Does tylenol contain caffeine: FAQs About TYLENOL® Products, Safety & Dosing

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FAQs About TYLENOL® Products, Safety & Dosing

FAQs About TYLENOL® Products, Safety & Dosing | TYLENOL®
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Learn the basics about dosing, safety and specific product info.

General

QA Text:

TYLENOL^® is safe and effective when used as directed. The safety of TYLENOL^® at recommended doses has been established through 50 years of use and scientific investigation. Do not exceed the recommended dosage as it may cause liver damage.

Acetaminophen is an active ingredient in all TYLENOL^® products and in more than 600 other over-the-counter (OTC) and prescription medicines. Do not take more than one medicine containing acetaminophen at the same time.

TYLENOL^® contains the active ingredient acetaminophen, which is a pain reliever and fever reducer. It works by elevating the body’s overall pain threshold so you feel less pain, and lowers your fever by helping your body eliminate excess heat.

A fever is the body’s response to a disease characterized by a rise in body temperature. A rectal temperature at or above 100.4⁰F, an oral temperature at or above 99.4⁰F, or an axillary temperature at or above 99⁰F is usually considered the threshold for a fever.

Acetaminophen is an effective pain reliever and fever reducer. Acetaminophen is thought to relieve mild to moderate pain by elevating your body’s overall pain threshold. It is also thought to lower your fever by helping your body eliminate excess heat.

Dextromethorphan is a cough suppressant indicated for the temporary relief of cough due to the common cold/flu.

Phenylephrine is a nasal decongestant indicated to help clear nasal passages, promote nasal and sinus drainage, and for temporary relief of sinus congestion and pressure.

Guaifenesin is an expectorant indicated to help loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive.

No, TYLENOL^® products do not contain aspirin.

No, TYLENOL^® products do not contain caffeine.

You can take TYLENOL^® with or without regard to meals.

Both TYLENOL^® Cold & Flu Severe and TYLENOL^® Cold & Flu and TYLENOL^® Cold Multi-Symptom products contain acetaminophen, dextromethorphan, and phenylephrine. Therefore, both products can be used to temporarily reduce fever and are also indicated for the temporary relief of minor aches and pains, headache, sore throat, nasal congestion, cough, sinus congestion, and sinus pressure. Additionally, TYLENOL^® Cold & Flu Severe products contain guaifenesin, an expectorant, which helps to relieve chest congestion and clear out mucus.

Easy-to-swallow caplets are solid capsule-shaped tablets coated with a water-soluble coating. Gelcaps are solid capsule-shaped tablets coated with smooth gelatin, making them easier to swallow. Geltabs are solid, rounded tablets coated with smooth gelatin.

Acetaminophen is the active ingredient in TYLENOL^®. TYLENOL^® products do not contain aspirin, ibuprofen or naproxen, the active ingredients found in other nonprescription pain relievers. Each of these active ingredients relieves pain, but they work differently.

Learn more about active ingredients by comparing pain relievers here.

Children’s TYLENOL® Chewables FAQ

QA Text:

The main reason is to simplify the dosing of Children’s TYLENOL® for caregivers. The product concentration or strength will now be the same whether you choose Children’s TYLENOL® Liquids or Children’s TYLENOL® Chewables. With the 160 mg product Children will need to take fewer tablets per dose than with the 80 mg product which should improve ease of dosing, especially for older children, who are more likely to use the Children’s TYLENOL® Chewables.

Please check the expiration date of the product you have. If the product has expired please discard it appropriately. If the product is not expired, it can still be used; please read and follow the label instructions.

Unless instructed otherwise, do not dispose of unused medicines by emptying them into your sink, toilet, or storm drain. Some states may have regulations regarding pharmacy or community take-back programs in which they may receive and dispose of returned unused drugs for patients. It is recommended that a local pharmacy or local authority be contacted to determine if it participates in such programs.
In the event that take-back programs cannot dispose medicines, place them in the household trash taking the following steps.
1. Make sure that they are in an unrecognizable sealed container; ensuring that children, pets, and others do not have access to the contents of the container.
2. Dispose of the container in household trash.

Please always read and follow the label. Check the expiration date on the bottle. Unexpired product is safe to use according to the label instructions. Any medication that is beyond its expiration date should be discarded.

The labeling for Children’s TYLENOL® Chewables provide age and weight-based dosing for children ages 2 through 11 years. Please always read and follow the label.

The ½ tablet can be returned to the current bottle and stored with the bottle closed.

Children’s TYLENOL® Chewables 160 mg have been introduced to the market at a comparable price point to the 4 oz. Children’s TYLENOL® liquid products.

If you have questions, we recommend that you contact your healthcare provider to review and confirm the strength and dosing of acetaminophen before use.

Children’s TYLENOL® Suspension (Liquid) and Children’s TYLENOL® Chewables differ by dosage form and by available flavors. Both products are safe and effective for use in children ages 2-11 years when used as directed and provide the same doses of acetaminophen when used according to the label.

This is personal preference, or as directed by your healthcare professional. Both the Children’s TYLENOL® Suspension and the Children’s TYLENOL® Chewables are safe and effective for children ages 2-11 years when used as directed.

The Children’s TYLENOL® Chewables Grape and Bubblegum products both have a score, or a “break” line, to indicate the ½ tablet for dosing. Breaking the product in half to achieve the appropriate dose can be done using that score line. Some consumers may use a pill splitter to divide the tablet cleanly along the score line, but Children’s TYLENOL® Chewables should break along the score line just by using your fingers.

The Children’s TYLENOL® Chewables product has a score, or a “break line,” that assists in accurately splitting a tablet in half. You can use your fingers to break the tablet along the line, or if desired, you may use a tool such as a pill cutter to help break the tablet in half.

Children’s TYLENOL® Chewables are entering into the marketplace now and will be available shortly at different retailers. Please continue to check with your local stores for product availability.

Children’s TYLENOL® Chewables is only being sold in 160 mg strength. The lowest labeled dose for Children’s TYLENOL® Chewables has always been 160 mg (which is equivalent to two 80 mg tablets). If your child is under two years or under 24 pounds, please ask your doctor to recommend an appropriate product and dose.

The Children’s TYLENOL® Chewables are appropriate for most children aged 2-11 years. A half tablet of the 160 mg Children’s TYLENOL® Chewable tablet is equivalent to 80 mg. Please always read and follow the label to determine the correct dosing for your child.

This is personal preference, or as directed by your healthcare professional. Both the Children’s TYLENOL® Suspension and the Children’s TYLENOL® Chewables are appropriate for most children ages 2-11 years.

In the lower left of the carton and on the label, the packaging will state the 160 mg strength. Children’s TYLENOL® Chewables includes the brand name “Children’s TYLENOL® Chewables” on the package and is only sold in 160 mg strength. The Children’s TYLENOL® Chewables 160 mg Bubblegum tablets are pink and the Grape tablets are purple. Both are identified by the marking/ imprint on the tablet that says “TY 160” on one side and the word “Half” marked twice on the other side. We recommend that you always keep the tablets in their original containers (bottles) for ready access to the dosing directions and expiration date and to avoid unintended access.

Please check the expiration dates on the bottles. You may continue to use the product as long as it has not expired. Please keep the products in their original bottles—do not combine 2 strengths in one container.

You should always use only one acetaminophen-containing medicine at a time. Always read and follow the label when administering any medicine to your child. Ask your doctor if you have further questions regarding appropriate dosing for your child.

Safety + Dosing

QA Text:

We do not recommend using any products beyond their expiration date. If your product has expired, please contact your local pharmacy to learn about how to properly discard it and obtain a new product.

Yes, if you schedule your doses correctly and take no more than 5 total doses in 24 hours. These products are to be used if you have symptoms. TYLENOL^® Daytime products provide daytime relief for your cold and flu symptoms. Do not take TYLENOL^® Daytime and Nighttime products at the same time and only use products that treat the symptom you have. Always use TYLENOL^® products as directed and read the entire product label before using.

No, TYLENOL^® Cold or Sinus products contain a nasal decongestant. Do not use two decongestants at the same time.

As stated on the product label, TYLENOL^® products may be taken no sooner than every 4 hours after the last dose. Always use TYLENOL^® products as directed and read the product label.

Only TYLENOL^® Cold Multi-Symptom Liquid (Nighttime) contains doxylamine succinate, an antihistamine, which may cause marked drowsiness. Ask a doctor or pharmacist before use if you are taking sedatives or tranquilizers. Alcohol, sedatives, and tranquilizers may increase the drowsiness effect. Always use the product as directed and read the label.

TYLENOL^® contains acetaminophen. Severe liver damage may occur if you take 3 or more alcoholic drinks every day while using a TYLENOL^® product.

The package label of all OTC pain medicines advise consumers to “stop use and ask a doctor if … pain gets worse or lasts more than 10 days…” This warning is necessary so that patients will seek appropriate medical attention if needed.

The safety of TYLENOL^® at recommended doses has been established through 50 years of use and scientific investigation; however, if you take too much, you could harm your liver.

In case of overdose, consumers are instructed to get medical help or contact a Poison Control Center right away. (1-800-222-1222). Quick medical attention is critical for adults as well as for children even if no signs or symptoms are noticed.

TYLENOL^® should not be used with other products containing acetaminophen.

Ask a doctor or pharmacist before use if you are taking the blood-thinning drug warfarin.

Always read and follow the label.

If you are under a doctor’s care for any serious condition, or are taking any other drugs, you should talk to your doctor if you want to know more or have other questions.

If you are taking any other drugs, including herbal supplements, you should talk to your doctor or pharmacist if you want to know more or have other questions. Always use the product as directed and read the label.

In order to help soothe your cold while taking TYLENOL^® Cold products, you should:

Get lots of rest, especially while you have a fever. Rest helps your body fight illness.
Drink lots of fluids. Soups and other fluids can help loosen mucus.
Soothe a sore throat by gargling with warm salt water or try throat sprays or lozenges.

