reported in patients with and without history of psychiatric disorders. All patients (particularly those with psychotic or bipolar disorders) should be monitored closely, especially during treatment initiation and at times of dose changes. Extreme caution should be exercised when CNS stimulants are given to patients with a history of psychosis, depression, mania, or bipolar disorder. Prior to initiating therapy, all patients should be screened for risk factors for developing a manic episode (e.g., comorbid or history of depressive symptoms or family history of suicide, bipolar disease, or depression). If any psychiatric symptoms emerge or are exacerbated, treatment suspension should be considered. Some CNS stimulants are contraindicated in patients with marked agitation or anxiety.

References

  1. "Product Information. Provigil (modafinil)." Cephalon, Inc PROD (2001):
  2. "Product Information. Cylert (pemoline)." Abbott Pharmaceutical PROD (2001):
  3. "Product Information. Ritalin (methylphenidate)." Novartis Pharmaceuticals PROD (2001):
  4. "Product Information. Dopram (doxapram)." West Ward Pharmaceutical Corporation PROD (2001):
  5. "Product Information. Dexedrine (dextroamphetamine)." SmithKline Beecham PROD (2001):
  6. "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
  7. "Product Information. Didrex (benzphetamine)." Pharmacia and Upjohn PROD (2001):
  8. "Product Information. Prelu-2 (phendimetrazine)." Boehringer-Ingelheim PROD (2001):
  9. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  10. "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals PROD (2001):
  11. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  12. "Product Information. Concerta (methylphenidate)." Alza (2002):
  13. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
  14. "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
  15. "Product Information. Nuvigil (armodafinil)." Cephalon Inc (2007):
  16. "Product Information. Phendimetrazine Tartrate SR (phendimetrazine)." Sandoz Inc (2012):
  17. "Product Information. Fintepla (fenfluramine)." Zogenix, Inc (2020):
  18. "Product Information. Qsymia (phentermine-topiramate)." Vivus Inc SUPPL-23 (2023):
  19. "Product Information. Phentermine Hydrochloride (phentermine)." Tagi Pharma Inc (2019):
  20. "Product Information. Desoxyn (methamphetamine)." Recordati Rare Diseases Inc SUPPL-38 (2023):
View all 20 references
Major

Methylxanthines (applies to acetaminophen/butalbital/caffeine) PUD

Major Potential Hazard, High plausibility. Applicable conditions: Peptic Ulcer

Methylxanthines are known to stimulate peptic acid secretion. Therapy with products containing methylxanthines should be administered with extreme caution in patients with active peptic ulcer disease. Some manufacturers consider their use to be contraindicated under such circumstance.

References

  1. Stoller JL "Oesophageal ulceration and theophylline." Lancet 2 (1985): 328-9
  2. "Product Information. Theo-Dur (theophylline)." Schering Corporation PROD (2001):
  3. Alterman P, Spiegel D, Feldman J, Yaretzky A "Histamine h2-receptor antagonists and chronic theophylline toxicity." Am Fam Physician 54 (1996): 1473
  4. "Product Information. Lufyllin (dyphylline)." Wallace Laboratories PROD (2001):
View all 4 references
Moderate

Acetaminophen (applies to acetaminophen/butalbital/caffeine) PKU

Moderate Potential Hazard, High plausibility. Applicable conditions: Phenylketonuria

Several oral acetaminophen and acetaminophen-combination products, particularly flavored chewable tablets, contain the artificial sweetener, aspartame (NutraSweet). Aspartame is converted to phenylalanine in the gastrointestinal tract following ingestion. Chewable and effervescent formulations of acetaminophen products may also contain phenylalanine. The aspartame/phenylalanine content should be considered when these products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).

