Acetaminophen / butalbital / caffeine Disease Interactions

There are 17 disease interactions with acetaminophen / butalbital / caffeine:

Acetaminophen (Includes Acetaminophen/butalbital/caffeine) ↔ Alcoholism

Severe Potential Hazard, High plausibility

Applies to: Alcoholism

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. Whitcomb DC, Block GD "Association of acetaminopphen hepatotoxicity with fasting and ethanol use." JAMA 272 (1994): 1845-50
  2. Bonkovsky HL "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA 274 (1995): 301
  3. 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
View all 11 references

Acetaminophen (Includes Acetaminophen/butalbital/caffeine) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Acetaminophen is primarily metabolized in the liver to inactive forms. However, small quantities are converted by minor pathways to metabolites that can cause hepatotoxicity or methemoglobinemia. Patients with hepatic impairment may be at increased risk of toxicity due to increased minor metabolic pathway activity. Likewise, chronic or overuse of acetaminophen can saturate the primary hepatic enzymes and lead to increased metabolism by minor pathways. 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 in patients with hepatic insufficiency. Clinical monitoring of hepatic function is recommended. 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. Gillette JR "An integrated approach to the study of chemically reactive metabolites of acetaminophen." Arch Intern Med 141 (1981): 375-9
  2. "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical, Raritan, NJ.
  3. Clements JA, Critchley JA, Prescott LF "The role of sulphate conjugation in the metabolism and disposition of oral and intravenous paracetamol in man." Br J Clin Pharmacol 18 (1984): 481-5
View all 6 references

Barbiturates (Includes Acetaminophen/butalbital/caffeine) ↔ Acute Alcohol Intoxication

Severe Potential Hazard, High plausibility

Applies to: Alcoholism, Acute Alcohol Intoxication

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. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  3. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
View all 8 references

Barbiturates (Includes Acetaminophen/butalbital/caffeine) ↔ Drug Dependence

Severe Potential Hazard, High plausibility

Applies to: 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. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  3. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
View all 9 references

Barbiturates (Includes Acetaminophen/butalbital/caffeine) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

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. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  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. "Product Information. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
View all 9 references

Barbiturates (Includes Acetaminophen/butalbital/caffeine) ↔ Porphyria

Severe Potential Hazard, High plausibility

Applies to: Porphyria

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. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  2. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
  3. "Product Information. Butisol Sodium (butabarbital)" Wallace Laboratories, Cranbury, NJ.
View all 8 references

Barbiturates (Includes Acetaminophen/butalbital/caffeine) ↔ Rash

Severe Potential Hazard, High plausibility

Applies to: 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. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Mebaral (mephobarbital)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  3. 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
View all 12 references

Barbiturates (Includes Acetaminophen/butalbital/caffeine) ↔ Respiratory Depression

Severe Potential Hazard, High plausibility

Applies to: Asphyxia, Sleep Apnea, 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. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  3. Plaa GL "Acute toxicity of antiepileptic drugs." Epilepsia 16 (1975): 183-91
View all 9 references

Methylxanthines (Includes Acetaminophen/butalbital/caffeine) ↔ Pud

Severe Potential Hazard, High plausibility

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

Acetaminophen (Includes Acetaminophen/butalbital/caffeine) ↔ Pku

Moderate Potential Hazard, High plausibility

Applies to: 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, Raritan, NJ.

Barbiturates (Includes Acetaminophen/butalbital/caffeine) ↔ Adrenal Insufficiency

Moderate Potential Hazard, High plausibility

Applies to: Adrenal Insufficiency, 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. Seconal Sodium (secobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  2. "Product Information. Amytal Sodium (amobarbital)" Lilly, Eli and Company, Indianapolis, IN.
  3. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
View all 6 references

Barbiturates (Includes Acetaminophen/butalbital/caffeine) ↔ Depression

Moderate Potential Hazard, High plausibility

Applies to: Depression

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. "Multum Information Services, Inc. Expert Review Panel"
  2. "Product Information. Butisol Sodium (butabarbital)" Wallace Laboratories, Cranbury, NJ.
  3. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
View all 7 references

Barbiturates (Includes Acetaminophen/butalbital/caffeine) ↔ Hematologic Toxicity

Moderate Potential Hazard, Low plausibility

Applies to: 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. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
  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
View all 9 references

Barbiturates (Includes Acetaminophen/butalbital/caffeine) ↔ Osteomalacia

Moderate Potential Hazard, Low plausibility

Applies to: 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. "Product Information. Phenobarbital (phenobarbital)." Lilly, Eli and Company, Indianapolis, IN.
  2. 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
  3. 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
View all 6 references

Barbiturates (Includes Acetaminophen/butalbital/caffeine) ↔ Paradoxical Reactions

Moderate Potential Hazard, Moderate plausibility

Applies to: 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. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  2. "Product Information. Nembutal Sodium (pentobarbital)" Abbott Pharmaceutical, Abbott Park, IL.
  3. Mayhew LA, Hanzel TE, Ferron FR, Kalachnik JE, Harder SR "Phenobarbital exacerbation of self-injurious behavior." J Nerv Ment Dis 180 (1992): 732-3
View all 9 references

Caffeine (Includes Acetaminophen/butalbital/caffeine) ↔ Cardiotoxicity

Moderate Potential Hazard, Moderate plausibility

Applies to: 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"

Methylxanthines (Includes Acetaminophen/butalbital/caffeine) ↔ Gerd

Moderate Potential Hazard, High plausibility

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

You should also know about...

acetaminophen / butalbital / caffeine drug Interactions

There are 880 drug interactions with acetaminophen / butalbital / caffeine

acetaminophen / butalbital / caffeine alcohol/food Interactions

There are 4 alcohol/food interactions with acetaminophen / butalbital / caffeine

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

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.

Do not stop taking any medications without consulting your healthcare provider.

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