NARCOTICANALGESICS AND ASPIRIN (Systemic)
Some commonly used brand names are:
In the U.S.?
- Damason-P 5
- Darvon Compound-65 9
- Empirin with Codeine No.3 2
- Empirin with Codeine No.4 2
- Endodan 6
- Lortab ASA 5
- Panasal 5/500 5
- PC-Cap 9
- Percodan 6
- Percodan-Demi 6
- Propoxyphene Compound-65 9
- Roxiprin 6
- Synalgos-DC 1
- Talwin Compound 7
In Canada?
- Anacin with Codeine 3
- C2 Buffered with Codeine 4
- C2 with Codeine 3
- Darvon-N Compound 9
- Darvon-N with A.S.A. 8
- Endodan 6
- Novo-AC and C 3
- Oxycodan 6
- Percodan 6
- Percodan-Demi 6
- 692 9
- 222 3
- 282 3
- 292 3
Other commonly used names are:
- A.C.&C
- AC and C
- Co-codaprin
- dihydrocodeine compound
- drocode and aspirin
- propoxyphene hydrochloride compound
Note: | For quick reference, the following narcotic analgesics and aspirincombinations are numbered to match the corresponding brand names. |
# In Canada, Aspirin is a brand name. Acetylsalicylic acid is the generic name inCanada. ASA, a synonym for acetylsalicylic acid, is the term that commonlyappears on Canadian product labels.
Category
Description
Combination medicines containing narcotic analgesics (nar-KOT-ik an-al-JEE-zicks)and aspirin (AS-pir-in)are used to relieve pain. A narcotic analgesic and aspirin used together mayprovide better pain relief than either medicine used alone. In some cases,relief of pain may come at lower doses of each medicine.
Narcotic analgesics act in the central nervous system (CNS) to relievepain. Many of their side effects are also caused by actions in the CNS. Whennarcotics are used for a long time, your body may get used to them so thatlarger amounts are needed to relieve pain. This is called tolerance to themedicine. Also, when narcotics are used for a long time or in large doses,they may become habit-forming (causing mental or physical dependence). Physicaldependence may lead to withdrawal symptoms when you stop taking the medicine.
Aspirin does not become habit-forming when taken for a long time or inlarge doses, but it may cause other unwanted effects if too much is taken.
In the U.S., these medicines are available only with your medical doctor'sor dentist's prescription. In Canada, some strengths of aspirin, codeine,and caffeine combination are available without a prescription.
These medicines are available in the following dosage forms:
Oral- Aspirin, Caffeine, and Dihydrocodeine
- Aspirin and Codeine
- Aspirin, Codeine, and Caffeine
- Aspirin, Codeine, and Caffeine, Buffered
- Hydrocodone and Aspirin
- Oxycodone and Aspirin
- Tablets (U.S. and Canada)
- Pentazocine and Aspirin
- Propoxyphene and Aspirin
- Propoxyphene, Aspirin, and Caffeine
- Capsules (U.S. and Canada)
- Tablets (Canada)
Before Using This Medicine
In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your doctor will make. For narcotic analgesicand aspirin combinations, the following should be considered:
Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to a narcotic analgesic, aspirin or other salicylates, includingmethyl salicylate (oil of wintergreen), or any of the following medicines:
- Diclofenac (e.g., Voltaren)
- Diflunisal (e.g., Dolobid)
- Etodolac (e.g., Lodine)
- Fenoprofen (e.g., Nalfon)
- Floctafenine (e.g., Idarac)
- Flurbiprofen, oral (e.g., Ansaid)
- Ibuprofen (e.g., Motrin)
- Indomethacin (e.g., Indocin)
- Ketoprofen (e.g., Orudis)
- Ketorolac (e.g., Toradol)
- Meclofenamate (e.g., Meclomen)
- Mefenamic acid (e.g., Ponstel)
- Nabumetone (e.g., Relafen)
- Naproxen (e.g., Naprosyn)
- Oxaprozin (e.g., Daypro)
- Oxyphenbutazone (e.g., Tandearil)
- Phenylbutazone (e.g., Butazolidin)
- Piroxicam (e.g., Feldene)
- Sulindac (e.g., Clinoril)
- Suprofen (e.g., Suprol)
- Tenoxicam (e.g., Mobiflex)
- Tiaprofenic acid (e.g., Surgam)
- Tolmetin (e.g., Tolectin)
- Zomepirac (e.g., Zomax)
Also tell your health care professional if you are allergic to any othersubstances, such as foods, preservatives, or dyes.
Pregnancy?
