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acetaminophen, caffeine, and dihydrocodeine

Generic Name: acetaminophen, caffeine, and dihydrocodeine (a SEET a MIN oh fen, KAF een, dye HYE droe KOE deen)
Brand Name: Trezix, Panlor DC, Panlor SS, Zerlor

What is acetaminophen, caffeine, and dihydrocodeine?

Acetaminophen is a pain reliever that increases the effects of dihydrocodeine.

Caffeine is a central nervous system stimulant. It relaxes muscle contractions in blood vessels to improve blood flow.

Dihydrocodeine is an opioid pain medication. An opioid is sometimes called a narcotic.

Acetaminophen, caffeine, and dihydrocodeine is a combination medicine used to relieve moderate to severe pain.

Acetaminophen, caffeine, and dihydrocodeine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about acetaminophen, caffeine, and dihydrocodeine?

You should not use this medicine if you have a stomach condition called paralytic ileus, or severe or uncontrolled asthma. Do not take more than your recommended dose. Acetaminophen overdose can damage your liver or cause death.

Do not use this medicine if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine.

Medicines that contain dihydrocodeine should not be given to a child just after surgery to remove the tonsils or adenoids.

Stop taking this medicine and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling.

What should I discuss with my healthcare provider before taking acetaminophen, caffeine, and dihydrocodeine?

You should not use this medicine if you are allergic to acetaminophen (Tylenol) or dihydrocodeine, or if you have:

  • severe or uncontrolled asthma; or

  • a stomach condition called paralytic ileus.

Do not use acetaminophen, caffeine, and dihydrocodeine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

Medicines that contain dihydrocodeine should not be given to a child just after surgery to remove the tonsils or adenoids.

Some medicines can interact with dihydrocodeine and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications.

To make sure this medicine is safe for you, tell your doctor if you have:

  • liver disease, cirrhosis, a history of alcoholism, or if you drink more than 3 alcoholic beverages per day;

  • sleep apnea or other breathing disorders;

  • kidney disease;

  • a history of head injury or brain tumor;

  • epilepsy or other seizure disorder;

  • low blood pressure;

  • a stomach or intestinal disorder;

  • underactive thyroid;

  • a pancreas disorder;

  • Addison's disease or other adrenal gland disorder;

  • enlarged prostate, urination problems;

  • abnormal curvature of the spine;

  • mental illness;

  • a history of drug or alcohol addiction; or

  • if you use a sedative like Valium (diazepam, alprazolam, lorazepam, Ativan, Klonopin, Restoril, Tranxene, Versed, Xanax, and others).

Tell your doctor if you are pregnant. If you use dihydrocodeine while you are pregnant, your baby could become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on habit-forming medicine may need medical treatment for several weeks.

This medicine can pass into breast milk and may harm a nursing baby. The use of dihydrocodeine by some nursing mothers may lead to life-threatening side effects in the baby. Do not breast-feed while taking acetaminophen, caffeine, and dihydrocodeine.

How should I take acetaminophen, caffeine, and dihydrocodeine?

Follow all directions on your prescription label. Never take this medicine in larger amounts, or for longer than prescribed. An overdose can damage your liver or cause death. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Dihydrocodeine may be habit-forming. Never share this medicine with another person. MISUSE OF NARCOTIC MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription.

If you need surgery or medical tests, tell the doctor ahead of time that you are using this medicine.

Do not stop using acetaminophen, caffeine, and dihydrocodeine suddenly after long-term use, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine.

Store at room temperature away from moisture and heat. Keep the medicine in a place where others cannot get to it.

Keep track of the amount of medicine used from each new bottle. Dihydrocodeine is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

What happens if I miss a dose?

Since this medicine is used for pain, you are not likely to miss a dose. Skip any missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose can be fatal, especially in a child or other person using the medicine without a prescription.

The first signs of an acetaminophen overdose include loss of appetite, nausea, vomiting, stomach pain, sweating, and confusion or weakness. Later symptoms may include pain in your upper stomach, dark urine, and yellowing of your skin or the whites of your eyes.

Overdose symptoms may also include extreme drowsiness or insomnia, restless feeling, tremors, fast heart rate, pinpoint pupils, fainting, weak pulse, seizure (convulsions), coma, blue lips, shallow breathing, or no breathing.

What should I avoid while taking acetaminophen, caffeine, and dihydrocodeine?

Do not drink alcohol. Dangerous side effects or death could occur.

This medication may impair your thinking or reactions. Avoid driving or operating machinery until you know how acetaminophen, caffeine, and dihydrocodeine will affect you. Dizziness or severe drowsiness can cause falls or other accidents.

Ask a doctor or pharmacist before using any other cold, allergy, pain, or sleep medication. Acetaminophen (sometimes abbreviated as APAP) is contained in many combination medicines. Taking certain products together can cause you to get too much acetaminophen which can lead to a fatal overdose. Check the label to see if a medicine contains acetaminophen or APAP.

Acetaminophen, caffeine, and dihydrocodeine side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

In rare cases, acetaminophen may cause a severe skin reaction that can be fatal. This could occur even if you have taken acetaminophen in the past and had no reaction. Stop taking this medicine and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling. If you have this type of reaction, you should never again take any medicine that contains acetaminophen.

Like other narcotic medicines, dihydrocodeine can slow your breathing. Death may occur if breathing becomes too weak.

Stop using this medication and call your doctor at once if you have:

  • shallow breathing, slow heartbeat;

  • fast or pounding heart rate, feeling light-headed, fainting;

  • confusion, hallucinations, unusual thoughts or behavior;

  • muscle twitching;

  • problems with urination;

  • infertility, missed menstrual periods;

  • impotence, sexual problems, loss of interest in sex;

  • easy bruising or bleeding;

  • liver problems--nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or

  • low cortisol levels-- nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

This medicine is more likely to cause breathing problems in older adults and people who are severely ill, malnourished, or otherwise debilitated.

Common side effects include:

  • slowed breathing;

  • dizziness, drowsiness, tired feeling, headache, confusion;

  • nausea, vomiting, stomach pain, constipation, diarrhea;

  • indigestion, loss of appetite;

  • sweating, itching;

  • dry mouth, blurred vision; or

  • little or no urinating;

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Acetaminophen, caffeine, and dihydrocodeine dosing information

Usual Adult Dose for Pain:

Initial dose: 2 capsules orally every 4 hours as needed
Maximum dose: 5 doses or 10 capsules in 24 hours; no more than 2 capsules should be taken within any 4-hour period.

Comment:
-Individualize therapy taking into account patients pain severity, prior analgesic treatment experiences, and risk factors for addiction, abuse, and misuse.

Use: For the management of moderate to moderately severe pain that is severe enough to require an opioid analgesic and for which alternative treatments are inadequate.

What other drugs will affect acetaminophen, caffeine, and dihydrocodeine?

This medicine can interact with many other drugs and cause dangerous side effects or death. Be sure your doctor knows if you also use:

  • other narcotic medications--opioid pain medicine or prescription cough medicine;

  • drugs that make you sleepy or slow your breathing--a sleeping pill, muscle relaxer, sedative, tranquilizer, or antipsychotic medicine; or

  • drugs that affect serotonin levels in your body--medicine for depression, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting.

This list is not complete. Other drugs may interact with acetaminophen, caffeine, and dihydrocodeine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about acetaminophen, caffeine, and dihydrocodeine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 6.05.

Last reviewed: October 06, 2016
Date modified: November 30, 2016

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