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Acetaminophen / Dichloralphenazone / Isometheptene Mucate Side Effects

Medically reviewed by Drugs.com. Last updated on Jun 14, 2023.

Applies to acetaminophen / dichloralphenazone / isometheptene mucate: oral capsule.

Other side effects

Some side effects of acetaminophen / dichloralphenazone / isometheptene mucate may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common side effects

  • drowsiness

Rare side effects

  • dizziness
  • fast or irregular heartbeat

Serious side effects

Along with its needed effects, acetaminophen/dichloralphenazone/isometheptene mucate may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur while taking acetaminophen / dichloralphenazone / isometheptene mucate:

Less common side effects

  • unusual tiredness or weakness

Rare side effects

  • black, tarry stools
  • blood in urine or stools
  • pinpoint red spots on skin
  • skin rash, hives, or itching
  • sore throat and fever
  • unusual bleeding or bruising
  • yellow eyes or skin

Symptoms of dependence on this medicine

Symptoms of acetaminophen overdose

Managing side effects (general information)

For healthcare professionals

Applies to acetaminophen / dichloralphenazone / isometheptene mucate: oral capsule.

Hypersensitivity adverse events

Hypersensitivity side effects including transient dizziness and skin rash have been reported with the use of acetaminophen/dichloralphenazone/isometheptene. Hypersensitivity reactions, including anaphylaxis and fixed drug eruptions have been reported rarely in association with acetaminophen use.[Ref]

Transient dizziness and skin rash can usually be eliminated by reducing the dose of acetaminophen/dichloralphenazone/isometheptene.[Ref]

Hepatic

Hepatic side effects including severe and sometimes fatal dose dependent hepatitis have been reported with the use of acetaminophen in alcoholic patients. Hepatotoxicity has been increased during fasting.[Ref]

Alcoholic patients may develop hepatotoxicity after even modest doses of acetaminophen. In healthy patients, approximately 15 grams of acetaminophen is necessary to deplete liver glutathione stores by 70% in a 70 kg person. However, hepatotoxicity has been reported following smaller doses. Glutathione concentrations may be repleted by the antidote N-acetylcysteine. One case report has suggested that hypothermia may also be beneficial in decreasing liver damage during overdose.

In a recent retrospective study of 306 patients admitted for acetaminophen overdose, 6.9% had severe liver injury but all recovered. None of the 306 patients died.

One study has suggested that acetaminophen may precipitate acute biliary pain and cholestasis. The mechanism of this effect may be related to inhibition of prostaglandin and alterations in the regulation of the sphincter of Oddi.

Cases of acute pancreatitis have been reported rarely with the use of acetaminophen.[Ref]

Gastrointestinal

Gastrointestinal side effects have been rare with the use of acetaminophen except in alcoholics and after overdose.[Ref]

Renal

Renal side effects including acute tubular necrosis and interstitial nephritis have been rare with the use of acetaminophen. Adverse renal effects have been most often observed after overdose, after chronic abuse (often with multiple analgesics), or in association with acetaminophen-related hepatotoxicity.[Ref]

Acute tubular necrosis with acetaminophen use usually occurs in conjunction with liver failure, but has been observed as an isolated finding in rare cases. A possible increase in the risk of renal cell carcinoma has been associated with chronic acetaminophen use as well.

A recent case-control study of patients with end-stage renal disease suggested that long term consumption of acetaminophen may significantly increase the risk of end-stage renal disease particularly in patients taking more than two pills per day.[Ref]

Hematologic

Hematologic side effects including rare cases of thrombocytopenia associated with acetaminophen have been reported. Methemoglobinemia with resulting cyanosis has also been observed in the setting of acute overdose.[Ref]

Dermatologic

Dermatologic side effects including erythematous skin rashes associated with acetaminophen have been reported rarely. Acetaminophen associated bullous erythema and purpura fulminans have also been reported.[Ref]

Respiratory

Respiratory side effects including a case of acetaminophen-induced eosinophilic pneumonia have been reported.[Ref]

Cardiovascular

Cardiovascular side effects including at least two cases of hypotension have been reported following the administration of acetaminophen.[Ref]

Two cases hypotension have been reported following the administration of acetaminophen. Both patients experienced significant decreases in blood pressure. One of the two patients required pressor agents to maintain adequate mean arterial pressures. Neither episode was associated with symptoms of anaphylaxis. Neither patient was rechallenged after resolution of the initial episode.[Ref]

References

1. Kawada A, Hiruma M, Noguchi H, Ishibashi A (1996) "Fixed drug eruption induced by acetaminophen in a 12-year-old girl." Int J Dermatol, 35, p. 148-9

2. (2022) "Product Information. Midrin (APAP/dichloralphenazone/isometheptene)." Carnrick Laboratories Inc

3. Zimmerman HJ, Maddrey WC (1995) "Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: analysis of instances of therapeutic misadventure." Hepatology, 22, p. 767-73

4. Gursoy M, Haznedaroglu IC, Celik I, Sayinalp N, Ozcebe OI, Dundar SV (1996) "Agranulocytosis, plasmacytosis, and thrombocytosis followed by a leukemoid reaction due to acute acetaminophen toxicity." Ann Pharmacother, 30, p. 762-5

5. Nelson EB, Temple AR (1995) "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA, 274, p. 301

6. Singer AJ, Carracio TR, Mofenson HC (1995) "The temporal profile of increased transaminase levels in patients with acetaminophen-induced liver dysfunction." Ann Emerg Med, 26, p. 49-53

7. Lee WM (1995) "Medical progress: drug-induced hepatotoxicity." N Engl J Med, 333, p. 1118-27

8. Perneger TV, Whelton PK, Klag MJ (1994) "Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs." N Engl J Med, 331, p. 1675-79

9. Shoenfeld Y, Shaklai M, Livni E, Pinkhas J (1980) "Thrombocytopenia from acetaminophen." N Engl J Med, 303, p. 47

10. Filipe PL, Freitas JP, Decastro JC, Silva R (1995) "Drug eruption induced by acetaminophen in infectious mononucleosis." Int J Dermatol, 34, p. 220-1

11. Kondo K, Inoue Y, Hamada H, Yokoyama A, Kohno N, Hiwada K (1993) "Acetaminophen-induced eosinophilic pneumonia." Chest, 104, p. 291-2

12. Brown G (1996) "Acetaminophen-induced hypotension." Heart Lung, 25, p. 137-40

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Further information

Acetaminophen/dichloralphenazone/isometheptene mucate side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

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