Use of TYLENOL^® with other pain relievers (such as aspirin, ibuprofen, naproxen sodium, ketoprofen or prescription pain relievers) is not recommended, unless directed by your doctor.

Do not use TYLENOL^® with any other products containing acetaminophen (prescription or nonprescription). If you are not sure whether a drug contains acetaminophen, ask a doctor or pharmacist.

If you are under a doctor’s care for any serious condition, or are taking any other drugs, you should talk to your doctor if you want to know more or have other questions.

No. TYLENOL^® Cold and TYLENOL^® Sinus caplets should be swallowed whole. Do not crush, chew, or dissolve the caplets in your mouth. Always use the product as directed and read the label.

TYLENOL^® Cold and TYLENOL^® Sinus products are indicated for adults and children 12 years and older. For children under 12 years, please ask your doctor.

Symptoms + Conditions

QA Text:

TYLENOL^® (acetaminophen) is indicated for the reduction of fever and the temporary relief of minor aches and pains associated with:

The common cold
Headache
Toothache
Muscular aches
Backache
Minor pain of arthritis
Premenstrual and menstrual cramps

Acetaminophen, the active ingredient in TYLENOL^®, has not been shown to reduce inflammation.

TYLENOL^® (acetaminophen) is not indicated for migraine headaches

Sinus headaches are usually characterized by a throbbing pain in your forehead or behind your eyes that may increase when you lean forward or lie down. You may also experience pressure between your eyes or tenderness in your cheekbones, a sore throat, runny nose or cough. These symptoms may be a result of your nasal passages becoming swollen due to environmental irritants, allergies, or even a cold. As cold and flu symptoms can be very similar, please refer to the following differences:

A cold is characterized by a runny nose, watery eyes, stuffy nose, and congestion, sneezing and coughing. These symptoms build over 48 hours and may last for 3-10 days. Unlike the cold, flu symptoms such as fever and chills appear very quickly and may last for 7-14 days (and may linger for up to 3 weeks). Other symptoms include body aches and pains, weakness and fatigue.

If you are under a doctor’s care for any serious condition, or are taking any other drugs, you should talk to your doctor if you want to know more or have other questions.

Talk to a doctor or pharmacist before use if you have liver disease.

Pregnancy + Children

QA Text:

If you are pregnant or nursing a baby, seek the advice of your healthcare professional before using TYLENOL^® or any other medication.

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Tylenol & Caffeine | Livestrong.com

Caffeine can be found in coffee, tea and some soft drinks.

Tylenol is a brand name for acetaminophen, an over-the-counter pain reliever sold in the U.S. and other countries. Tylenol has been used for many years to treat muscle aches, toothaches, arthritis and fever. Caffeine is a nervous system stimulant found in soft drinks, tea, chocolate and coffee. Adverse reactions can occur when you combine caffeine with certain medications, so it is important to know caffeine’s effect on Tylenol before taking the medication.

Tylenol

Tylenol was developed in 1955 by McNeil Laboratories and was later purchased by Johnson & Johnson in 1959. Tylenol was developed as an alternative to aspirin, a drug known to increase the risk of stomach bleeding and irritation. Tylenol relieves mild to moderate pain and is available as a tablet, capsule, liquid, rectal suppository or chewable tablet. Tylenol changes the way the body senses pain and helps cool the body during times of fever. Tylenol is sometimes added to cold and cough formulas to treat aches and pains caused by the common cold or flu. Some pediatricians suggest Tylenol for reactions to vaccinations, including tenderness at the site, mild fever and general achiness.

Caffeine

Caffeine is naturally found in coffee beans, tea, cocoa and the kola nuts used to flavor some soft drinks. The U.S. Food and Drug Administration report that 90 percent of the people in the world use caffeine on a daily basis in some form. Caffeine is a central nervous system stimulant, meaning it affects your brain and the way you feel. Many people drink caffeinated beverages to feel more awake and energized. Caffeine can also cause adverse reactions, such as rapid heart beat, difficulty sleeping, increased blood pressure and nervousness. The FDA states that two 5-oz. cups of coffee a day are safe for most healthy individuals, but ask your doctor what amount is safe for you.

Combination Drugs

Additional substances are sometimes added to medications to improve the effectiveness of the drug. Some drug formulas combine acetaminophen with small doses of caffeine to increase the pain-relieving effects of acetaminophen. You can often find this combination in premenstrual syndrome formulas that are sold over-the-counter for menstrual cramps, muscle aches and tiredness. Caffeine and acetaminophen are also used together in migraine headache formulas sold in drugstores. Doses of Tylenol greater than 4000 mg within a 24-hour period can cause liver damage, so monitor all products you take within a 24-hour period that contain acetaminophen.

Warnings

People with heart problems should avoid caffeine because it causes the heart to pump harder, resulting in elevated blood pressure and increased heart rate. Caffeine can also cause digestive problems by increasing the amount of acid in the stomach, especially with high amounts of caffeine. Tylenol can also be dangerous in large doses, resulting in jaundice, convulsions, liver failure and coma. Unless directed by your physician, avoid taking more than 4000 mg of Tylenol a day and seek emergency medical treatment for symptoms of acetaminophen overdose.

acetaminophen, aspirin, and caffeine | Michigan Medicine

What is the most important information I should know about this medicine?

Do not give this medicine to a child or teenager with a fever, flu symptoms, or chicken pox. Aspirin can cause Reye’s syndrome, a serious and sometimes fatal condition in children.

Do not take more than the recommended dose. An acetaminophen overdose can damage your liver or cause death.

Call your doctor at once if you have: nausea, upper stomach pain, loss of appetite, dark urine, yellowing of your skin or eyes, clay-colored stools, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds.

In rare cases, acetaminophen may cause a severe skin 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.

What is acetaminophen, aspirin, and caffeine?

Acetaminophen is a pain reliever and a fever reducer. Aspirin is a salicylate (sa-LIS-il-ATE). Caffeine is a central nervous system stimulant.

Acetaminophen, aspirin, and caffeine is a combination medicine used to treat pain caused by tension headaches, migraine headaches, muscle aches, menstrual cramps, arthritis, toothaches, the common cold, or nasal congestion.

Do not use aspirin for heart or blood vessel conditions unless your doctor tells you to.

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

What should I discuss with my healthcare provider before taking this medicine?

Do not give this medicine to a child or teenager with a fever, flu symptoms, or chicken pox. Aspirin can cause Reye’s syndrome, a serious and sometimes fatal condition in children.

You should not use this medicine if you are allergic to acetaminophen (Tylenol), aspirin, caffeine, or any NSAIDs (diclofenac, ibuprofen, indomethacin, meloxicam, naproxen, Advil, Aleve, Motrin, and others).

Aspirin may cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are taking this medicine.

Ask a doctor or pharmacist if this medicine is safe to use if you have ever had:

liver disease, cirrhosis, a history of alcoholism, or if you drink more than 3 alcoholic beverages per day;
asthma or seasonal allergies;
fever with a stiff neck;
stomach ulcer, stomach or intestinal bleeding, ulcerative colitis;
bleeding problems;
kidney disease; or
if you use medicine to treat glaucoma or prevent blood clots.

If you take acetaminophen, aspirin, and caffeine to treat headache pain, seek medical attention if you have:

a headache so bad you have to lie down;
a headache that causes vomiting;
what feels like the worst headache you’ve ever had;
a headache that seems different from your usual headaches;
a headache every day;
a headache after coughing, bending, exercising, or head injury;
if you have never had migraines diagnosed by a doctor; or
if you are having your first headache after age 50.

Ask a doctor before using this medicine if you are pregnant or breastfeeding.

Taking aspirin during late pregnancy may cause bleeding in the mother or the baby during delivery. Ask a doctor before using this medicine if you are pregnant.

Do not give this medicine to anyone younger than 18 years old without medical advice.

How should I take this medicine?

Use exactly as directed on the label, or as prescribed by your doctor. Never use more than the recommended dose. An overdose of acetaminophen can damage your liver or cause death.

Take with food or milk if the medicine upsets your stomach.

Call your doctor if your symptoms do not improve after 7 days of treatment, or if you have a fever lasting longer than 3 days, or any swelling or pain lasting longer than 10 days.

Overuse of migraine headache medicine (more than 10 days per month) can make headaches worse. Tell your doctor if this medicine seems to stop working as well.

This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using acetaminophen, aspirin, and caffeine.

If you need surgery, dental work, or a medical procedure, you may need to stop taking this medicine for a short time.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Since acetaminophen, aspirin, and caffeine is used when needed, you may not be on a dosing schedule. Skip any missed dose if it’s almost time for your next dose. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of acetaminophen can damage your liver or cause death.

Early signs of acetaminophen overdose include loss of appetite, nausea, vomiting, sweating, or weakness. Later symptoms may include upper stomach pain, dark urine, and yellowing of your skin or eyes.

Overdose symptoms may also include ringing in your ears, headache, diarrhea, hallucinations, fast or slow heart rate, or seizure (convulsions).

What should I avoid while taking this medicine?

Avoid drinking alcohol. It may increase your risk of liver damage or stomach bleeding.

Ask a doctor or pharmacist before using other medicines for pain, fever, swelling, or cold/flu symptoms. They may contain ingredients similar to acetaminophen or aspirin (such as ibuprofen, ketoprofen, or naproxen).

Avoid coffee, tea, cola, energy drinks or other sources of caffeine while taking this medication. They can add to the side effects of the caffeine in the medication.

What are the possible side effects of this medicine?

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty 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.

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

severe anxiety, agitation, confusion, panic;
easy bruising or bleeding;
a light-headed feeling, like you might pass out;
dehydration symptoms –feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin;
symptoms of stomach bleeding –bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;
high potassium –nausea, weakness, tingly feeling, chest pain, irregular heartbeats, loss of movement; or
liver problems –nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Common side effects may include:

upset stomach, heartburn;
depressed mood, feeling anxious or restless; or
sleep problems (insomnia).