References

  1. "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical PROD (2002):
Moderate

Barbiturates (applies to acetaminophen/butalbital/caffeine) adrenal insufficiency

Moderate Potential Hazard, High plausibility. Applicable conditions: Panhypopituitarism

Barbiturates, especially phenobarbital, secobarbital and butabarbital, may diminish the systemic effects of exogenous and endogenous corticosteroids via induction of hepatic microsomal enzymes, thereby accelerating the metabolism of corticosteroids. In addition, barbiturates may interfere with pituitary corticotropin production. Therapy with barbiturates should be administered cautiously in patients with adrenal insufficiency. Patients with borderline hypoadrenalism should be monitored closely, and patients receiving steroid supplementation may require an adjustment in dosage when barbiturates are added to or withdrawn from their medication regimen.

References

  1. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company PROD (2001):
  2. "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company PROD (2001):
  3. "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical PROD (2001):
  4. "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company PROD (2001):
  5. "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals PROD (2001):
  6. "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories PROD (2001):
View all 6 references
Moderate

Barbiturates (applies to acetaminophen/butalbital/caffeine) depression

Moderate Potential Hazard, High plausibility.

Barbiturates depress the central nervous system and may cause or exacerbate mental depression. Therapy with barbiturates should be administered cautiously in patients with a history of depression or suicidal tendencies. It may be prudent to refrain from dispensing large quantities of medication to these patients.

References

  1. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company PROD (2001):
  2. "Multum Information Services, Inc. Expert Review Panel"
  3. "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company PROD (2001):
  4. "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical PROD (2001):
  5. "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company PROD (2001):
  6. "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals PROD (2001):
  7. "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories PROD (2001):
View all 7 references
Moderate

Barbiturates (applies to acetaminophen/butalbital/caffeine) hematologic toxicity

Moderate Potential Hazard, Low plausibility. Applicable conditions: Bone Marrow Depression/Low Blood Counts

Hematologic toxicity, including agranulocytosis, thrombocytopenic purpura and megaloblastic anemia, has been reported rarely during use of barbiturates. Therapy with barbiturates should be administered cautiously in patients with preexisting blood dyscrasias or bone marrow suppression. Blood counts are recommended prior to and periodically during long-term therapy, and patients should be instructed to immediately report any signs or symptoms suggestive of blood dyscrasia such as fever, sore throat, local infection, easy bruising, petechiae, bleeding, pallor, dizziness, or jaundice. Barbiturate therapy should be discontinued if blood dyscrasias occur.

References

  1. Van Hoof A, Chamone DA, Vermylen J "Platelet aggregation and anaesthesia." Lancet 2 (1980): 373
  2. Kiorboe E, Plum CM "Megaloblastic anaemia developing during treatment of epilepsy." Acta Med Scand Suppl 445 (1966): 349-57
  3. Iivanainen M, Savolainen H "Side effects of phenobarbital and phenytoin during long-term treatment of epilepsy." Acta Neurol Scand Suppl 97 (1983): 49-67
  4. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company PROD (2001):
  5. "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company PROD (2001):
  6. "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical PROD (2001):
  7. "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company PROD (2001):
  8. "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals PROD (2001):
  9. "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories PROD (2001):
View all 9 references
Moderate

Barbiturates (applies to acetaminophen/butalbital/caffeine) osteomalacia

Moderate Potential Hazard, Low plausibility. Applicable conditions: Vitamin D Deficiency

Rickets and osteomalacia have rarely been reported following prolonged use of barbiturates, possibly due to increased metabolism of vitamin D as a result of enzyme induction by barbiturates. Long-term therapy with barbiturates should be administered cautiously in patients with vitamin D deficiency.