- For aspirin: Studies in humans have notshown that aspirin causes birth defects. However, studies in animals haveshown that aspirin causes birth defects.
Some reports have suggested that too much use of aspirin late in pregnancymay cause a decrease in the newborn's weight and possible death of the fetusor newborn baby. However, the mothers in these reports had been taking muchlarger amounts of aspirin than are usually recommended. Studies of motherstaking aspirin in the doses that are usually recommended did not show theseeffects. However, regular use of aspirin late in pregnancy may cause unwantedeffects on the heart or blood flow in the fetus or in the newborn baby. Also,use of aspirin during the last 2 weeks of pregnancy may cause bleeding problemsin the fetus before or during delivery or in the newborn baby.
Too much use of aspirin during the last 3 months of pregnancy may increasethe length of pregnancy, prolong labor, cause other problems during delivery,or cause severe bleeding in the mother before, during, or after delivery. Do not take aspirin during the last 3 months of pregnancyunless it has been ordered by your doctor. - For narcotic analgesics: Although studieson birth defects with narcotic analgesics have not been done in pregnant women,they have not been reported to cause birth defects. However, hydrocodone causedbirth defects in animal studies when given in very large doses. Codeine didnot cause birth defects in animals, but it caused slower development of bonesand other toxic or harmful effects on the fetus. Pentazocine and propoxyphenedid not cause birth defects in animals. There is no information about whetherdihydrocodeine or oxycodone causes birth defects in animals.
Too much use of a narcotic during pregnancy may cause the fetus to becomedependent on the medicine. This may lead to withdrawal side effects in thenewborn baby. Also, some of these medicines may cause breathing problems inthe newborn baby if taken just before or during delivery. - For caffeine: Studies in humans have notshown that caffeine (contained in some of these combination medicines) causesbirth defects. However, studies in animals have shown that caffeine causesbirth defects when given in very large doses (amounts equal to those presentin 12 to 24 cups of coffee a day).
Breast-feeding?These combination medicines have not been reportedto cause problems in nursing babies. However, aspirin, caffeine, codeine,and propoxyphene pass into the breast milk. It is not known whether dihydrocodeine,hydrocodone, oxycodone, or pentazocine passes into the breast milk.
Children?Do not give a medicine containingaspirin to a child or a teenager with a fever or other symptoms of a virusinfection, especially flu or chickenpox, without first discussing its usewith your child's doctor. This is very important because aspirin maycause a serious illness called Reye's syndrome in children with fever causedby a virus infection, especially flu or chickenpox. Children who do not havea virus infection may also be more sensitive to the effects of aspirin, especiallyif they have a fever or have lost large amounts of body fluid because of vomiting,diarrhea, or sweating. This may increase the chance of side effects duringtreatment.
The narcotic analgesic in this combination medicine can cause breathingproblems, especially in children younger than 2 years of age. These childrenare usually more sensitive than adults to the effects of narcotic analgesics.Also, unusual excitement or restlessness may be more likely to occur in childrenreceiving these medicines.
Older adults?Elderly people are especially sensitive to the effectsof aspirin and of narcotic analgesics. This may increase the chance of sideeffects, especially breathing problems caused by narcotic analgesics, duringtreatment.
Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are takinga narcotic analgesic and aspirin combination, it is especially important thatyour health care professional know if you are taking any of the following:
- Anticoagulants (blood thinners) or
- Carbenicillin by injection (e.g., Geopen) or
- Cefamandole (e.g., Mandol) or
- Cefoperazone (e.g., Cefobid) or
- Cefotetan (e.g., Cefotan) or
- Dipyridamole (e.g., Persantine) or
- Divalproex (e.g., Depakote) or
- Heparin or
- Medicine for inflammation or pain, except narcotics, or
- Pentoxifylline (e.g., Trental) or
- Plicamycin (e.g., Mithracin) or
- Ticarcillin (e.g., Ticar) or
- Valproic acid (e.g., Depakene)?Taking these medicines togetherwith aspirin may increase the chance of bleeding
- Antidiabetics, oral (diabetes medicine you take by mouth)?Aspirinmay increase the effects of the antidiabetic medicine; a change in the doseof the antidiabetic medicine may be needed if aspirin is taken regularly
- Carbamazepine (e.g., Tegretol)?Propoxyphene can increase theblood levels of carbamazepine, which increases the chance of serious sideeffects
- Central nervous system (CNS) depressants or
- Diarrhea medicine or
- Methotrexate (e.g., Mexate) or
- Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine[e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane],doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g.,Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil])or