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.

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

Other drugs may affect acetaminophen, aspirin, and caffeine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

Where can I get more information?

Your pharmacist can provide more information about acetaminophen, aspirin, and caffeine.

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.
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 1996-2021 Cerner Multum, Inc. Version: 8.02. Revision date: 7/29/2020.

Extra Strength Tylenol Use and Overdose

Extra Strength Tylenol is a popular over-the-counter medication used to relieve pain, including arthritis pain. However, you must be careful when taking Tylenol not to exceed the maximum daily dose, as an overdose is toxic to the liver. Learn more about how Extra Strength Tylenol differs from regular strength Tylenol or Tylenol Arthritis Pain.

Ellen Lindner / Verywell

Available Strengths

When you go to your local drugstore, you will see many different types of pain relievers (NSAIDS, aspirin, acetaminophen) sold over the counter. There is not just one kind of Tylenol—several strengths of Tylenol are sold over the counter.

All products labeled Tylenol contain acetaminophen as their active ingredient and they also contain certain inactive ingredients. The difference in Tylenol products has to do with the amount of acetaminophen in each tablet, caplet, capsule, or gelcap. This is measured in milligrams (mg).

Strengths of Tylenol products:

Each regular strength Tylenol contains 325 mg acetaminophen.
Each Extra Strength Tylenol contains 500 mg acetaminophen.
Each Tylenol Arthritis Pain contains 650 mg acetaminophen.

Directions for Use

Adults and children 12 years and over should take 2 tablets, caplets, gelcaps, or tablespoons every 6 hours as needed with no more than 6 tablets, caplets, or gelcaps in 24 hours. Extra strength Tylenol should not be taken for more than 10 days unless directed by a doctor.

Take no more than 6 Extra Strength Tylenol per day. The maximum allowable daily dose of Tylenol (acetaminophen) is 3 grams (3,000 mg) in adults. For children it is recommended to carefully read the packaging and to consult your doctor for proper dosage.

In 2011, the makers of Tylenol lowered the maximum allowable daily dose of Tylenol from 4 grams (4,000 mg) to 3 grams (3,000 mg) to encourage safe usage.

Overdose Symptoms

The generic name for Tylenol is acetaminophen. Ingestion of too much acetaminophen can be deadly because it can be toxic to the liver.

If you have to take Tylenol or acetaminophen for more than just a day or two, consult with your physician about the source of pain or fever. Please remember that pain or fever are symptoms or signs of illness, respectively. Acetaminophen may provide some immediate relief but is not a long-term cure or solution.

Acetaminophen overdose is one of the most common overdoses throughout the world. Because acetaminophen (Tylenol and other formulations) is sold over the counter, many people incorrectly think that it’s absolutely safe.

Always follow the label and take only one medicine containing the same active ingredient at a time. Knowing your pain relievers is important and can reassure you of the safety and efficacy of Tylenol when used as directed.

As with all medications with active ingredients, bad things can happen when you take too much Tylenol. Specifically, the following symptoms can occur if you take too much acetaminophen:

Nausea
Diarrhea
Vomiting
Upset stomach
Sweating
Abdominal pain
Coma

Symptoms of acetaminophen overdose can take 12 or more hours to manifest. If you or a loved one suspects acetaminophen overdose, it’s imperative to go to the emergency room as quickly as possible.

Too much acetaminophen is harmful to the liver. Liver damage secondary to ingestion of too much acetaminophen can either be acute (short-term) or chronic (long-term).

Depending on how much acetaminophen was digested and how quickly a person receives treatment (eight hours or fewer), a person can recover from acute acetaminophen overdose.

A Word From Verywell

The strength of Tylenol you decide to purchase is based on your personal preference. Don’t forget to ask your doctor and pharmacist for their best recommendation. Extra Strength Tylenol is relatively inexpensive. Of course, generic acetaminophen should be cheaper in all categories.

Be vigilant about the cumulative effect of Tylenol. Meaning, many narcotic analgesics, and cold medicines contain acetaminophen—so they count towards your maximum daily allowable amount of 3,000 mg. Pay attention and keep track of your acetaminophen intake.

Caffeine and acetaminophen don’t mix well

Sep 27 2007

Consuming large amounts of caffeine while taking acetaminophen, one of the most widely used painkillers in the United States, could potentially cause liver damage, according to a preliminary laboratory study reported in the Oct. 15 print issue of ACS’ Chemical Research in Toxicology, a monthly journal.

The toxic interaction could occur not only from drinking caffeinated beverages while taking the painkiller but also from using large amounts of medications that intentionally combine caffeine and acetaminophen for the treatment of migraine headaches, menstrual discomfort and other conditions, the researchers say.

Health experts have warned for years that consuming excess alcohol while taking acetaminophen can trigger toxic interactions and cause liver damage and even death. However, this is the first time scientists have reported a potentially harmful interaction while taking the painkiller with caffeine, the researchers say.

While the studies are preliminary findings conducted in bacteria and laboratory animals, they suggest that consumers may want to limit caffeine intake — including energy drinks and strong coffee — while taking acetaminophen.

Chemist Sid Nelson, Ph.D., and colleagues, of the University of Washington in Seattle, tested the effects of acetaminophen and caffeine on E. coli bacteria genetically engineered to express a key human enzyme in the liver that detoxifies many prescription and nonprescription drugs. The researchers found that caffeine triples the amount of a toxic byproduct, N-acetyl-p-benzoquinone imine (NAPQI), that the enzyme produces while breaking down acetaminophen. This same toxin is responsible for liver damage and failure in toxic alcohol-acetaminophen interactions, they say.

In previous studies, the same researchers showed that high doses of caffeine can increase the severity of liver damage in rats with acetaminophen-induced liver damage, thus supporting the current finding.

“People should be informed about this potentially harmful interaction,” Nelson says. “The bottom line is that you don’t have to stop taking acetaminophen or stop taking caffeine products, but you do need to monitor your intake more carefully when taking them together, especially if you drink alcohol.”

Nelson points out that the bacteria used in the study were exposed to ‘megadoses’ of both acetaminophen and caffeine, much higher than most individuals would normally consume on a daily basis. Most people would similarly need to consume unusually high levels of these compounds together to have a dangerous effect, but the toxic threshold has not yet been determined, he says.

Certain groups may be more vulnerable to the potentially toxic interaction than others, Nelson says. This includes people who take certain anti-epileptic medications, including carbamazepine and phenobarbital, and those who take St. John’s Wort, a popular herbal supplement. These products have been shown to boost levels of the enzyme that produces the toxic liver metabolite NAPQI, an effect that will likely be heightened when taking both acetaminophen and caffeine together, he says.

Likewise, people who drink a lot of alcohol may be at increased risk for the toxic interaction, Nelson says. That’s because alcohol can trigger the production of yet another liver enzyme that produces the liver toxin NAPQI. The risks are also higher for those who take large amounts of medications that combine both acetaminophen and caffeine, which are often used together as a remedy for migraine headaches, arthritis and other conditions.

The researchers are currently studying the mechanism by which this toxic interaction occurs and are considering human studies in the future, they say. The National Institutes of Health funded the initial animal and bacterial studies.

http://www.acs.org/

Tylenol NO. 1 – Uses, Side Effects, Interactions

How does this medication work? What will it do for me?

This combination product contains three medications: acetaminophen, codeine, and caffeine.

Acetaminophen belongs to the group of medications called analgesics (pain relievers) and antipyretics (fever reducers).

Codeine belongs to the group of medications called narcotic analgesics.

Caffeine belongs to the group of medications called stimulants.

This combination of medications is used to treat mild-to-moderate pain associated with conditions such as headache, dental pain, muscle pain, painful menstruation, pain following an accident, and pain following operations.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Tylenol No. 1® is no longer being manufactured for sale in Canada. For brands that may still be available, search under acetaminophen – codeine – caffeine. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

How should I use this medication?

The usual recommended dose is 1 tablet taken every 4 to 6 hours as required. If 1 tablet is not effective, take 2 tablets at the next dose time. The dose should be adjusted according to the amount of pain experienced. The maximum dose of this medication is 12 tablets in 24 hours. Taking more than 12 tablets (or a maximum of 4,000 mg of acetaminophen) in a 24-hour period may cause severe liver damage, and could be fatal.

This medication may be taken with or without food. Tablets should be swallowed whole. Do not cut, break, crush, chew, or dissolve the tablets, as this may lead to dangerous and potentially fatal side effects.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Acetaminophen should not be taken to relieve pain for more than 5 days or to relieve a fever for more than 3 days, unless directed by a doctor.

It is important to take this medication exactly as prescribed by your doctor. If your doctor has told you to take this medication on a regular basis and you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you:

are allergic to acetaminophen, caffeine, codeine, or any ingredients of the medication
are overdosed on or intoxicated by alcohol, hypnotics, analgesics, or psychotropic medications
have mild pain that can be managed with other pain medications
are 12 years of age or younger
are 18 years of age or younger and are having or have recently had surgery for removal tonsils or adenoids
are experiencing acute asthma or other obstructive airway disease
are experiencing acute respiratory depression
are taking a monoamine oxidase (MAO) inhibitor (e.g., phenelzine, tranylcypromine) or have taken one in the last 14 days
have a blockage of the gastrointestinal tract, particularly paralytic ileus
have a head injury, a brain tumour, or increased pressure inside the head or spinal cord
have a convulsive (seizure) disorder
have a suspected abdominal condition that may require surgery
have severely reduced liver or kidney function
are a known CYP2D6 ultra-rapid metabolizer (someone who converts codeine into its active metabolite more rapidly and completely)
are pregnant or breast-feeding, in labour, or delivering

Non-prescription medications containing codeine should not be used for people under 18 years old.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

constipation
decreased ability or interest in sexual activity
decreased appetite
dry mouth
drowsiness
lightheadedness
nausea
sweating
trouble sleeping
vomiting

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

abdominal pain
dizziness when rising from a lying down or sitting position
fainting
fast, slow, or irregular heartbeat
headache
itching
mood changes
nervousness
restlessnessskin rash
vision problems
weakness or difficulty with muscle coordination

Stop taking the medication and seek immediate medical attention if any of the following occur:

confusion
hallucinations
seizures
signs of a serious allergic reaction (i.e., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
signs of breathing problems (e.g., shortness of breath, wheezing, irregular or troubled breathing)
signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
symptoms of a bowel blockage (e.g., abdominal pain, severe constipation, nausea)
symptoms of overdose (e.g., cold, clammy skin; abnormally slow or weak breathing; severe dizziness; confusion; slow heartbeat; or extreme drowsiness)
symptoms of serotonin syndrome (e.g., agitation or restlessness, loss of muscle control, muscle twitching, tremor, diarrhea)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

HEALTH CANADA ADVISORY

July 31, 2020

Health Canada has issued new information concerning the use of non-prescription pain relief products containing codeine. To read the full Health Canada Advisory, visit Health Canada’s web site at www.hc-sc.gc.ca.

