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Excedrin Disease Interactions

There are 21 disease interactions with Excedrin (acetaminophen / aspirin / caffeine).

Major

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

Acetaminophen (applies to Excedrin) 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. (2002) "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical
  2. (2022) "Product Information. Acetaminophen (acetaminophen)." Hikma Pharmaceuticals USA Inc.
Major

Aspirin (applies to Excedrin) coagulation

Major Potential Hazard, High plausibility. Applicable conditions: Coagulation Defect, Bleeding, Thrombocytopathy, Thrombocytopenia, Vitamin K Deficiency

The use of aspirin is contraindicated in patients with significant active bleeding or hemorrhagic disorders such as hemophilia, von Willebrand's disease, or telangiectasia. Aspirin interferes with coagulation by irreversibly inhibiting platelet aggregation and prolonging bleeding time. The non-aceylated salicylates (i.e. salicylate salts such as sodium or magnesium salicylate) do not demonstrate these effects and may be appropriate substitutions in these patients. However, all salicylates can interfere with the action of vitamin K and induce a dose-dependent alteration in hepatic synthesis of coagulation factors VII, IX and X. At usual recommended dosages, a slight increase in prothrombin time (PT) may occur. Therapy with salicylates, especially aspirin, should be administered with extreme caution in patients with hypoprothrombinemia, vitamin K deficiency, thrombocytopenia, thrombotic thrombocytopenic purpura, severe hepatic impairment, or anticoagulant use.

References

  1. Moroz LA (1977) "Increased blood fibrinolytic activity after aspirin ingestion." N Engl J Med, 296, p. 525-9
  2. Garg SK, Sarker CR (1974) "Aspirin-induced thrombocytopenia on an immune basis." Am J Med Sci, 267, p. 129-32
  3. Sbarbaro JA, Bennett RM (1977) "Aspirin hepatotoxicity and disseminated intravascular coagulation." Ann Intern Med, 86, p. 183-5
  4. Bochner F, Williams DB, Morris PM, Siebert DM, Lloyd JV (1988) "Pharmacokinetics of low-dose oral modified release, soluble and intravenous aspirin in man, and effects on platelet function." Eur J Clin Pharmacol, 35, p. 287-94
  5. Patrono C (1994) "Aspirin as an antiplatelet drug." N Engl J Med, 330, p. 1287-94
  6. American Medical Association, Division of Drugs and Toxicology (1994) "Drug evaluations annual 1994." Chicago, IL: American Medical Association;
  7. Ferraris VA, Ferraris SP (1995) "Preoperative aspirin ingestion increases operative blood loss after coronary artery bypass grafting - update." Ann Thorac Surg, 59, p. 1036-7
  8. Buerke M, Pittroff W, Meyer J, Darius H (1995) "Aspirin therapy: optimized platelet inhibition with different loading and maintenance doses." Am Heart J, 130, p. 465-72
  9. Hirsh J, Dalen JE, Fuster V, Harker LB, Patrono C, Roth G (1995) "Aspirin and other platelet-active drugs: the relationship among dose, effectiveness, and side effects." Chest, 108 Suppl, s247-57
  10. (2001) "Product Information. Ecotrin (aspirin)." SmithKline Beecham
  11. He J, Whelton PK, Vu B, Klag MJ (1998) "Aspirin and risk of hemorrhagic stroke: a meta-analysis of randomized controlled trials." JAMA, 280, p. 1930-35
  12. Petty GW, Brown RD, Whisnant JP, Sicks JD, O'Fallon WM, Wiebers DO (1999) "Frequency of major complications of aspirin, warfarin, and intravenous heparin for secondary stroke prevention: a population study." Ann Intern Med, 130, p. 14-22
  13. "Product Information. Bayer Aspirin (acetylsalicylsyra)." Bayer
  14. Colwell JA (1999) "Aspirin and risk of hemorrhagic stroke." JAMA, 282, p. 731-2
View all 14 references
Major