References

  1. Sotaniemi EA, Hakkarainen HK, Puranen JA, Lahti RO "Radiologic bone changes and hypocalcemia with anticonvulsant therapy in epilepsy." Ann Intern Med 77 (1972): 389-94
  2. Zerwekh JE, Homan R, Tindall R, Pak CY "Decreased serum 24,25-dihydroxyvitamin D concentration during long- term anticonvulsant therapy in adult epileptics." Ann Neurol 12 (1982): 184-6
  3. Marsden CD, Reynolds EH, Parsons V, Harris R, Duchen L "Myopathy associated with anticonvulsant osteomalacia." Br Med J 4 (1973): 526-7
  4. Iivanainen M, Savolainen H "Side effects of phenobarbital and phenytoin during long-term treatment of epilepsy." Acta Neurol Scand Suppl 97 (1983): 49-67
  5. Doriguzzi C, Mongini T, Jeantet A, Monga G "Tubular aggregates in a case of osteomalacic myopathy due to anticonvulsant drugs." Clin Neuropathol 3 (1984): 42-5
  6. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company PROD (2001):
View all 6 references
Moderate

Barbiturates (applies to acetaminophen/butalbital/caffeine) paradoxical reactions

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Hyperkinetic Syndrome of Childhood

Paradoxical reactions characterized by excitability and restlessness may occur in pediatric patients with hyperactive aggressive disorders. Such patients should be monitored for signs of paradoxical stimulation during therapy with barbiturates.

References

  1. Mayhew LA, Hanzel TE, Ferron FR, Kalachnik JE, Harder SR "Phenobarbital exacerbation of self-injurious behavior." J Nerv Ment Dis 180 (1992): 732-3
  2. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company PROD (2001):
  3. Sylvester CE, Marchlewski A, Manaligod JM "Primidone or phenobarbital use complicating disruptive behavior disorders." Clin Pediatr (Phila) 33 (1994): 252-3
  4. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  5. "Product Information. Amytal Sodium (amobarbital)." Lilly, Eli and Company PROD (2001):
  6. "Product Information. Nembutal Sodium (pentobarbital)." Abbott Pharmaceutical PROD (2001):
  7. "Product Information. Seconal Sodium (secobarbital)." Lilly, Eli and Company PROD (2001):
  8. "Product Information. Mebaral (mephobarbital)." Sanofi Winthrop Pharmaceuticals PROD (2001):
  9. "Product Information. Butisol Sodium (butabarbital)." Wallace Laboratories PROD (2001):
View all 9 references
Moderate

Caffeine (applies to acetaminophen/butalbital/caffeine) cardiotoxicity

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Tachyarrhythmia, Myocardial Infarction, Post MI Syndrome, Hypertension, Hyperthyroidism, Angina Pectoris

Like other methylxanthines, caffeine at high dosages may be associated with positive inotropic and chronotropic effects on the heart. Caffeine may also produce an increase in systemic vascular resistance, resulting in elevation of blood pressure. Therapy with products containing caffeine should be administered cautiously in patients with severe cardiac disease, hypertension, hyperthyroidism, or acute myocardial injury. Some clinicians recommend avoiding caffeine in patients with symptomatic cardiac arrhythmias and/or palpitations and during the first several days to weeks after an acute myocardial infarction.

References

  1. "Multum Information Services, Inc. Expert Review Panel"
Moderate

CNS stimulants (applies to acetaminophen/butalbital/caffeine) liver disease

Moderate Potential Hazard, Moderate plausibility.

In general, CNS stimulants are extensively metabolized by the liver. Their plasma clearance may be decreased and their half-life prolonged in patients with impaired hepatic function. Therapy with CNS stimulants should be administered cautiously in patients with moderate to severe liver disease, and the dosage should be adjusted accordingly in certain agents. Additionally, postmarketing reports have shown that atomoxetine can cause severe liver injury; laboratory testing should be done at the first sign/symptom of liver dysfunction (jaundice, dark urine, upper quadrant tenderness) and treatment should be discontinued in patients with evidence of liver injury.