Abdominal conditions: Codeine may make the diagnosis of abdominal conditions more difficult or it may worsen these conditions. If you have an abdominal condition such as inflammatory or obstructive bowel disease, acute cholecystitis, or pancreatitis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Accidental use: Accidental ingestion or use of this medication by someone for whom it has not been prescribed can lead to a fatal overdose. Children are especially at risk. Keep this medication out of sight and reach of children.

Alcohol and other medications that cause drowsiness: Do not combine this medication with alcohol or other medications (e.g., antidepressants, sleeping pills, anxiety medications) that cause drowsiness since additional drowsiness or suppressed breathing can occur and be dangerous and possibly life-threatening.

Breathing: Codeine can suppress breathing. If you are at risk for breathing difficulties (e.g., if you have asthma or chronic lung disease), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Constipation: Codeine can be very constipating. Eating a high-fibre diet and following good bowel habits will help to minimize this effect. If you develop constipation easily, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Dependence and withdrawal: This medication contains codeine. Physical dependence, psychological dependence, and abuse have occurred with the use of codeine. People with a history of past or current substance use problems may be at greater risk of developing abuse or addiction while taking this medication. Abuse is not a problem with people who require this medication for pain relief.

If you suddenly stop taking this medication, you may experience withdrawal symptoms such as anxiety, sweating, trouble sleeping, shaking, pain, nausea, tremors, diarrhea, and hallucinations. If you have been taking this medication for a while, it should be stopped gradually as directed by your doctor.

Drowsiness/reduced alertness: This medication may cause drowsiness. Do not drive, operate machinery, or perform other potentially hazardous tasks until you have determined how this medication affects you.

Head injury: If you have a head injury or increased pressure in the head, you may have a higher risk of experiencing side effects (breathing problems) or worsening of your condition while taking this medication. Discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: If you have kidney disease or reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Acetaminophen can cause decreased liver function. If you have liver disease or reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Taking too much acetaminophen with codeine may cause liver problems.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Low blood pressure: Codeine may cause low blood pressure or make low blood pressure worse. If you experience severe dizziness, especially when standing from a lying or sitting position, contact your doctor.

Other medical conditions: If you are about to undergo surgery of the biliary tract, approach taking codeine with caution, as it may worsen your condition. Codeine will worsen the effects of acute alcohol intoxication and delirium tremens.

As well, if you have low thyroid (hypothyroidism), Addison’s disease, benign prostatic hypertrophy (enlarged prostate), gallbladder disease, urethral stricture, decreased function of the adrenal glands, or porphyria, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Ultra-rapid codeine metabolizers: Some people process codeine faster and more completely than others due to a genetic variation. This can result in higher-than-expected drug levels in the body, which may result in overdose symptoms and serious or life-threatening effects on breathing. If you are known to be a rapid metabolizer of codeine you should avoid using this medication.

Worsening symptoms: If redness or swelling occurs in the area of pain, if symptoms do not improve or they worsen, or if new symptoms develop (e.g., high fever, rash, itching, persistent headache) while you are taking this medication, contact your doctor as soon as possible. These may be signs of other conditions that require medical attention.

Seizures: This medication may cause seizures. Seizures are more likely to occur when higher doses of this medication are taken. If you have a history of epilepsy or medical conditions that increase the risk of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Serotonin syndrome: Although rare, severe reactions are possible when codeine is combined with other medications that act on serotonin, such as tricyclic antidepressants and serotonin reuptake inhibitors (medications used to treat depression). Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, or changes in mental state including delirium and agitation. Coma and death are possible.

If you are taking antidepressants, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately. Infants born to mothers who have been taking codeine for long periods of time may experience dangerous withdrawal symptoms at birth.

Breast-feeding: Acetaminophen, codeine, and caffeine pass into breast milk. Some of the codeine dose is converted into morphine by the body, once it has been taken. For some people, this change happens much faster than for others. If this happens to a nursing mother, the baby is at risk of receiving a morphine overdose through the breast milk. If you are breast-feeding and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children under 12 years old. Medications containing codeine should not be given to people under 18 years old for pain management after surgery to remove the tonsils and or adenoids.

Non-prescription products containing codeine should not be used by people under 18 years old. Recent evidence shows that young people who use opioids, including codeine, may be more likely to have problems with the misuse of medications and other substances later in life.

Seniors: Seniors who take this medication may be more likely to experience side effects or worsening of preexisting medical conditions.

What other drugs could interact with this medication?

There may be an interaction between acetaminophen – codeine – caffeine and any of the following:

abiraterone acetate
aclidinium
alcohol
amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
antihistamines (e.g., cetirizine, diphenhydramine, hydroxyzine, loratadine)
antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
apalutamide
atropine
azelastine
azole antifungals (e.g. fluconazole, ketoconazole, voriconazole)
baclofen
barbiturates (e.g., butalbital, pentobarbital, phenobarbital)
belladonna
benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
benztropine
bosentan
brimonidine
buprenorphine
bupropion
buspirone
butorphanol
cannabis
cinacalcet
chloral hydrate
cobicistat
cocaine
conivaptan
dapsone
darifenacin
desmopressin
diltiazem
disopyramide
dronedarone
diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
dronabinol
dronedarone
efavirenz
eluxadoline
enzalutamide
flavoxate
flibanserin
general anaesthetics (medications used to put people to sleep before surgery)
glycopyrrolate
grapefruit juice
HIV protease inhibitors (e.g., atazanavir, darunavir, lopinavir, ritonavir)
indacaterol
ipratropium
isoniazid
kava kava
ketotifen
lithium
lumacaftor and ivacaftor
macrolide antibiotics (e.g., clarithromycin, erythromycin)
magnesium sulfatemethadone
methylene blue
metoclopramide
mirabegron
mirtazapine
modafinil
monoamine oxidase (MAO) inhibitors (e.g., moclobemide, phenelzine, selegiline, tranylcypromine)
muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine)
nabilone
naltrexone
other narcotic pain relievers (e.g., fentanyl, hydrocodone, morphine)
olodaterol
other products containing acetaminophen, caffeine, or codeine
oxybutynin
pramipexole
prilocaine
quinidine
quinine
rifabutin
rifampin
ritonavir
ropinirole
St. John’s wort
scopolamine
seizure medications (e.g., carbamazepine, clobazam, levetiracetam, phenobarbital, phenytoin, primidone, topiramate, valproic acid, zonisamide)
selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
somatostatin analogs (e.g., lanreotide, octreotide, pasireotide)
suvorexant
tapentadol
terbinafine
thalidomide
ticlopidine
tiotropium
tolterodine
tramadol
trazodone
tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
“triptan” migraine medications (e.g., rizatriptan, sumatriptan)
tryptophan
tyrosine kinase inhibitors (e.g., dasatinib, imatinib, nilotinib)
umeclidinium
vaccines
verapamil
warfarin
zolpidem
zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

stop taking one of the medications,
change one of the medications to another,
change how you are taking one or both of the medications, or
leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Tylenol-NO-1

‘But why? I feel fine!’

Thomas A. Viola, RPH, CCP

I was worried about her, and I was not going to hide it. I needed to make sure this patient knew exactly how serious her situation was. “Just go to the hospital,” I said. “Go now.”

“Why?” she replied, nervously. “I’m fine.”

“We don’t know that for sure,” I said. “Trust me.”

“C’mon, it was only 18 tablets,” she said. “I won’t take any today.”

“Just go to the hospital,” I replied. “I’ll bring flowers.”

“But why?” she said. “I feel fine!”

Finally, I could see the look of concern grow on her face.

“I’ll be ok, right?” she asked. “I mean, it’s just Tylenol, right?”

To be honest, I wasn’t sure. I knew this patient and her history. She had a history of a seizure disorder for which she was taking Dilantin (phenytoin). She regularly consumed alcohol, in her own words, “Probably more than I should.” And, she just admitted to taking 18 caplets of Tylenol Extra Strength 500 mg for a total of 9000 mg of acetaminophen in the last 24 hours to treat a severe migraine headache.

Acetaminophen is often referred to as “APAP,” an acronym for its chemical name, N-acetyl-p-aminophenol. It has analgesic (pain relieving) and antipyretic (fever reducing) activity that is equivalent to that of aspirin, but very weak anti-inflammatory effects when compared with aspirin.

Although acetaminophen was approved by the FDA in 1951, little is known about its exact mechanism of action. It is thought that acetaminophen shares a common mechanism of action with aspirin and the NSAIDs in that it inhibits prostaglandin synthesis. However, acetaminophen appears to be much more active in the central nervous system than aspirin or the NSAIDs.

Treatment for dental pain

Acetaminophen is indicated for the relief of mild to moderate pain from headaches, toothaches, muscle aches, menstrual cramps, minor arthritic pain, and for the reduction of fever. Numerous studies have also demonstrated acetaminophen’s effectiveness in treating mild to moderate dental pain. Peak pain relief with acetaminophen occurs approximately one hour after administration and has been shown to last up to four hours.