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

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

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

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

NSAIDs (applies to Excedrin) asthma

Major Potential Hazard, High plausibility.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated in patients with history of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs; severe, sometimes fatal, anaphylactic reactions to NSAIDs have been reported in such patients. A subpopulation of patients with asthma may have aspirin-sensitive asthma which may include chronic rhinosinusitis complicated by nasal polyps, severe potentially fatal bronchospasm, and/or intolerance to aspirin and other NSAIDs. Since cross-reactivity between aspirin and other NSAIDs has been reported in such aspirin-sensitive patients, therapy with any NSAID should be avoided in patients with this form of aspirin sensitivity. NSAIDs should be used with caution in patients with preexisting asthma (without known aspirin sensitivity), and these patients should be monitored for changes in the signs and symptoms of asthma.

References

  1. (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn
  2. (2002) "Product Information. Nalfon (fenoprofen)." Xspire Pharma
  3. (2002) "Product Information. Indocin (indomethacin)." Merck & Co., Inc
  4. (2002) "Product Information. Orudis (ketoprofen)." Wyeth-Ayerst Laboratories
  5. (2002) "Product Information. Naprosyn (naproxen)." Syntex Laboratories Inc
  6. (2001) "Product Information. Clinoril (sulindac)." Merck & Co., Inc
  7. (2001) "Product Information. Tolectin (tolmetin)." McNeil Pharmaceutical
  8. (2001) "Product Information. Voltaren (diclofenac)." Novartis Pharmaceuticals
  9. (2001) "Product Information. Relafen (nabumetone)." SmithKline Beecham
  10. (2001) "Product Information. Feldene (piroxicam)." Pfizer U.S. Pharmaceuticals
  11. (2001) "Product Information. Ansaid (flurbiprofen)." Pharmacia and Upjohn
  12. (2001) "Product Information. Lodine (etodolac)." Wyeth-Ayerst Laboratories
  13. (2001) "Product Information. Daypro (oxaprozin)." Searle
  14. (2001) "Product Information. Celebrex (celecoxib)." Searle
  15. (2001) "Product Information. Mobic (meloxicam)." Boehringer-Ingelheim
View all 15 references
Major

Salicylates (applies to Excedrin) GI toxicity

Major Potential Hazard, High plausibility. Applicable conditions: Peptic Ulcer, Duodenitis/Gastritis, Gastrointestinal Hemorrhage, Gastrointestinal Perforation, History - Peptic Ulcer, Alcoholism, Colitis/Enteritis (Noninfectious), Colonic Ulceration

Salicylates, particularly aspirin, can cause dose-related gastrointestinal bleeding and mucosal damage, which may occur independently of each other. Occult, often asymptomatic GI blood loss is quite common with usual dosages of aspirin and stems from the drug's local effect on the GI mucosa. During chronic therapy, this type of bleeding may occasionally produce iron deficiency anemia. In contrast, major upper GI bleeding rarely occurs except in patients with active peptic ulcers or recent GI bleeding. However, these patients generally do not experience greater occult blood loss than healthy patients following small doses of aspirin. Mucosal damage associated with the use of salicylates may lead to development of peptic ulcers with or without bleeding, reactivation of latent ulcers, and ulcer perforation. Therapy with salicylates and related agents such as salicylamide should be considered and administered cautiously in patients with a history of GI disease or alcoholism, particularly if they are elderly and/or debilitated, since such patients may be more susceptible to the GI toxicity of these drugs and seem to tolerate ulceration and bleeding less well than other individuals. Extreme caution and thorough assessment of risks and benefits are warranted in patients with active or recent GI bleeding or lesions. Whenever possible, especially if prolonged use is anticipated, treatment with non-ulcerogenic agents should be attempted first. If salicylates are used, close monitoring for toxicity is recommended. Some adverse GI effects may be minimized by administration with high dosages of antacids, use of enteric-coated or extended-release formulations, and/or concurrent use of a histamine H2-receptor antagonist or a cytoprotective agent such as misoprostol. Patients with active peptic ulceration or GI bleeding treated with salicylates should generally be administered a concomitant anti-ulcer regimen.