- Vancomycin (e.g., Vancocin)?The chance of side effects maybe increased
- Naltrexone (e.g., Trexan)?Naltrexone keeps narcotic analgesicsfrom working to relieve pain; people taking naltrexone should use pain relieversthat do not contain a narcotic
- Probenecid (e.g., Benemid) or
- Sulfinpyrazone (e.g., Anturane)?Aspirin can keep these medicinesfrom working as well for treating gout; also, use of sulfinpyrazone and aspirintogether may increase the chance of bleeding
- Urinary alkalizers (medicine that makes the urine less acid, suchas acetazolamide [e.g., Diamox], calcium- and/or magnesium-containing antacids,dichlorphenamide [e.g., Daranide], methazolamide [e.g., Neptazane], potassiumor sodium citrate and/or citric acid, sodium bicarbonate [baking soda])?Thesemedicines may make aspirin less effective by causing it to be removed fromthe body more quickly
- Zidovudine (e.g., AZT, Retrovir)?Higher blood levels of zidovudineand an increased chance of serious side effects may occur
Other medical problems?The presence of other medicalproblems may affect the use of narcotic analgesic and aspirin combinations.Make sure you tell your doctor if you have any other medical problems, especially:
- Alcohol and/or other drug abuse, or history of, or
- Asthma, allergies, and nasal polyps (history of) or
- Brain disease or head injury or
- Colitis or
- Convulsions (seizures), history of, or
- Emotional problems or mental illness or
- Emphysema or other chronic lung disease or
- Kidney disease or
- Liver disease or
- Underactive thyroid?The chance of serious side effects maybe increased
- Anemia or
- Overactive thyroid or
- Stomach ulcer or other stomach problems?Aspirin may make theseconditions worse
- Enlarged prostate or problems with urination or
- Gallbladder disease or gallstones?Narcotic analgesics haveside effects that may be dangerous if these medical problems are present
- Gout?Aspirin can make this condition worse and can also lessenthe effects of some medicines used to treat gout
- Heart disease?Large amounts of aspirin and caffeine (presentin some of these combination medicines) can make some kinds of heart diseaseworse
- Hemophilia or other bleeding problems or
- Vitamin K deficiency?Aspirin increases the chance of seriousbleeding
Proper Use of This Medicine
Take this medicine with food or a full glass (8 ounces) of water tolessen stomach irritation.
Do not take this medicine if it has a strong vinegar-likeodor. This odor means the aspirin in it is breaking down. If you haveany questions about this, check with your health care professional.
Take this medicine only as directed by your medicaldoctor or dentist. Do not take more of it, do not take it more often,and do not take it for a longer time than your medical doctor or dentist ordered.This is especially important for children and elderly patients, who are usuallymore sensitive to the effects of these medicines. If too much of a narcoticanalgesic is taken, it may become habit-forming (causing mental or physicaldependence) or lead to medical problems because of an overdose. Also, takingtoo much aspirin may cause stomach problems or lead to medical problems becauseof an overdose.
If you think that this medicine is not working as well after you have beentaking it for a few weeks, do not increase the dose.Instead, check with your medical doctor or dentist.
Dosing?The dose of these medicines will be differentfor different patients. Follow your doctor's orders orthe directions on the label. The following information includes onlythe average doses of these medicines. If your dose isdifferent, do not change it unless your doctor tells you to do so.
The number of capsules or tablets that you take depends on the strengthof the medicine and on the amount of pain you are having.
For aspirin, caffeine, and dihydrocodeine- For oral dosage form (capsules):
- For pain:
- Adults?2 capsules every four hours as needed.
- Children?Dose must be determined by your doctor.
For aspirin and codeine- For oral dosage form (tablets):
- For pain:
- Adults?1 or 2 tablets every four hours as needed.
- Children?Dose must be determined by your doctor.
For aspirin, codeine, and caffeine- For oral dosage form (tablets):
- For pain:
- Adults?1 or 2 tablets every four hours as needed.
- Children?Dose must be determined by your doctor.
For buffered aspirin, codeine, and caffeine- For oral dosage form (tablets):
- For pain:
- Adults?1 or 2 tablets every four hours as needed.
- Children?Dose must be determined by your doctor.
For hydrocodone and aspirin- For oral dosage form (tablets):
- For pain:
- Adults?1 or 2 tablets every four to six hours as needed.
- Children?Dose must be determined by your doctor.
For oxycodone and aspirin- For oral dosage form (tablets):
- For pain:
- Adults?1 or 2 half-strength tablets, or 1 full-strength tablet,every four to six hours as needed.
- Children up to 6 years of age?Use is not recommended.
- Children 6 to 12 years of age?One-quarter of a half-strengthtablet every six hours as needed.