A combination of 600 mg of ibuprofen and 500 mg of acetaminophen administered every six hours will provide superior relief of post-surgical dental pain without an opioid and without approaching or exceeding the maximum recommended daily dose for either drug.

While acetaminophen is clearly effective in relieving mild to moderate dental pain, its efficacy is questionable in treating moderate to severe post-surgical dental pain, using the pain normally associated with impacted third-molar extraction as a standard. However, there is considerable evidence that combining acetaminophen with an NSAID, such as ibuprofen or naproxen, offers superior analgesia. Several studies have demonstrated that the combination of acetaminophen and an NSAID was more effective than either acetaminophen or an NSAID alone. Acetaminophen and NSAIDs have similar, but still different, mechanisms of action, so a combination of the two ingredients offers a synergistic approach to pain relief.

Products combining acetaminophen and either ibuprofen (Advil) or naproxen sodium (Aleve) would, therefore, provide additive analgesia without the need for increased doses and without a corresponding increase in adverse effects. For example, a combination of 600 mg of ibuprofen and 500 mg of acetaminophen administered every six hours will provide superior relief of post-surgical dental pain without an opioid and without approaching or exceeding the maximum recommended daily dose for either drug. Unfortunately, there is still no nonprescription analgesic product available in the United States that provides such a combination of ingredients.

The effect of caffeine

Several nonprescription analgesics combine acetaminophen with aspirin and/or caffeine. While there is little evidence to support that analgesia is enhanced by the combination of acetaminophen and aspirin, there is considerable evidence that products containing caffeine demonstrate greater analgesic efficacy than products containing acetaminophen and/or aspirin alone, especially for the treatment of migraine headaches.

Caffeine is not thought to possess any analgesic properties on its own; however, when combined with traditional analgesics, such as acetaminophen and/or aspirin, it improves its analgesic efficacy. Previous studies have found that caffeine decreases pain in the central nervous system. However, the mechanism by which caffeine exerts this effect is unknown.

Recent studies have indicated that caffeine’s vasoconstrictive effects may help alleviate acute post-therapeutic dental pain by decreasing swelling and inflammation. One study concluded that 300 mg of acetaminophen with 20 mg of caffeine was as effective as 300 mg of acetaminophen with 20 mg of codeine after 30 minutes in treating pain following the placement of dental implants, while also producing significantly lower levels of inflammation for the first three days.

Another study concluded that the combination of 400/100 mg ibuprofen/caffeine showed superior efficacy to 400 mg ibuprofen alone in the treatment of severe dental pain following third molar extractions, indicating that caffeine is indeed an effective analgesic adjuvant. Thus, the inclusion of caffeine in combination with ibuprofen and/or acetaminophen may serve to increase the analgesic effect of the combination while limiting the overall amount of ibuprofen and/or acetaminophen used.

For patients in whom aspirin and other NSAIDs are contraindicated, acetaminophen is usually the drug of choice. Although acetaminophen is not a true anti-inflammatory drug, it can be effective in treating pain resulting from inflammation. It is also the drug of choice for fever reduction in children and teenagers because it is not associated with the development of Reye’s syndrome.

Acetaminophen has little, if any, effect on specific organ systems. At therapeutic doses, acetaminophen does not affect platelet adhesiveness or uric acid excretion and does not cause gastric bleeding or any of the other side effects usually associated with aspirin or NSAIDs. However, chronic acetaminophen ingestion at doses of 2 to 4 grams per day for longer than one week has been shown to raise INR values, and patients taking such doses should have their INR monitored more frequently.

Adverse reactions

The most serious adverse effect associated with the use of acetaminophen is drug-induced liver toxicity due to an acute or chronic overdose with the drug. Overdose from acetaminophen has become an issue due to its widespread availability and frequency of use. It has been reported that overdoses of acetaminophen result in emergency room visits for over 80,000 Americans every year.

The degree of liver damage from acetaminophen is directly related to the dose ingested. The liver is the primary site in the body where acetaminophen is metabolized. About 94% of each dose of acetaminophen is metabolized in the liver by glucuronidation (binding to a glucuronide molecule) and sulfation (binding to a sulfate molecule) and these metabolites are excreted in the urine by the kidneys. Another 2% of each dose is excreted in the urine unchanged. Finally, about 4% of each dose is metabolized by cytochrome p450 enzyme systems in the liver.

The p450 enzyme systems form an intermediate metabolite called N-acetyl-p-benzoquinoeimine (NAPQI), which turns out to be a liver-toxic compound. Ordinarily, this toxic metabolite is rendered harmless within the liver by combining it with gluthathione. Thus, acetaminophen and its metabolites are themselves actually not harmful to the liver.

However, after an overdose the excessive amount of acetaminophen in the liver can overwhelm or saturate the glucuronidation and sulfation pathways. When this happens, more of the acetaminophen is processed through the cytochrome P-450 system, and thus, more of the toxic metabolite, NAPQI, is produced. If the liver does not have enough gluthathione to combine with the NAPQI, it is then free to induce rapid liver cell death and potentially deadly acute liver failure.

When used as labeled, acetaminophen is generally considered to be safe. The usual adult dose of acetaminophen is 325 mg to 1000 mg three to four times daily, not to exceed 4000 mg over a 24-hour period. However, in recent years, the US Food and Drug Administration (FDA) has taken several steps to reduce the likelihood of acetaminophen-induced liver toxicity.

In response to the growing incidence of accidental acetaminophen overdoses, in January 2011 the FDA issued a safety announcement asking drug manufacturers to limit the strength of acetaminophen in prescription drug products to 325 mg per tablet, capsule, or other dosage unit. In addition, a boxed warning highlighting the potential for severe liver injury was added to the label of all prescription drug products that contain acetaminophen.

In early 2014, the FDA requested withdrawal of over 120 applications for combination prescription acetaminophen drug products containing more than 325 mg acetaminophen per dosage unit. The FDA also reminded pharmacists and physicians to stop prescribing and dispensing combination prescription acetaminophen products containing more than 325 mg. As a result, all manufacturers have discontinued marketing combination prescription drug products that contain more than 325 mg of acetaminophen.

Interestingly, non-prescription (OTC) products containing acetaminophen, such as Tylenol, were not affected by this action. In the 2011 safety announcement, the FDA indicated that information about the potential for liver injury is already required on the label for OTC products containing acetaminophen. However, in July 2011, Johnson & Johnson and Ortho-McNeil, the manufacturers of Tylenol, issued new labeling that changed the maximum daily recommended dose of Tylenol from 4,000 mg to 3,000 mg in one day.

Why do acetaminophen overdoses occur? Acetaminophen is one of many drugs that have a narrow therapeutic index, which means that there is a narrow range between a “safe” dose and an “overdose.” Unfortunately, the toxicity level is different for everyone. Many patients may not realize that overdoses of acetaminophen may cause liver damage. Acetaminophen has long been considered the “safe” analgesic because it produces virtually no side effects at regular doses.

Moreover, it is easy to accidentally take more than the recommended dose of acetaminophen since many patients are not aware that prescription pain relievers, such as Vicodin and Percocet, contain acetaminophen. In addition, many over-the-counter medications contain acetaminophen as an active ingredient, including cough and flu remedies, headache medications, allergy medications, and even sleep aids. Compounding this issue is the fact that acetaminophen may be listed on ingredient labels as “APAP” or some other abbreviation that many patients may not recognize as acetaminophen.

Severe liver toxicity after acetaminophen overdose is life-threatening. Several risk factors may increase the risk of liver toxicity in certain patients. Individuals with preexisting liver disease are most susceptible. In addition, acetaminophen-induced liver toxicity is potentiated by chronic alcohol consumption. Finally, medications that induce cytochrome p450 enzyme systems, such as Dilantin (phenytoin), may increase the production of acetaminophen’s toxic metabolite, NAPQI, and thus, increase the risk of liver cell death.

Suitable treatments for acetaminophen-induced liver toxicity do exist and are effective if initiated quickly. However, the signs and symptoms of acetaminophen overdose may not appear until several days after ingestion of the drug. This delayed reaction only serves as initial positive reinforcement for delay in initiating treatment, especially with acetaminophen’s relative lack of adverse effects and perceived safety at therapeutic doses. Symptoms of acetaminophen overdose include nausea, vomiting, and abdominal pain. However, these symptoms may be mistaken for symptoms of the flu or other benign conditions.

As for my patient? I stopped off at the local hospital on my way home. Much to my relief my patient was there and was receiving treatment. She thanked me profusely for encouraging her to get to the hospital as quickly as she could. Of course, I made a quick stop at the gift counter. After all, I did promise to bring the flowers.

THOMAS A. VIOLA, RPH, CCP, In addition to his daily practice of the profession of pharmacy, Thomas A. Viola, RPh, CCP, also serves the professions of dentistry, dental hygiene, and dental assisting as an educator, published writer, and professional speaker. As an educator, Viola is a member of the faculty of seven dental hygiene and dental assisting programs, as well as several national board exam review courses. Visit Viola’s website: www.tomviola.com.

90,000 THYLENOL AND CAFFEINE – HEALTH

Tylenol is a brand name for acetaminophen, an over-the-counter pain reliever sold in the United States and other countries.Tylenol has been used for many years to treat muscle pain, toothache, arthritis, and fever. Caffeine is a nervous system stimulant found in soft drinks, tea, chocolate and coffee. Adverse reactions can occur when caffeine is combined with certain medications, so it is important to know the effects of caffeine on Tylenol before taking medications.

Tylenol

Tylenol was developed by McNeil Laboratories in 1955 and was later acquired by Johnson & Johnson in 1959.Tylenol was developed as an alternative to aspirin, a drug known to increase the risk of bleeding and stomach irritation. Tylenol relieves mild to moderate pain and is available as a tablet, capsule, liquid, rectal suppository, or chewable tablet. Tylenol alters the body’s perception of pain and helps cool it during fever. Tylenol is sometimes added to cold and cough formulas to treat pain caused by the common cold or flu. Some pediatricians recommend Tylenol for vaccine reactions, including local tenderness, mild fever, and general pain.