References

  1. Bergmann JF, Chassany O, Geneve J, Abiteboul M, Caulin C, Segrestaa JM (1992) "Endoscopic evaluation of the effect of ketoprofen, ibuprofen and aspirin on the gastroduodenal mucosa." Eur J Clin Pharmacol, 42, p. 685-8
  2. Mehta S, Dasarathy S, Tandon RK, Mathur M, Malaviya AN (1992) "A prospective randomized study of the injurious effects of aspirin and naproxen on the gastroduodenal mucosa in patients with rheumatoid arthritis." Am J Gastroenterol, 87, p. 996-1000
  3. Naschitz JE, Yeshurun D, Odeh M, Bassan H, Rosner I, Stermer E, Levy N (1990) "Overt gastrointestinal bleeding in the course of chronic low-dose aspirin administration for secondary prevention of arterial occlusive disease." Am J Gastroenterol, 85, p. 408-11
  4. Sabesin SM, Boyce HW Jr, King CE, Mann JA, Ruoff G, Wall E (1988) "Comparative evaluation of gastrointestinal intolerance produced by plain and tri-buffered aspirin tablets." Am J Gastroenterol, 83, p. 1220-5
  5. Graham DY, Smith JL (1986) "Aspirin and the stomach." Ann Intern Med, 104, p. 390-8
  6. Levy M, Miller DR, Kaufman DW, Siskind V, Schwingl P, Rosenberg L, Strom B, Shapiro S (1988) "Major upper gastrointestinal tract bleeding. Relation to the use of aspirin and other nonnarcotic analgesics." Arch Intern Med, 148, p. 281-5
  7. Prichard PJ, Kitchingman GK, Walt RP, Daneshmend TK, Hawkey CJ (1989) "Human gastric mucosal bleeding induced by low dose aspirin, but not warfarin." BMJ, 298, p. 493-6
  8. Roderick PJ, Wilkes HC, Meade TW (1993) "The gastrointestinal toxicity of aspirin: an overview of randomised controlled trials." Br J Clin Pharmacol, 35, p. 219-26
  9. Wilcox CM, Shalek KA, Cotsonis G (1994) "Striking prevalence of over-the-counter nonsteroidal anti- inflammatory drug use in patients with upper gastrointestinal hemorrhage." Arch Intern Med, 154, p. 42-6
  10. Silagy CA, McNeil JJ, Donnan GA, Tonkin AM, Worsam B, Campion K (1993) "Adverse effects of low-dose aspirin in a healthy elderly population." Clin Pharmacol Ther, 54, p. 84-9
  11. American Medical Association, Division of Drugs and Toxicology (1994) "Drug evaluations annual 1994." Chicago, IL: American Medical Association;
  12. Weil J, Colinjones D, Langman M, Lawson D, Logan R, Murphy M, Rawlins M, Vessey M, Wainwright P (1995) "Prophylactic aspirin and risk of peptic ulcer bleeding." BMJ, 310, p. 827-30
  13. Savon JJ, Allen ML, Dimarino AJ, Hermann GA, Krum RP (1995) "Gastrointestinal blood loss with low dose (325 mg) plain and enteric-coated aspirin administration." Am J Gastroenterol, 90, p. 581-5
  14. Stalnikowiczdarvasi R (1995) "Gastrointestinal bleeding during low-dose aspirin administration for prevention of arterial occlusive events: a critical analysis." J Clin Gastroenterol, 21, p. 13-6
  15. (2001) "Product Information. Salflex (salsalate)." Carnrick Laboratories Inc
  16. (2001) "Product Information. Ecotrin (aspirin)." SmithKline Beecham
  17. Marks RD (1996) "Aspirin use and fecal occult blood testing." Am J Med, 100, p. 596-7
  18. Greenberg PD, Cello JP, Rockey DC (1996) "Asymptomatic chronic gastrointestinal blood loss in patients taking aspirin or warfarin for cardiovascular disease." Am J Med, 100, p. 598-604
  19. Lanas A, Serrano P, Bajador E, Esteva F, Benito R, Sainz R (1997) "Evidence of aspirin use in both upper and lower gastrointestinal perforation." Gastroenterology, 112, p. 683-9
View all 19 references
Major

Salicylates (applies to Excedrin) renal dysfunction

Major Potential Hazard, High plausibility.