- Children 12 years of age and older?One-half of a half-strengthtablet every six hours as needed.
For pentazocine and aspirin- For oral dosage form (tablets):
- For pain:
- Adults?2 tablets three or four times a day as needed.
- Children?Dose must be determined by your doctor.
For propoxyphene and aspirin- For oral dosage form (capsules):
- For pain:
- Adults?1 capsule every four hours as needed.
- Children?Dose must be determined by your doctor.
For propoxyphene, aspirin, and caffeine- For oral dosage form (capsules or tablets):
- For pain:
- Adults?1 capsule or tablet every four hours as needed.
- Children?Dose must be determined by your doctor.
Missed dose?If your medical doctor or dentist has ordered youto take this medicine according to a regular schedule and you miss a dose,take it as soon as you remember. However, if it is almost time for your nextdose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Storage?To store this medicine:
- Keep out of the reach of children. Overdose is very dangerous inyoung children.
- Store away from heat and direct light.
- Do not store this medicine in the bathroom, near the kitchen sink,or in other damp places. Heat or moisture may cause the medicine to breakdown.
- Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
If youwill be taking this medicine for a long time (for example, for several monthsat a time), your doctor should check your progress at regular visits.
Check the labels of all nonprescription (over-the-counter[OTC]) and prescription medicines you now take. If any contain a narcotic,aspirin, or other salicylates, check with your health care professional.Taking them together with this medicine may cause an overdose.
This medicine will add to the effects of alcohol and other CNS depressants(medicines that slow down the nervous system, possibly causing drowsiness).Some examples of CNS depressants are antihistamines or medicine for hay fever,other allergies, or colds; sedatives, tranquilizers, or sleeping medicine;other prescription pain medicine or narcotics; barbiturates; medicine forseizures; muscle relaxants; or anesthetics, including some dental anesthetics.Also, stomach problems may be more likely to occur if you drink alcoholicbeverages while you are taking aspirin. Do not drinkalcoholic beverages, and check with your medical doctor or dentist beforetaking any of the medicines listed above, while you are using this medicine.
Taking acetaminophen or certain other medicines together with the aspirinin this combination medicine may increase the chance of unwanted effects.The risk will depend on how much of each medicine you take every day, andon how long you take the medicines together. If your medical doctor or dentistdirects you to take these medicines together on a regular basis, follow hisor her directions carefully. However, do not take acetaminophen or any ofthe following medicines together with this combination medicine for more thana few days, unless your medical doctor or dentist has directed you to do soand is following your progress:
- Diclofenac (e.g., Voltaren)
- Diflunisal (e.g., Dolobid)
- Etodolac (e.g., Lodine)
- Fenoprofen (e.g., Nalfon)
- Floctafenine (e.g., Idarac)
- Flurbiprofen, oral (e.g., Ansaid)
- Ibuprofen (e.g., Motrin)
- Indomethacin (e.g., Indocin)
- Ketoprofen (e.g., Orudis)
- Ketorolac (e.g., Toradol)
- Meclofenamate (e.g., Meclomen)
- Mefenamic acid (e.g., Ponstel)
- Nabumetone (e.g., Relafen)
- Naproxen (e.g., Naprosyn)
- Oxaprozin (e.g., Daypro)
- Phenylbutazone (e.g., Butazolidin)
- Piroxicam (e.g., Feldene)
- Sulindac (e.g., Clinoril)
- Tenoxicam (e.g., Mobiflex)
- Tiaprofenic acid (e.g., Surgam)
- Tolmetin (e.g., Tolectin)
This medicine may cause some people to become drowsy, dizzy, or lightheaded,or to feel a false sense of well-being. Make sure youknow how you react to this medicine before you drive, use machines, or doanything else that could be dangerous if you are dizzy or are not alert andclearheaded.
Dizziness, lightheadedness, or fainting may occur, especially when youget up suddenly from a lying or sitting position. Getting up slowly may helplessen this problem.
Nausea or vomiting may occur, especially after the first couple of doses.This effect may go away if you lie down for a while. However, if nausea orvomiting continues, check with your doctor. Lying down for a while may alsohelp some other side effects, such as dizziness or lightheadedness.
Before having any kind of surgery (including dental surgery) or emergencytreatment, tell the medical doctor or dentist in charge that you are takingthis medicine.
Do not take this medicine for 5 days before any surgery, including dentalsurgery, unless otherwise directed by your medical doctor or dentist. Takingaspirin during this time may cause bleeding problems.