Caffeine

Caffeine is naturally found in coffee beans, tea, cocoa and cola nuts, which are used to flavor some soft drinks. The FDA reports that 90 percent of the world’s people consume caffeine in some form on a daily basis. Caffeine is a central nervous system stimulant, meaning it affects your brain and how you feel. Many people drink caffeinated beverages to feel more alert and alert.Caffeine can also cause side effects such as increased heart rate, difficulty sleeping, high blood pressure, and nervousness. The FDA says two are 5 ounces. cups of coffee a day are safe for most healthy people, but ask your doctor how much coffee is safe for you.

Combined preparations

Sometimes additional substances are added to drugs to increase the effectiveness of the drug. In some formulations, acetaminophen is combined with small doses of caffeine to enhance the pain relieving effect of acetaminophen.You can often find this combination in over-the-counter PMS formulas for menstrual cramps, muscle aches and fatigue. Caffeine and acetaminophen are also used together in over-the-counter migraine formulas. Tylenol doses over 4,000 mg in 24 hours can cause liver damage, so watch out for any foods you take within 24 hours that contain acetaminophen.

Warnings

People with heart problems should avoid caffeine because it makes the heart work harder, which leads to high blood pressure and heart rate.Caffeine can also cause digestive problems due to an increase in the amount of acid in the stomach, especially those with a high caffeine content. Tylenol can also be dangerous in high doses, causing jaundice, seizures, liver failure, and coma. Unless your doctor prescribes you, avoid taking more than 4,000 mg of Tylenol per day and seek emergency medical attention for symptoms of an acetaminophen overdose.

90,000 P – has an analgesic, antipyretic and anti-inflammatory effect

Askofen-P, an analgesic with an optimal * combination of three active ingredients, can help cope with pain.Askofen-P is a gentle, time-tested product at an affordable price **

The analgesic effect of is achieved through a combination of three main active ingredients: paracetamol, acetylsalicylic acid and caffeine.

Acetylsalicylic acid in Ascofen-P has analgesic, antipyretic and anti-inflammatory effects. It is associated with the suppression of the enzyme cyclooxygenase 1 and 2 types, which regulate the synthesis of prostaglandins – mediators of pain and inflammation.

Paracetamol is an analgesic with analgesic and antipyretic effects, which are achieved by the action of the drug on the centers of pain and thermoregulation in the brain. Paracetamol has a well-studied mechanism of action and safety profile.

Caffeine – is an active ingredient that stimulates the respiratory and vasomotor centers of the brain and helps relieve fatigue and increase mental and physical performance.Caffeine acts as an auxiliary component, which, according to studies, is able to enhance the analgesic effect of paracetamol and acetylsalicylic acid.

Thanks to these components, the drug Askofen-P® helps to relieve common pain syndromes caused by neurological and inflammatory diseases, as well as muscle, headache, joint and toothache.

Indications for use

In adults and children (over 15 years old) as an anesthetic for mild to moderate pain syndrome:

headache
migraine
toothache
muscle and joint pain
neuralgia
algodismenorrhea

In adults, it can be used for ARVI and influenza as an antipyretic agent.

Askofen-P® is a time-tested and affordable ** analgesic that has been trusted for over 20 years.

Acetaminophen, Caffeine, and Codeine | Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^®, contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: Canada

Atasol-15 [DSC]; Atasol-30 [DSC]; Atasol-8 [DSC]; TEVA-Lenoltec # 1; TEVA-Lenoltec # 2; TEVA-Lenoltec # 3; Triatec-8 Forte; Tylenol # 2 [DSC]; Tylenol # 3 [DSC]; Wampole-Acetaminophen / Cod / Caff

Warning

This medicine is a strong pain reliever that can be addictive, abuse or misuse.Misuse or abuse of this drug can lead to overdose and death. Please consult your doctor.
You will be closely monitored to avoid misuse, abuse or dependence on this drug.
This drug may cause very bad and sometimes deadly breathing problems. Call a doctor right away if breathing is slow, shallow, or difficult.
The risk of serious, sometimes fatal, respiratory distress may be increased when this drug is started or if the dose is increased.
Even one dose of this drug, taken by another person or by mistake, can be deadly, especially in children. If this drug has been taken by another person or by mistake, get medical help right away.
Store all medicines in a safe place.Keep all medicines out of the reach of children and pets.
This medicine contains acetaminophen. Liver disorders have been reported during acetaminophen use. In some cases, these disorders required liver transplantation or resulted in death. In most cases, liver problems have occurred in patients taking more than 4,000 milligrams (mg) of acetaminophen per day. Often, patients used not one, but several drugs containing acetaminophen.
This medicinal product contains an opioid. Serious side effects have occurred with the use of opioid drugs with benzodiazepines, alcohol, marijuana, or other forms of cannabis, as well as prescription or over-the-counter drugs that can cause drowsiness or slow action. These effects include slowed down or labored breathing and death. Benzodiazepines include drugs such as alprazolam, diazepam, and lorazepam. Benzodiazepines can be used to treat many health conditions such as anxiety, sleep disturbances, or seizures.If you have any questions, please consult your doctor.
Many drugs interact with this drug, which can increase the risk of side effects, such as deadly breathing problems. Check with your doctor and pharmacist to make sure this drug is safe to use with all your other drugs.
Do not take with alcohol or foods containing alcohol.Dangerous, sometimes deadly, effects can develop.
Get immediate medical attention if you feel very sleepy, dizzy, or pass out. Guardians or others should seek immediate medical attention if the patient does not respond, does not respond, or does not respond normally, or if he is asleep and does not wake up.
Long-term use of this drug during pregnancy may cause withdrawal in newborns.This can be life threatening. Consult your doctor.

What is this drug used for?

Used to relieve pain.

What do I need to tell my doctor BEFORE taking this drug?

If you are allergic to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergy and how it manifested itself.
If you have any of the following health conditions: Lung or breathing problems such as bronchial asthma, difficulty breathing, or sleep apnea; high levels of carbon dioxide in the blood; gastrointestinal obstruction or narrowing.
If you have any of the following health problems: heart disease, kidney disease, or liver disease.
If you have any of the following health conditions: abdominal pain, appendicitis, or pancreatitis.
If you have recently drunk large amounts of alcohol or taken a large number of drugs that slow the reaction rate, such as phenobarbital, or some pain relievers, such as oxycodone.
If you have convulsions.
If you currently have alcohol withdrawal.
If you are very sleepy.
If you have recently suffered a head injury, brain injury, or have recently developed a tumor or increased intracranial pressure.
If you are giving birth.
if you are breastfeeding. Do not breast-feed while taking this drug.
If you have taken a drug for depression or Parkinson’s disease in the past 14 days.These include isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. An episode of very high blood pressure may occur.
If you are taking any of the following drugs: linezolid or methylene blue.
If you are taking any of the following drugs: buprenorphine, butorphanol, nalbuphine, or pentazocine.
If your doctor has told you that the metabolism of certain drugs is accelerated in your body.
If the patient is a child.Do not give this drug to a child.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all the medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems. You need to make sure that this drug is safe for your medical condition and in combination with other drugs you are already taking.Do not start or stop taking any drug or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

Tell all healthcare providers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
It is not recommended to use other medicinal products containing acetaminophen. Read the instructions for medicines carefully.Taking too much acetaminophen can lead to liver problems.
Follow the instructions exactly. Do not exceed your prescribed daily dose of acetaminophen. If you are unsure of the daily dose of acetaminophen, ask your doctor or pharmacist for it. Some patients may take this drug in doses of up to 4,000 milligrams (mg) per day as directed by a healthcare professional. Some patients (such as those with liver disease and children) require a lower acetaminophen dose.If you have exceeded your daily dose of acetaminophen, contact your doctor immediately, even if you do not feel worse.
Avoid driving or other activities that require increased attention until you see how this drug affects you.
To reduce the risk of dizziness or loss of consciousness, get up slowly from a lying or sitting position. Use caution when going up and down stairs.
Long-term or regular use of opioid medications like this can lead to dependence.Reducing the dose or stopping suddenly from this drug can cause a serious risk of a withdrawal reaction or other serious impairment. Talk to your doctor before lowering the dose or stopping this drug. Follow your doctor’s instructions. Tell your doctor if you experience severe pain, mood changes, suicidal thoughts, or any other side effects.
This drug may interfere with some laboratory tests.Tell all healthcare providers and lab staff that you are taking this drug.
Long-term use of an opioid drug can lead to a decrease in sex hormone levels. If you have decreased interest in sex, impaired fertility, missing menstrual periods (in women), or changes in sexual function (in men), see your doctor.
This drug may increase the risk of seizures in some people, including people with a history of seizures.Talk with your doctor to see if you are at increased risk of seizures with this drug.
Limit caffeine (such as tea, coffee and cola) and chocolate. When taken with this drug, it can cause nervousness, tremors and tachycardia.
Occasional use of this type of opioid can cause very severe adrenal dysfunction. Call your doctor right away if you experience very severe dizziness or fainting, very severe nausea or vomiting, decreased appetite, feeling very tired or weak.
If you are 65 years of age or older, use this drug with caution. You may have more side effects.
In children, the risk of very serious side effects may be higher. This risk may be more likely in children with breathing problems. Deadly breathing problems have occurred in some children with codeine. Consult your doctor.
If used during pregnancy, the drug may have a harmful effect on the fetus.If you are pregnant or become pregnant while taking this drug, call your doctor right away.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can have serious and sometimes deadly side effects. Call your doctor or get medical help right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
Signs of liver problems such as dark urine, feeling tired, lack of appetite, nausea or abdominal pain, light stools, vomiting, yellowing of the skin and eyes.
Difficulty, slow or shallow breathing.
Noisy breathing.
Severe drowsiness.
Severe dizziness or fainting.
Convulsions.
Confusion of consciousness.
Severe abdominal pain.
Severe constipation.
Difficulty urinating or change in the amount of urine excreted.
Mood swings.
Hallucinations (a person sees or hears something that is not in reality).
Change in vision.
Fever or chills.
Sore throat.
Any unexplained bruising or bleeding.
Weakness.
For problems with body movement control.
Feeling of an abnormal heartbeat.
Possible severe skin reaction (Stevens-Johnson syndrome / toxic epidermal necrolysis).This can lead to serious and permanent health problems and sometimes death. Get immediate medical attention if you experience symptoms such as redness, skin swelling with blistering or scaling (with or without a high fever), redness or irritation of the eyes, and ulceration in the mouth, throat, nose, or eyes.
A serious and sometimes deadly condition called serotonin syndrome can develop when this drug is used with certain other drugs.Call your doctor right away if you develop agitation, imbalance, confusion, hallucinations, fever, tachycardia or irregular heartbeat, flushing, muscle twitching or stiffness, seizures, tremors or tremors, excessive sweating, severe diarrhea, nausea or vomiting , severe headache.