Salicylate and its metabolites are eliminated almost entirely by the kidney. Therapy with salicylate drugs should be administered cautiously in patients with renal impairment, especially if it is severe. Reduced dosages may be necessary to avoid drug accumulation. Clinical monitoring of renal function is recommended during prolonged therapy, since the use of salicylate drugs has rarely been associated with renal toxicities, including elevations in serum creatinine, renal papillary necrosis, and acute tubular necrosis with renal failure. Most of the data have been derived from experience with aspirin but may apply to other salicylates as well. In patients with impaired renal function, aspirin has caused reversible and sometimes marked decreases in renal blood flow and glomerular filtration rate. Adverse renal effects have usually reversed rapidly following withdrawal of aspirin therapy.

References

  1. Kimberly RP, Plotz PH (1977) "Aspirin-induced depression of renal function." N Engl J Med, 296, p. 418-24
  2. Riegger GA, Kahles HW, Elsner D, Kromer EP, Kochsiek K (1991) "Effects of acetylsalicylic acid on renal function in patients with chronic heart failure." Am J Med, 90, p. 571-5
  3. Carmichael J, Shankel SW (1985) "Effects of nonsteroidal anti-inflammatory drugs on prostaglandins and renal function." Am J Med, 78, p. 992-1000
  4. Wen SF, Parthasarathy R, Iliopoulos O, Oberley TD (1992) "Acute renal failure following binge drinking and nonsteroidal antiinflammatory drugs." Am J Kidney Dis, 20, p. 281-5
  5. Maher JF (1984) "Analgesic nephropathy. Observations, interpretations, and perspective on the low incidence in America." Am J Med, 76, p. 345-8
  6. Muther RS, Potter DM, Bennett WM (1981) "Aspirin-induced depression of glomerular filtration rate in normal humans: role of sodium balance." Ann Intern Med, 94, p. 317-21
  7. American Medical Association, Division of Drugs and Toxicology (1994) "Drug evaluations annual 1994." Chicago, IL: American Medical Association;
  8. Whelton A (1995) "Renal effects of over-the-counter analgesics." J Clin Pharmacol, 35, p. 454-63
  9. (2001) "Product Information. Salflex (salsalate)." Carnrick Laboratories Inc
  10. (2001) "Product Information. Ecotrin (aspirin)." SmithKline Beecham
  11. (2001) "Product Information. Rexolate (sodium thiosalicylate)." Hyrex Pharmaceuticals
View all 11 references
Major

Salicylates (applies to Excedrin) Reye's syndrome

Major Potential Hazard, High plausibility. Applicable conditions: Influenza, Varicella-Zoster

The use of salicylates, primarily aspirin, in children with varicella infections or influenza-like illnesses has been associated with an increased risk of Reye's syndrome. Although a causal relationship has not been established, the majority of evidence to date seems to support the association. Most authorities, including the American Academy of Pediatrics Committee on Infectious Diseases, recommend avoiding the use of salicylates in children and teenagers with known or suspected varicella or influenza and during presumed outbreaks of influenza. If antipyretic or analgesic therapy is indicated under these circumstances, acetaminophen may be an appropriate alternative. The same precautions should also be observed with related agents such as salicylamide or diflunisal because of their structural and pharmacological similarities to salicylate.

