Carisoprodol / Aspirin / Codeine Phosphate

Pronunciation: car-eye-so-PRO-dole/ASS-pihr-in/KOE-deen FOSS-fate
Class: Skeletal muscle relaxant, Analgesic, Narcotic analgesic

Trade Names

Soma compound with codeine
- Tablets 200 mg carisoprodol, 325 mg aspirin, 16 mg codeine

Pharmacology

Carisoprodol

Produces skeletal muscle relaxation, probably as a result of its sedative properties.

Slideshow: Prescription Drug Addiction - Are You at Risk?

Aspirin

Inhibits prostaglandin synthesis, resulting in analgesia, anti-inflammatory activity, and inhibition of platelet aggregation.

Codeine

Stimulates opiate receptors in the CNS.

Indications and Usage

Adjunct to rest, physical therapy, and other measures for the relief of pain, muscle spasm, and limited mobility associated with acute, painful musculoskeletal conditions.

Contraindications

Acute intermittent porphyria; bleeding disorders; allergic or idiosyncratic reactions to any component of product.

Dosage and Administration

Adults and Children (12 yr of age and older)

PO 1 or 2 tablets 4 times daily.

General Advice

Administer without regard to meals, but administer with food if GI upset occurs.

Storage/Stability

Store at controlled room temperature (59° to 86°F). Protect from moisture.

Drug Interactions

Ammonium chloride

By lowering the urinary pH, agents such as ammonium chloride can elevate plasma salicylate levels.

Antacids

By raising urinary pH, antacids may increase salicylate elimination, decreasing plasma salicylate levels; conversely, discontinuing antacid therapy may increase levels.

Anticoagulants (eg, warfarin)

Aspirin may enhance the potential for bleeding in patients on anticoagulants.

Antidiabetic drugs (oral)

May enhance hypoglycemia.

Corticosteroids

Salicylate plasma levels may be decreased.

Ethyl alcohol

Increased risk of aspirin-induced fecal blood loss.

Methotrexate

Increased risk of methotrexate toxicity.

Probenecid, sulfinpyrazone

Uricosuric effect of these agents may be decreased by large doses of aspirin, in addition, renal excretion of salicylate may be reduced.

Laboratory Test Interactions

Aspirin

May cause false-positive reading of urine glucose by copper reduction method ( Clinitest ) and false-negative readings by glucose oxidase method ( Clinistix ); may interfere with urine tests of 5-hydroxyindoleacetic acid, ketone, phenolsulfonphthalein, and vanillylmandelic acid.

Codeine

May interfere with amylase and lipase determinations for up to 24 h after administration.

Adverse Reactions

Cardiovascular

Carisoprodol

Tachycardia; postural hypotension; facial flushing.

CNS

Carisoprodol

Drowsiness; dizziness; vertigo; ataxia; tremor; agitation; irritability; headache; depression; syncope; insomnia.

Codeine

Sedation; dizziness.

Dermatologic

Aspirin

Rash; pruritus; urticaria.

EENT

Aspirin

Tinnitus.

Codeine

Miosis.

GI

Carisoprodol

Nausea; vomiting; epigastric distress; hiccup.

Aspirin

Nausea; vomiting; gastritis; occult bleeding; constipation; diarrhea; gastric erosion.

Codeine

Nausea; vomiting; constipation.

Hematologic

Carisoprodol

Leukopenia; pancytopenia.

Respiratory

Aspirin

Asthma.

Miscellaneous

Carisoprodol

Idiosyncratic reactions (including extreme weakness, transient quadriplegia, dizziness, ataxia, temporary loss of vision, diplopia, mydriasis, dysarthria, agitation, euphoria, confusion, disorientation); allergic reactions (including skin rash, erythema multiforme, pruritus, eosinophilia, and fixed drug eruptions.

Aspirin

Angioedema; aspirin intolerance (including rhinorrhea, shortness of breath, edema).

Precautions

Monitor

Musculoskeletal symptoms

Assess musculoskeletal symptoms before starting therapy and periodically during treatment.


Pregnancy

Category C .

Lactation

Carisoprodol, aspirin, and codeine are excreted in breast milk.

Children

Safety and efficacy in children younger than 12 yr of age not established.

Special Risk Patients

Use with caution in patients with compromised renal or hepatic function, in elderly or debilitated patients, patients with a history of gastritis or peptic ulcer, and addiction-prone individuals.

Drug dependence

Drug dependence of the morphine type may result.

Idiosyncratic reactions

Rarely first dose may cause idiosyncratic reactions. Monitor for signs of idiosyncratic reaction: extreme weakness, transient quadriplegia, dizziness, ataxia, double vision or temporary loss of vision, slurred speech, agitation, confusion, disorientation. Discontinue therapy and notify health care provider immediately if noted.

Sodium metabisulfite

Contains metabisulfite, a sulfite that may cause allergic-type reactions, including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in susceptible patients.

Overdosage

Symptoms

Carisoprodol

Stupor, coma, shock, respiratory depression, rarely death

Aspirin

Headache, tinnitus, hearing difficulty, dim vision, dizziness, lassitude, hyperpnea, rapid breathing, thirst, nausea, vomiting, sweating, occasionally diarrhea, hyperthermia, dehydration, delirium, mental disturbances, skin eruptions, GI hemorrhage, pulmonary edema; CNS stimulation followed by increasing depression, stupor, coma

Codeine

Pinpoint pupils, CNS depression, coma, respiratory failure, cardiovascular collapse

Patient Information

  • Advise patient to take 1 to 2 tablets as prescribed, up to 4 times daily if needed for muscle pain, muscle spasm, or limited mobility.
  • Advise patient to take without regard to meals but to take with food if GI upset occurs.
  • Instruct patient to avoid alcoholic beverages and other depressants while taking this medication.
  • Advise patient that drug may impair judgment, thinking, or motor skills, or cause drowsiness. Use caution while driving or performing other tasks requiring mental alertness until tolerance is determined.
  • Advise patient to stop taking the drug and notify health care provider if any of the following symptoms occur: allergic reaction, unusual bleeding or bruising, shortness of breath, black or tarry stools, vomiting of blood or coffee ground-like material, excessive sedation, extreme weakness, paralysis, dizziness, stumbling, double vision or temporary loss of vision, slurred speech, agitation, confusion, disorientation.

Copyright © 2009 Wolters Kluwer Health.

Hide
(web4)