What are some other side effects of this drug?

Any medicine can have side effects.However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

Dizziness.
Sleepiness.
Nausea or vomiting.
Constipation.
Pain in the intestines.
Lack of hunger.
Dry mouth.
Excessive sweating.
Sleep disorders.
Headache.
Anxiety.
Nervous tension and agitation.

This list of potential side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088.You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

Take with or without food. Take with food if the medicine causes nausea.
Swallow whole. Do not chew, break, or dissolve.
Do not take the drug in higher doses than the doctor prescribed.Taking more than the prescribed amount of the drug increases the risk of serious side effects.
Do not take this drug for longer than your doctor prescribed.
If this drug is taken for a long time or in high doses, its effectiveness may be reduced and a higher dose may be needed to obtain the same effect. The so-called drug tolerance develops. Talk to your doctor if this drug stops working.Do not take the drug in higher doses than your doctor prescribed.
Do not take this drug with any other strong pain reliever or with a pain reliever patch without first consulting your doctor.

What should I do if a dose of a drug is missed?

If you are taking this medication regularly, take the missed dose as soon as you can.
If it is time for your next dose, do not take the missed dose and then return to your normal dose schedule.
Do not take 2 doses at the same time or an additional dose.
In most cases, this drug is used as needed. Do not take this medicine more often than prescribed by your doctor.

How do I store and / or discard this drug?

Store at room temperature, protected from light. Store in a dry place. Do not store in the bathroom.
The lid must be tightly closed.
Store this medication in a protected place, out of the reach of children, and out of the reach of other people.A box or room, which is locked with a key, can act as a protected storage location for the drug. Keep all medicines out of the reach of pets.
Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

If your health does not improve or even worsens, see your doctor.
You should not give your medicine to anyone and take other people’s medicines.
Some medicines may come with other patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
Some medicines may come with other patient information sheets. Check with your pharmacist. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
If you think an overdose has occurred, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are appropriate for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient.Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a treatment guide and does not replace information provided to you by your healthcare professional. For complete information on the possible risks and benefits of taking this drug, consult your doctor.

Copyright

Excedrin • – alchetron, the free social encyclopedia

Excedrin is an over-the-counter headache pain reliever, usually in the form of tablets or caplets. It contains acetaminophen (Tylenol), aspirin, and caffeine. Until the end of 2005 it was manufactured by Bristol-Myers Squibb, but in July 2005 it was purchased (and is now manufactured) by Novartis, along with other products from the BMS over-the-counter business.

Excedrin was one of the top ten selling OTC medicine brands in the United States. There are other brands on the market that contain the same combination of drugs such as Roter APC tablets available in Europe.

The brand became famous for advertisements in which Excedrin cured particularly unpleasant and excruciating headaches (which were named in advertisements as “Excedrin headaches”, later called “Excedrin tension headaches”).

In 2007, the brand expanded into marketing for other types of pain with the introduction of Excedrin Back & Body, which removed caffeine from the normal blend.

Versions

Over the years, various types of drug have been introduced:

1960 Excedrin Extra Strength (formula last changed in 1978) In 1960, Bristol-Myers Squibb introduced Excedrin Extra Strength for headaches, the first product headache treatment multi-ingredient formulations.Contains 250 mg acetaminophen, 250 mg aspirin and 65 mg caffeine
1969 Excedrin PM first headache and sleeping pills combined product. Contains 500 mg of acetaminophen and 38 mg of diphenhydramine citric acid as a sleep aid, the same active ingredients as PM Tylenol, which was introduced years later.
Excedrin Migraine 1998 In early 1998, the FDA granted market authorization to Excedrin Migraine for the relief of migraine pain and related symptoms.Excedrin Migraine has continued the trend to market pain products for certain types of pain, becoming the first migraine treatment available to consumers without a prescription, even though it has the identical active ingredients to the regular Excedrin Strength Complementary Product, 250 mg acetaminophen, 250 mg aspirin and caffeine at 65 mg. In fact, at the launch of the product, its advertising slogan was “Excedrin, now Excedrin Migraine,” noting that the two were the same product.
2003 Excedrin Tension Headache Contains 500 mg acetaminophen and 65 mg caffeine.
2005 Excedrin Sinus Headache Contains 325 mg acetaminophen and 5 mg phenylephrine HCl as a decongestant.
2007 Excedrin Back and Body is a dual-ingredient formula, stating that it “works two ways – an anesthetic and a right pain blocker where it hurts.” Contains 250 mg acetaminophen, 250 mg aspirin.
[Year Unknown] Excedrin Monthly Complete Excedrin Monthly Complete continues the trend to sell pain products for specific types of pain, even though it has identical active ingredients to the regular Excedrin and Migraine Strength Complementary Product Excedrin, acetaminophen 250 mg , 250 mg of aspirin and 65 mg of caffeine.

Ownership

In 2005, Bristol-Myers Squibb announced the sale of its North American consumer medicine business (including Excedrin, Comtrex and Carey brands) to Novartis for $ 660 million to focus on drugs for the ten most profitable disease areas.

2012 recall

January 9, 2012 Novartis announced that it has voluntarily recalled all of its many select bottle packaging configurations of Excedrin products with expiry dates of December 20, 2014 or earlier as a precaution because products may contain occasional tablets, capsules or caplets from other Novartis products, or contain broken or chipped tablets.The recall was conducted with the knowledge of the US Food and Drug Administration. Wholesalers and retailers were ordered to stop distribution and return the affected product. Consumers in possession of the recalled Excedrin were ordered to stop using the product and contact Novartis. Novartis said Excedrin will ship to stores on October 15th and customers will start seeing it by November 1st.

Popular culture

In Stephen King’s novel The Flamboyant, the protagonist Jack Torrance chewed Excedrin tablets (and relished their taste), first as a cure for his persistent hangover headaches and later when his alcoholic symptoms reappeared.This would be a difficult act to complete in reality, as the active compounds in Excedrin are all very bitter,

and could lead to chemical burns of the mouth due to aspirin.

In Episode 8 Family Guy, “Simple Rules for Buying My Minor Daughter,” Peter buys some Excedrin for Lois and opens an account for it at Goldman’s Pharmacy, which he later cannot afford to pay.

In Friends, Tom C Nap Partners, Joey Tribbiani offers Ross Geller some warm milk and Excedrin in the afternoon because he wants to take another nap with him.

Paracetamol can not be washed down with coffee – medical news

Simultaneous intake of pain reliever acetaminophen (paracetamol, Tylenol, etc.) and large amounts of coffee can lead to liver damage, American scientists have shown. Experiments have shown that adding coffee increases the formation of a toxic by-product of acetaminophen metabolism threefold.

Simultaneous administration of pain reliever acetaminophen (paracetamol, Tylenol, etc.)and large volumes of coffee can damage the liver, according to the journal Chemical Research in Toxicology.

Scientists at the University of Washington found that adding coffee increases the formation of a toxic by-product of acetaminophen metabolism, the so-called N-acetyl-p-benzoquinone imine (NAPQI), threefold.

These results were obtained when studying the effects of these substances on specially created genetically engineered strains of E. coli bacteria. These bacteria produce enzymes that are produced in the human liver and are involved in the metabolism of acetaminophen and a number of other drugs.

“Caffeine can interact with an enzyme involved in the formation of the toxic metabolite of acetaminophen, increasing its production. As a result, liver damage can occur, ”said study leader Sid Nelson.

The new findings are supported by earlier studies showing that high doses of caffeine increased liver damage in rats following acetaminophen, Nelson noted.

Meanwhile, taking a small amount of coffee in combination with acetaminophen is not dangerous, the researchers believe.Liver damage can occur if you drink “ten times more caffeine than a couple of cups of coffee,” Nelson said.

However, the toxic effect of this combination may appear much earlier in combination with alcohol, antiepileptic drugs and combination drugs that include caffeine and acetaminophen. The latter are widely used to treat migraines, arthritis and other diseases, the scientist added.

Paracetamol | GxP News

Paracetamol is a drug approved as an antipyretic drug for people of all ages.The World Health Organization (WHO) recommends using paracetamol for children only at temperatures above 38.5 ° C (101.3 ° F). A meta-analysis shows that the drug is less effective than Ibuprofen.

Paracetamol, also known as acetaminophen is a drug with the chemical name N-acetyl-p-aminophenone, widely used as an analgesic (pain reliever) and antipyretic agent.

Paracetamol is an international non-proprietary name approved in Australia and the United Kingdom, and acetaminophen is an adapted name in the United States and Japan.

The drug is used as an analgesic to relieve headaches and other pains, and is the main ingredient in various medicines for the flu and colds. In combination with opioid analgesics, paracetamol can be used to relieve more severe pain, such as postoperative pain, and to relieve pain in cancer patients.

