Isometheptene Mucate / Dichloralphenazone / Acetaminophen

Pronunciation: eye-so-meth-EPP-teen MYOO-kate/die-klor-uhl-FEN-uh-zone/ASS-et-ah-MEE-noe-fen
Class: Migraine combination

Trade Names

Epidrin
- Capsules 65 mg isometheptene mucate, 100 mg dichloralphenazone, 325 mg APAP

Midrin
- Capsules 65 mg isometheptene mucate, 100 mg dichloralphenazone, 325 mg APAP

Migratine
- Capsules 65 mg isometheptene mucate, 100 mg dichloralphenazone, 325 mg APAP

Pharmacology

Isometheptene mucate acts as sympathomimetic to constrict dilated cranial and cerebral arterioles. Dichloralphenazone is a mild sedative that reduces emotional reaction to pain of vascular and tension headaches. Acetaminophen is a mild analgesic.

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Indications and Usage

Relief of tension and vascular headaches. FDA has classified drug as possibly effective in treatment of migraine headaches.

Contraindications

Glaucoma; severe cases of renal disease; hypertension; organic heart disease; hepatic disease; MAOI therapy.

Dosage and Administration

Migraine Headache
Adults

PO 2 capsules at once, followed by 1 capsule every h until headache is relieved (max, 5 capsules in 12 h period).

Tension Headache
Adults

PO 1 to 2 capsules every 4 h (max, 8 capsules/day).

General Advice

  • Administer at first sign of migraine headache.
  • Administer with full glass of water.

Storage/Stability

Store at room temperature in dry place in tightly closed container.

Drug Interactions

MAOIs

May result in severe headache, hypertension, hyperpyrexia, and possible hypertensive crisis.

Laboratory Test Interactions

None well documented.

Adverse Reactions

CNS

Transient dizziness or drowsiness.

Dermatologic

Rash.

Precautions

Warnings

These products contain acetaminophen. Acetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant and death. Most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed 4,000 milligrams per day, and often involve more than one acetaminophen-containing product.


Pregnancy

Pregnancy category undetermined.

Lactation

Undetermined.

Children

Safety and efficacy not established.

Special Risk Patients

Observe caution in patients with hypertension or peripheral vascular disease and after recent CV attacks.

Hepatotoxicity

Can occur with chronic ingestion of acetaminophen. Chronic alcohol abusers are especially at risk.

Overdosage

Symptoms

Nausea; vomiting; drowsiness; confusion; liver tenderness; low or high BP; cardiac arrhythmias; jaundice; acute hepatic and renal failure.

Patient Information

  • Instruct patient to take drug at first sign of impending headache.
  • Encourage patient to rest in quiet, dark room after taking drug.
  • Advise patient not to drink alcoholic beverages.
  • Instruct patient to notify health care provider of dizziness or skin rash.
  • Instruct patient to notify health care provider if headache persists.

Copyright © 2009 Wolters Kluwer Health.

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