References

  1. Epidemiology Office, Divisiion of Viral and Rickettsial Diseasses, Center for Infectious Diseases, Centers for Disease Control. (1989) "Leads from the MMWR. Reye syndrome surveillance--United States, 1987 and 1988." JAMA, 261, 3520,
  2. Hasking GJ, Duggan JM (1982) "Encephalopathy from bismuth subsalicylate." Med J Aust, 2, p. 167
  3. (2001) "Product Information. Pepto-Bismol (bismuth subsalicylate)." Procter and Gamble Pharmaceuticals
  4. (2001) "Product Information. Salflex (salsalate)." Carnrick Laboratories Inc
  5. (2001) "Product Information. Ecotrin (aspirin)." SmithKline Beecham
  6. Arvin A, Kliegman R, Nelson W, Behrman R, eds. (1996) "Nelson Textbook of Pediatrics." Philadelphia, PA: W.B. Saunders Company
  7. American Academy of Pediatrics. Committee on Infectious Diseases; Peter G, ed. (1997) "Red BooK: Report of the Committee on Infectious Diseases." Grove Village, IL: American Academy of Pediatrics
  8. Belay ED, Bresee JS, Holman RC, Khan AS, Shahriari A, Schonberger LB (1999) "Reye's syndrome in the United States from 1981 through 1997." N Engl J Med, 340, p. 1377-82
  9. (2001) "Product Information. Rexolate (sodium thiosalicylate)." Hyrex Pharmaceuticals
View all 9 references
Moderate

Acetaminophen (applies to Excedrin) 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. (2002) "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical
Moderate

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

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

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

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

Salicylates (applies to Excedrin) anemia

Moderate Potential Hazard, Moderate plausibility.

Occult, often asymptomatic GI blood loss occurs quite frequently with the use of normal dosages of aspirin and stems from the drug's local effect on the GI mucosa. During chronic therapy, this type of bleeding may occasionally produce iron deficiency anemia. Other salicylates reportedly cause little or no GI blood loss at usual dosages, but may do so at high dosages. Prolonged therapy with salicylates, particularly aspirin, should be administered cautiously in patients with or predisposed to anemia. Periodic monitoring of hematocrit is recommended. The same precautions should also be observed with the use of related agents such as salicylamide because of their structural and pharmacological similarities to salicylate.

References

  1. Naschitz JE, Yeshurun D, Odeh M, Bassan H, Rosner I, Stermer E, Levy N (1990) "Overt gastrointestinal bleeding in the course of chronic low-dose aspirin administration for secondary prevention of arterial occlusive disease." Am J Gastroenterol, 85, p. 408-11
  2. Prichard PJ, Kitchingman GK, Walt RP, Daneshmend TK, Hawkey CJ (1989) "Human gastric mucosal bleeding induced by low dose aspirin, but not warfarin." BMJ, 298, p. 493-6
  3. Savon JJ, Allen ML, Dimarino AJ, Hermann GA, Krum RP (1995) "Gastrointestinal blood loss with low dose (325 mg) plain and enteric-coated aspirin administration." Am J Gastroenterol, 90, p. 581-5
  4. Stalnikowiczdarvasi R (1995) "Gastrointestinal bleeding during low-dose aspirin administration for prevention of arterial occlusive events: a critical analysis." J Clin Gastroenterol, 21, p. 13-6
  5. (2001) "Product Information. Salflex (salsalate)." Carnrick Laboratories Inc
  6. (2001) "Product Information. Ecotrin (aspirin)." SmithKline Beecham
  7. Marks RD (1996) "Aspirin use and fecal occult blood testing." Am J Med, 100, p. 596-7
  8. Greenberg PD, Cello JP, Rockey DC (1996) "Asymptomatic chronic gastrointestinal blood loss in patients taking aspirin or warfarin for cardiovascular disease." Am J Med, 100, p. 598-604
View all 8 references
Moderate

Salicylates (applies to Excedrin) dialysis

Moderate Potential Hazard, High plausibility. Applicable conditions: hemodialysis

Salicylate and its metabolites are readily removed by hemodialysis and, to a lesser extent, by peritoneal dialysis. Doses should either be scheduled for administration after dialysis or supplemental doses be given after dialysis.