For patients taking the buffered aspirin, codeine,and caffeine combination (C2 Buffered with Codeine):
- This product contains antacids that can keep many other medicines,especially some medicines used to treat infections, from working properly.This problem can be prevented by not taking the 2 medicines too close together.Ask your pharmacist how long you should wait between taking any other medicineand the buffered aspirin, codeine, and caffeine combination.
For diabetic patients:
- False urine sugar test results may occur if you are regularly taking8 or more 325-mg (5-grain) or 5 or more 500-mg doses of aspirin a day. Smalleramounts or occasional use of aspirin usually will not affect urine sugar tests.If you have any questions about this, check with your health care professional,especially if your diabetes is not well controlled.
Narcotic analgesics may cause dryness of the mouth. For temporary relief,use sugarless candy or gum, melt bits of ice in your mouth, or use a salivasubstitute. However, if dry mouth continues for more than 2 weeks, check withyour dentist. Continuing dryness of the mouth may increase the chance of dentaldisease, including tooth decay, gum disease, and fungus infections.
If you have been taking this medicine regularly for several weeks or more, do not suddenly stop using it without first checkingwith your doctor. Depending on which of these medicines you have beentaking, and the amount you have been taking every day, your doctor may wantyou to reduce gradually the amount you are taking before stopping completely,to lessen the chance of withdrawal side effects.
If you think you or someone else may have taken anoverdose of this medicine, get emergency help at once. Taking an overdoseof this medicine or taking alcohol or CNS depressants with this medicine maylead to unconsciousness or death. Signs of overdose of this medicine includeconvulsions (seizures); hearing loss; confusion; ringing or buzzing in theears; severe excitement, nervousness, or restlessness; severe dizziness, severedrowsiness, shortness of breath or troubled breathing, and severe weakness.
Side Effects of This Medicine
Along with its needed effects, a medicinemay cause some unwanted effects. Although not all of these side effects mayoccur, if they do occur they may need medical attention.
Get emergency help immediatelyif any of the following symptoms of overdose occur:
Any loss of hearing; bloody urine; cold, clammy skin; confusion (severe); convulsions (seizures); diarrhea (severe or continuing); dizziness or lightheadedness(severe); drowsiness (severe); excitement, nervousness, or restlessness (severe); fever; hallucinations (seeing, hearing, or feelingthings that are not there); headache (severe or continuing); increased sweating; increasedthirst; low blood pressure; nausea or vomiting (severe or continuing); pinpointpupils of eyes; ringing or buzzing in the ears; shortness of breath or unusually slow or troubled breathing; slow heartbeat; stomach pain (severeor continuing); uncontrollable flapping movementsof the hands (especially in elderly patients); visionproblems; weakness (severe)
Also, check with your doctor as soon as possibleif any of the following side effects occur:
Less common or rare
Bloody or black, tarry stools; confusion; dark urine; fast, slow,or pounding heartbeat; increased sweating (more commonwith hydrocodone); irregular breathing; mental depression; pale stools; redness or flushing of face (more common with hydrocodone); skin rash, hives, or itching; stomachpain (severe); swelling of face; tightness in chest or wheezing; trembling or uncontrolledmuscle movements; unusual excitement (especiallyin children); unusual tiredness or weakness; vomiting of blood or material that looks like coffee grounds; yellow eyes or skin
Other sideeffects may occur that usually do not need medical attention. These side effectsmay go away during treatment as your body adjusts to the medicine. However,check with your doctor if any of the following side effects continue or arebothersome:
Less common or rare
Blurred or double vision or other changes in vision; constipation (more common with long-term use and with codeine); difficult, painful, or decreased urination; dryness of mouth; false sense of well-being; frequent urge to urinate; general feeling of discomfort or illness; headache; loss of appetite; nervousnessor restlessness; nightmares or unusual dreams; trouble in sleeping; unusual tiredness; unusual weakness
Although not all of the side effects listed above have been reported forall of these medicines, they have been reported for at least one of them.However, since all of the narcotic analgesics are very similar, any of theabove side effects may occur with any of these medicines.
After you stop using thismedicine, your body may need time to adjust. The length of time this takesdepends on which of these medicines you were taking, the amount of medicineyou were using, and how long you used it. During this period of time checkwith your doctor if you notice any of the following side effects:
Body aches; diarrhea; fever, runny nose, or sneezing; gooseflesh; increased sweating; increased yawning; loss of appetite; nauseaor vomiting; nervousness, restlessness, or irritability; shivering or trembling; stomach cramps; trouble in sleeping; weakness
Other side effectsnot listed above may also occur in some patients. If you notice any othereffects, check with your medical doctor or dentist.
Revised: 07/05/1995
