Acetaminophen / caffeine / dihydrocodeine

Class
Narcotic analgesics
Subclass
Semisynthetic opioids
Substance name
Acetaminophen / caffeine / dihydrocodeine, paracetamol / caffeine / dihydrocodeine
Brand names
Trezix®
Contains
Acetaminophen
Caffeine
Dihydrocodeine
Common formulations
Capsule
Dosage and administration
Adults patients
Symptomatic relief of pain • Severe, requiring opioids
•
Maintenance: 641/60/32 mg PO q4h PRN
•
Maximum: 3,205/300/160 mg per day
Titrate individually to a dose that provides adequate analgesia and minimizes adverse reactions.
Indications for use
Labeled indications
Adults
•
Symptomatic relief of pain (severe, requiring opioids)
Specific populations
Renal impairment
eGFR 20-50 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR 10-20 mL/min/1.73 m²
•
Reduce dose. Titrate to response.
eGFR < 10 mL/min/1.73 m²
•
Reduce dose. Titrate to response.
Renal replacement therapy
Continuous renal replacement
•
Reduce dose. Dose as in eGFR 10-20 mL/min/1.73 m². Titrate to response.
Intermittent hemodialysis
•
Reduce dose. Dose as in eGFR < 10 mL/min/1.73 m². Titrate to response.
Peritoneal dialysis
•
Reduce dose. Dose as in eGFR < 10 mL/min/1.73 m². Titrate to response.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: A, A
•
Insufficient evidence.
Breastfeeding
Consider alternative agents that may be safer.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
May potentially cause adverse effects in breastfed infants.
No overt adverse effects on lactation reported.
Adverse reactions
Rare < 0.1%
•
Acute generalized exanthematous pustulosis, allergic reactions, anaphylaxis, erythematous macules, renal failure, hallucinations, sleeping disorder, Stevens-Johnson syndrome, toxic epidermal necrolysis, tubulointerstitial nephritis
Unknown frequency
•
Acute liver failure, adrenal insufficiency, agranulocytosis, angioedema, death, ↓ WBC count, ↓ blood neutrophil count, ↓ platelet count, dependence and withdrawal reactions, hypotension, miosis, orthostatic hypotension, pancytopenia, premature atrial contractions, premature ventricular contractions, abdominal pain, confusion, constipation, diarrhea, dizziness, dry mouth, fatigue, generalized pruritus, headache, indigestion, insomnia, lightheadedness, loss of appetite, nausea, palpitations, scintillating scotoma, somnolence, sweating, tinnitus, urinary retention, vomiting, respiratory depression, sedation, thrombotic thrombocytopenic purpura, tachycardia, tremor, urticaria
Interactions
Drug(s)
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