References

  1. (2001) "Product Information. Salflex (salsalate)." Carnrick Laboratories Inc
  2. (2001) "Product Information. Ecotrin (aspirin)." SmithKline Beecham
  3. (2001) "Product Information. Rexolate (sodium thiosalicylate)." Hyrex Pharmaceuticals
Moderate

Salicylates (applies to Excedrin) G-6-PD deficiency

Moderate Potential Hazard, Moderate plausibility.

Salicylates, particularly aspirin, may cause or aggravate hemolysis in patients with pyruvate kinase or glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. However, this effect has not been clearly established. Until more data are available, therapy with salicylates should be administered cautiously in patients with G-6-PD deficiency. The same precaution should also be observed with the use of related agents such as salicylamide because of their structural and pharmacological similarities to salicylate.

References

  1. (2001) "Product Information. Salflex (salsalate)." Carnrick Laboratories Inc
  2. (2001) "Product Information. Ecotrin (aspirin)." SmithKline Beecham
  3. (2001) "Product Information. Rexolate (sodium thiosalicylate)." Hyrex Pharmaceuticals
Moderate

Salicylates (applies to Excedrin) hepatotoxicity

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease

The use of salicylates has occasionally been associated with acute, reversible hepatotoxicity, primarily manifested as elevations of serum transaminases, alkaline phosphatase and/or, rarely, bilirubin. Hepatic injury consistent with chronic active hepatitis has also been reported in a few patients, which resulted rarely in encephalopathy or death. Salicylate-induced hepatotoxicity appears to be dependent on serum salicylate concentration (> 25 mg/dL) and has occurred most frequently in patients with juvenile arthritis, active systemic lupus erythematosus, rheumatic fever, or preexisting hepatic impairment. Therapy with salicylates, particularly when given in high dosages, should be administered cautiously in these patients, and periodic monitoring of liver function is recommended. The same precautions should also be observed with the use of related agents such as salicylamide because of their structural and pharmacological similarities to salicylate. A dosage reduction may be necessary if liver function abnormalities develop and serum salicylate concentration exceeds 25 mg/dL, although serum transaminase elevations may sometimes be transient and return to pretreatment values despite continued therapy without dosage adjustment.

References

  1. Seaman WE, Ishak KG, Plotz PH (1974) "Aspirin-induced hepatotoxicity in patients with systemic lupus erythematosus." Ann Intern Med, 80, p. 1-8
  2. Wolfe JD, Metzger AL, Goldstein RC (1974) "Aspirin hepatitis." Ann Intern Med, 80, p. 74-6
  3. Sbarbaro JA, Bennett RM (1977) "Aspirin hepatotoxicity and disseminated intravascular coagulation." Ann Intern Med, 86, p. 183-5
  4. Jorup-Ronstrom C, Beermann B, Wahlin-Boll E, Melander A, Britton S (1986) "Reduction of paracetamol and aspirin metabolism during viral hepatitis." Clin Pharmacokinet, 11, p. 250-6
  5. Patel DK, Hesse A, Ogunbona A, Notarianni LJ, Bennett PN (1990) "Metabolism of aspirin after therapeutic and toxic doses." Hum Exp Toxicol, 9, p. 131-6
  6. American Medical Association, Division of Drugs and Toxicology (1994) "Drug evaluations annual 1994." Chicago, IL: American Medical Association;
  7. (2001) "Product Information. Salflex (salsalate)." Carnrick Laboratories Inc
  8. (2001) "Product Information. Rexolate (sodium thiosalicylate)." Hyrex Pharmaceuticals
View all 8 references

Excedrin drug interactions

There are 523 drug interactions with Excedrin (acetaminophen / aspirin / caffeine).

Excedrin alcohol/food interactions

There are 6 alcohol/food interactions with Excedrin (acetaminophen / aspirin / 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.