References

  1. "Product Information. Provigil (modafinil)." Cephalon, Inc PROD (2001):
  2. "Product Information. Dopram (doxapram)." West Ward Pharmaceutical Corporation PROD (2001):
  3. "Product Information. Dexedrine (dextroamphetamine)." SmithKline Beecham PROD (2001):
  4. "Product Information. Didrex (benzphetamine)." Pharmacia and Upjohn PROD (2001):
  5. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  6. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  7. "Product Information. Concerta (methylphenidate)." Alza (2002):
  8. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
  9. "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
  10. "Product Information. Nuvigil (armodafinil)." Cephalon Inc (2007):
  11. "Product Information. Phendimetrazine Tartrate SR (phendimetrazine)." Sandoz Inc (2012):
  12. "Product Information. Desoxyn (methamphetamine)." Recordati Rare Diseases Inc SUPPL-38 (2023):
View all 12 references
Moderate

CNS stimulants (applies to acetaminophen/butalbital/caffeine) renal dysfunction

Moderate Potential Hazard, Moderate plausibility.

Overall CNS stimulants should be administered with caution in patients with significantly impaired renal function as the reduction in the rate of elimination may alter the therapeutic response. The dosage should be adjusted accordingly in certain agents.

References

  1. "Product Information. Provigil (modafinil)." Cephalon, Inc PROD (2001):
  2. "Product Information. Dopram (doxapram)." West Ward Pharmaceutical Corporation PROD (2001):
  3. "Product Information. Didrex (benzphetamine)." Pharmacia and Upjohn PROD (2001):
  4. "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
  5. "Product Information. Phentermine Hydrochloride (phentermine)." Tagi Pharma Inc (2019):
  6. "Product Information. Desoxyn (methamphetamine)." Recordati Rare Diseases Inc SUPPL-38 (2023):
View all 6 references
Moderate

CNS stimulants (applies to acetaminophen/butalbital/caffeine) seizure disorders

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Seizures

Due to general central nervous system stimulation, therapy with CNS stimulant drugs may cause seizures. These drugs may lower the convulsive threshold in patients with history of seizures, with prior electroencephalogram (EEG) abnormalities without seizures, and very rarely, without history of seizures and no prior EEG evidence of seizures. Therapy with CNS stimulants should be used with caution in patients with or predisposed to seizures. If seizures occur, therapy should be discontinued.

References

  1. "Product Information. Provigil (modafinil)." Cephalon, Inc PROD (2001):
  2. "Product Information. Cylert (pemoline)." Abbott Pharmaceutical PROD (2001):
  3. "Product Information. Dexedrine (dextroamphetamine)." SmithKline Beecham PROD (2001):
  4. "Product Information. Didrex (benzphetamine)." Pharmacia and Upjohn PROD (2001):
  5. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  6. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  7. "Product Information. Concerta (methylphenidate)." Alza (2002):
  8. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
  9. "Product Information. Vyvanse (lisdexamfetamine)." Shire US Inc (2007):
  10. "Product Information. Nuvigil (armodafinil)." Cephalon Inc (2007):
  11. "Product Information. Phendimetrazine Tartrate SR (phendimetrazine)." Sandoz Inc (2012):
  12. "Product Information. Desoxyn (methamphetamine)." Recordati Rare Diseases Inc SUPPL-38 (2023):
View all 12 references
Moderate

Methylxanthines (applies to acetaminophen/butalbital/caffeine) GERD

Moderate Potential Hazard, High plausibility. Applicable conditions: Gastroesophageal Reflux Disease

Methylxanthines increase gastric acidity and may also relax lower esophageal sphincter, which can lead to gastric reflux into the esophagus. Therapy with products containing methylxanthines should be administered cautiously in patients with significant gastroesophageal reflux.

References

  1. Stoller JL "Oesophageal ulceration and theophylline." Lancet 2 (1985): 328-9
  2. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  3. Alterman P, Spiegel D, Feldman J, Yaretzky A "Histamine h2-receptor antagonists and chronic theophylline toxicity." Am Fam Physician 54 (1996): 1473
  4. "Product Information. Lufyllin (dyphylline)." Wallace Laboratories PROD (2001):
View all 4 references

Acetaminophen/butalbital/caffeine drug interactions

There are 672 drug interactions with acetaminophen / butalbital / caffeine.

Acetaminophen/butalbital/caffeine alcohol/food interactions

There are 6 alcohol/food interactions with acetaminophen / butalbital / caffeine.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.