Paracetamol is safe at recommended doses, but even a small overdose of the drug can be fatal.The drug is an active metabolite of phenacetin and acetanilide (analgesics and antipyretics popular in the past). Unlike phenacetin, acetanilide, and their combinations, paracetamol is not considered a carcinogen when taken in therapeutic doses.

Source: LifeBio.wiki

History of the discovery of paracetamol

Paracetamol was synthesized in 1877 at Johns Hopkins University (the work of the Harmon Northrop Morse scientist) in the reduction of p -nitrophenol with tin in glacial acetic acid.But it wasn’t until 1887 that clinical pharmacologist Joseph von Mehring tested paracetamol on patients.

In 1893, von Mehring published an article reporting the results of the clinical use of paracetamol and phenacetin, another aniline derivative. Von Mehring argued that, unlike phenacetin, paracetamol has some ability to induce methemoglobinemia. Paracetamol was then quickly rejected in favor of phenacetin.

Sales of phenacetin began Bayer as the leading pharmaceutical company at the time.Introduced into medicine by Heinrich Dreser in 1899, phenacetin has been popular for many decades.

For half a century, the results of Mehring’s work were not in doubt, until two teams of researchers from the United States analyzed the metabolism of acetanilide and paracetamol. In 1947, David Lester and Leon Greenberg found compelling evidence that paracetamol is one of the major acetanilide metabolites in human blood, and in subsequent studies, they reported that large doses of paracetamol given to white rats did not cause methemoglobinemia.

In three articles published in September 1948 in the Journal of Pharmacology and Experimental Therapeutics, Bernard Brodie, Julius Axelrod and Frederick Flynn, using more precise methods, confirmed that paracetamol is the main metabolite of acetanilide in the blood. human and found that it has the same effective analgesic effect as its predecessor.

In 1949, it was found that phenacetin is also metabolized to paracetamol.This led to the “rediscovery” of paracetamol. It has been suggested that contamination of paracetamol with 4-aminophenol (the substance from which it was synthesized by von Mehring) may have led to false conclusions.

Paracetamol was first marketed in the United States in 1953 by Sterling-Winthrop Co., which promoted it as safer for children and people with ulcers than aspirin. In 1955, in the USA, McNeil Laboratories began selling paracetamol under one of the most famous US trademarks, Tylenol, as an analgesic and antipyretic drug for children (Tylenol Children’s Elixir).

Paracetamol went on sale in the UK in 1956 when it was manufactured by Sterling Drug Inc. . by Frederick Stearns & Co under the Panadol brand.

Paracetamol began to be used relatively widely after the withdrawal of amidopyrine and phenacetin from circulation. Many paracetamol-containing combined dosage forms have appeared, including in combinations with acetylsalicylic acid, analgin, codeine, caffeine and other drugs.

Paracetamol is found in over 500 prescription and over-the-counter drugs in the United States.

Source: Wikipedia The Free Encyclopedia

Return to the main page of the Glossary

Why it is not necessary to interfere with drugs – Newspaper Kommersant № 154 (1557) from 22.08.1998

Newspaper “Kommersant” No. 154 of 08/22/1998 , p. 9

& nbsp Why drugs should not be interfered

What the Ministry of Health does not warn about
Rules for mixing medicinal cocktails
“Something has a headache – I’ll drink something from the pressure.Yes, and you have to take something from the stomach: probably ate something. Besides, I’m tired, I don’t want anything: I have to drink vitamins ”- this is how many argue, scooping out a pile of colorful medicines in beautiful packages from the nightstand and sending them orally one after another. how not to heal yourself to death.

Those who have read Stanislav Lem’s novel “Runny nose” may remember: there the protagonist is investigating mysterious deaths, a common feature of which was the susceptibility of all unfortunates to allergic rhinitis.Gradually it turns out that the long chain leading to death was a combination of an allergy medicine – plimazin – with other drugs (for example, anti-hair loss remedies), food (for example, fried almonds) and various active substances (for Lem, hydrogen sulfide baths) … This is, of course, detective fiction. But the author, a physician by training, well understood the problem of drug interactions both with other drugs and with other things that could be put into the mouth.

If you take medications with medications, then no medications will help anymore
The use of contraceptive pills together with antibiotics (tetracycline, chloramphenicol, ampicillin, neomycin and others) leads to a decrease in the contraceptive effect of the drug. The hormones that make up the tablets form compounds that are not absorbed in the small intestine. An enzyme of the intestinal microflora can break down these compounds, as a result of which the drug is returned to the body and the contraceptive effect is maintained.When the intestinal microflora is suppressed by antibiotics, splitting does not occur, the level of hormones in the blood can decrease so much that the contraceptive effect disappears – pregnancy occurs.
With long-term treatment with anticonvulsants from the group of barbituric acid derivatives (phenobarbital and others), cases of pronounced impairment of phosphorus-calcium metabolism were observed. Children developed rickets, and the elderly had a fracture of the femur. And more about barbituric acid: its derivatives can accelerate the conversion of vitamin D, as a result of which its content in the body decreases.
Local anesthetics (for example, novocaine) should not be combined with sulfa drugs (phthalazole and others), as their antimicrobial effect decreases. The mechanism of action of sulfonamides is based on their competitive antagonism with para-aminobenzoic acid (PABA), which is necessary for microorganisms as a “growth factor”. The antimicrobial effect is realized only with a significant excess of the concentration of sulfonamides over PABA in the environment surrounding the microbes. Since the destruction of novocaine in the body forms PABA, its concentration in the tissues increases and sulfonamides lose their “competitiveness”.

You can take a bite of medicine. But you need to know – what
An example of how food components can affect the effect of drugs is the simultaneous use of psychotropic drugs (for example, nialamide), which suppress the enzyme monoamine oxidase (MAO), and cheese. Cheese, as well as some other products (chicken liver, pickled herring), beer, riesling, sherry, martini contain a significant amount of tyramine, which is broken down by MAO. When the action of MAO is suppressed, toxic tyramine enters the bloodstream almost unhindered and causes an increase in pressure with headache, cardiac disorders, and cerebral hemorrhages.Cases of intracranial bleeding are described, a significant part of which ended in the death of patients.
The simultaneous intake of caffeine or caffeine-containing drugs with milk leads to the binding of milk proteins to about 30% of caffeine, and the release of the drug from such a complex is rather slow. Therefore, it is not recommended to drink caffeine preparations with milk.
When acetylsalicylic acid (aspirin) is taken with protein, fat-containing carbohydrate food, the absorption of the drug is reduced by about 2 times, which leads to a decrease in its effective therapeutic concentration in the blood.
Foods rich in iron salts (for example, apples), eaten together with drugs of the tetracycline series, inhibits the absorption of these antibiotics, which leads to a decrease in their concentration in the blood by 50% or more. It follows from this that during the period of taking tetracyclines, it is necessary to refrain from the simultaneous intake of food rich in iron salts.
Furadonin, introduced together with fatty foods, lingers longer in the stomach, where it dissolves and breaks down, which ultimately leads to a decrease in its concentration in the intestine, and this – to a decrease in its antimicrobial effect.
Under the influence of food rich in folic acid (for example, lettuce), the conversion is activated and the therapeutic concentration of sulfa drugs decreases. The same effect is observed for the Parkinson’s disease drug, levodopa, after consuming beans and nuts containing vitamin B6.
In the treatment of chronic heart failure and cirrhosis of the liver with diuretics in combination with cardiac glycoside preparations, the level of potassium in the body decreases in patients.This is dangerous: the ratio of potassium and sodium in the body should not deviate too much from a certain norm. Therefore, if you really need this type of treatment, it is recommended to eat foods rich in potassium: various dried fruits (figs, persimmons, dates, raisins, prunes, dried apricots), as well as bananas and baked potatoes.
When taking some medications, tea, coffee, cocoa and cola are not harmless. The caffeine in these drinks has a stronger effect on the body of women taking contraceptives, as a result of slowing its destruction in the liver and increasing its concentration in the blood.The appearance of nervousness, irritability, headache, rapid breathing, tremors, twitching, insomnia is possible.

To be treated with cognac – why not. But not together with aspirin
Alcohol enhances the damaging effect of acetylsalicylic acid (aspirin) on the gastric mucosa.
The simultaneous intake of alcohol and the anticonvulsant drug chloral hydrate is accompanied by a distinct suppression of the function of the central nervous system (CNS).In persons receiving chloral hydrate, alcohol can cause a vasodilatory reaction, palpitations, headaches and a decrease in blood pressure. Ethyl alcohol also enhances the inhibitory effect on the central nervous system of diphenhydramine. During treatment with clonidine, the use of alcoholic beverages is prohibited due to a decrease in pressure and the development of pronounced depression of the central nervous system, up to loss of consciousness. Taking barbiturates (barbital and others) together with alcohol can increase the toxicity of this group of hypnotics by more than 50%.
In patients who abuse alcohol, the activity of liver enzymes is increased. This is the reason for the acceleration of the conversion of paracetamol and its containing preparations (calpol, panadol, Tylenol, efferalgan), as a result of which substances are formed that have a toxic effect on the liver.
In smokers, the rate of conversion of the anesthetic pentazocine was found to be increased. That is, pentazocine from them requires a higher dose to show a sufficient analgesic effect than non-smokers.In smokers, the strength of the analgesic effect of propoxyphene, the calming effect of chlorpromazine, and the inhibitory effect on the central nervous system of diazepam decrease. When smoking, the diuretic effect of furosemide decreases, which occurs due to an increase in the release of antidiuretic hormone under the influence of nicotine contained in tobacco smoke.

Does tylenol contain caffeine: FAQs About TYLENOL® Products, Safety & Dosing

FAQs About TYLENOL® Products, Safety & Dosing

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Paracetamol can not be washed down with coffee – medical news

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History of the discovery of paracetamol

Why it is not necessary to interfere with drugs – Newspaper Kommersant № 154 (1557) from 22.08.1998

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