Aspirin/paracetamol/caffeine

"Cafenol" redirects here. Not to be confused with Caffenol.

"Excedrin" redirects here. For the brand, see Excedrin (brand).

Aspirin/paracetamol/caffeine is a combination drug for the treatment of pain, especially tension headache and migraine.^[1] It contains aspirin, a non-steroidal anti-inflammatory drug; paracetamol (acetaminophen), an analgesic; and caffeine, a stimulant.^[1]

Aspirin/paracetamol/caffeine

Combination of
Aspirin	NSAID
Paracetamol	Analgesic
Caffeine	Stimulant
Clinical data
Trade names	Excedrin, Vanquish, others
AHFS/Drugs.com	Multum Consumer Information
Routes of administration	By mouth
ATC code	N02BA51 (WHO)
Legal status
Legal status	US: OTC
Identifiers
CAS Number	53908-21-7
PubChem CID	9871508
ChemSpider	8047198
Chemical and physical data
3D model (JSmol)	Interactive image
SMILES O=C(Nc1ccc(O)cc1)C.O=C(O)c1ccccc1OC(=O)C.O=C2N(c1ncn(c1C(=O)N2C)C)C
InChI InChI=1S/C9H8O4.C8H10N4O2.C8H9NO2/c1-6(10)13-8-5-3-2-4-7(8)9(11)12;1-10-4-9-6-5(10)7(13)12(3)8(14)11(6)2;1-6(10)9-7-2-4-8(11)5-3-7/h2-5H,1H3,(H,11,12);4H,1-3H3;2-5,11H,1H3,(H,9,10) Key:BKMBGNWZSQNIKU-UHFFFAOYSA-N

Adverse effects

See also: Aspirin § Adverse effects, Paracetamol § Adverse effects, and Caffeine § Adverse effects

The recommended dosing has a low risk profile when taken occasionally in a well hydrated state. As with all medications containing paracetamol (acetaminophen), concomitant use with alcohol carries a significant risk of hepatotoxicity.^[2] The combination of paracetamol with aspirin also creates the risk of renal papillary necrosis if large doses are taken chronically. This is because paracetamol yields a toxic metabolite that can accumulate in the kidney while aspirin works to deplete the glutathione stores necessary to oxidize it. Additionally, chronic aspirin usage is associated with increased risk of gastrointestinal bleeding.^[3]

Chemical detection

The combination of these three compounds can be detected in pharmaceutical formulations, urine and blood serum in trace quantities using electrochemical methods.^[4]

Society and culture

Brand names

The combination was first introduced as the name Trigesic, as the formula of 125 mg paracetamol, 230 mg aspirin, and 30 mg caffeine, in July 1950 by Squibb, which is now Bristol Myers Squibb, but was recalled in the following year due to several reports that the drug might cause blood dyscrasia.^[5] In 1964 it was marketed under the trade name Vanquish by Sterling Drug,^{[citation needed]} which after a series of mergers and acquisitions became a unit of Bayer AG.^[6]

In the UK it is sold as Anadin Extra. In Germany, it is sold as dolomo, Dolopyrin AL, HA-Tabletten, Melabon K, Neuralgin, ratiopyrin, Thomapyrin Classic, Thomapyrin Intensiv,^[7] in Austria as Thomapyrin, and InfluASS, in Israel as Acamol Focus, Paramol Target and Exidol, in Romania as Antinevralgic P ^[8] and Antinevralgic Forte,^[9] and in Russia, Belarus and Eastern Europe as Citramon.^[10]

References

1. "Acetaminophen, aspirin, and caffeine Uses, Side Effects & Warnings". Drugs.com. 19 July 2022. Retrieved 12 July 2023.
2. Haberfeld H, ed. (2019). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. Thomapyrin-Tabletten.
3. Henrich WL, Agodoa LE, Barrett B, Bennett WM, Blantz RC, Buckalew VM, et al. (January 1996). "Analgesics and the kidney: summary and recommendations to the Scientific Advisory Board of the National Kidney Foundation from an Ad Hoc Committee of the National Kidney Foundation". American Journal of Kidney Diseases. 27 (1): 162–5. doi:10.1016/S0272-6386(96)90046-3. PMID 8546133.
4. Sanghavi BJ, Srivastava AK (2010). "Simultaneous voltammetric determination of acetaminophen, aspirin and caffeine using an in situ surfactant-modified multiwalled carbon nanotube paste electrode". Electrochimica Acta. 55 (28): 8638–8648. doi:10.1016/j.electacta.2010.07.093.
5. Spooner, J. B., & Harvey, J. G. (1976). The history and usage of paracetamol. Journal of International Medical Research, 4(4_suppl), 1-6.
6. Olmos D (September 14, 1994). "German Firm to Reclaim Bayer Aspirin Name : Drugs: It will acquire Sterling Winthrop's over-the-counter business and recover the rights it lost after WWI". Los Angeles Times. Retrieved May 3, 2013.
7. "Rote Liste". Retrieved 2020-01-24.
8. "Antinevralgic P comprimate" (PDF). Agenția Natională a Medicamentului și a Dispozitivelor Medicale din România.
9. Blanaru C (26 June 2013). "The launch of Antinevralgic Forte – reinventing a traditional brand". Branding Business. AdHugger.
10. "International Drug Names". Drugs.com. Retrieved 2020-01-24.