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Generic Name:

acetaminophen-caffeine-dihydrocodeine, Oral capsule

All Brands

  • Panlor DC (Discontinued)
  • Trezix
A discontinued drug is a drug that has been taken off the market due to safety issues, shortage of raw materials, or low market demand.
SECTION 1 of 4

Highlights for acetaminophen-caffeine-dihydrocodeine

Oral capsule
1

Acetaminophen/caffeine/dihydrocodeine is an oral drug used to treat moderate to severe pain.

2

Combining this drug with alcohol can worsen the drowsiness and dizziness side effects of acetaminophen/caffeine/dihydrocodeine. It may also lead to breathing problems.

3

This medication shouldn’t be used for pain in children after they’ve had their tonsils or adenoids removed. It can increase the risk of death in children who receive this medication.

4

Your doctor will determine your dose. Never take more than 4,000 mg of acetaminophen per day. This increases your risk of liver problems.

5

This drug can cause drowsiness, dizziness, and mental and physical slowness. Avoid doing tasks that require mental alertness while taking this drug.

IMPORTANT INFORMATION

FDA Warning

This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects. 

Serious liver problems. Acetaminophen may cause liver failure, which may lead to a liver transplant and death. Make sure you don’t take more than the maximum daily limit of acetaminophen, 4,000 mg per day.

Death in children. Dihydrocodeine can cause breathing problems and death in children who receive the medication after certain surgeries, such as having their tonsils or adenoids removed. Some children have a certain enzyme in their bodies that causes them to break down codeine faster than usual.

What is acetaminophen/caffeine/dihydrocodeine bitartrate?

Acetaminophen/caffeine/dihydrocodeine is a prescription drug and a controlled substance. It’s available as an oral capsule. 

This is a combination of three drugs in a single form. It’s important to know about all the drugs in the combination because they each may have unique traits.

This drug may be used as part of a combination therapy. That means you may need to take it with other drugs.

Why it's used

This medication is used to treat moderate to severe pain.

How it works

Acetaminophen/caffeine/dihydrocodeine works in your brain to block your ability to feel pain.

More Details

How It Works

Acetaminophen/caffeine/dihydrocodeine works in your brain to block your ability to feel pain. All three drugs work together to decrease pain. Acetaminophen works by increasing the pain limit and stopping an enzyme involved in inflammation. Caffeine causes blood vessels to become smaller, which may provide faster relief. Dihydrocodeine works by binding to opiate receptors to lower the ability to feel pain.

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acetaminophen-caffeine-dihydrocodeine Side Effects

Oral capsule

Most Common Side Effects

  • The most common side effects that occur with dihydrocodeine include:

    • lightheadedness
    • dizziness
    • drowsiness
    • headache
    • fatigue
    • itching
    • nausea
    • constipation
  • The most common side effects that occur with caffeine include:

    • anxiety
    • excitement
    • headaches
    • insomnia
    • irritability

Serious Side Effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life threatening, or if you think you’re experiencing a medical emergency, call 9-1-1.

  •  liver problems. Symptoms may include:

    • dark urine
    • light-colored stool
    • feeling full or not being hungry
    • vomiting
    • yellow skin or eyes
  • severe allergic reaction. Symptoms may include:

    • trouble breathing
    • swelling of your throat or tongue
    • hives
    • rash
    • itching
  • breathing problems. Symptoms may include:

    • slowed breathing
    • difficulty speaking
    • slow to arouse
    • confusion
    • bluish discoloration of your skin
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

Acetaminophen/caffeine/dihydrocodeine may cause drowsiness.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 4

acetaminophen-caffeine-dihydrocodeine May Interact with Other Medications

Oral capsule

Acetaminophen/caffeine/dihydrocodeine can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Food Interactions

Foods that contain caffeine: Acetaminophen/caffeine/dihydrocodeine contains caffeine. Combining it with food or drinks that contain caffeine will increase the amount of caffeine in your body, which could increase its effects.

Alcohol Interaction

Don’t drink alcohol while taking acetaminophen/caffeine/dihydrocodeine. Having 3 or more alcoholic drinks a day may increase your risk of liver damage.

Consuming alcohol while taking this medication can also increase your risk of breathing problems. It can also make the drowsiness and dizziness seen with this medication worse.

Medications That Might Interact with This Drug

Drugs that cause drowsiness

Examples are: 

  • sedatives (alprazolam, clonazepam, lorazepam, trazodone)
  • hypnotics (zolpidem, eszopiclone, zaleplon)
  • anti-psychotics (chlorpromazine, fluphenazine, haloperidol, quetiapine, risperidone, clozapine, olanzapine)
  • general anesthetics (propofol, ketamine, nitrous oxide)
  • skeletal muscle relaxants (cyclobenzaprine, baclofen, metaxalone)
  • other opioids (hydrocodone/acetaminophen, oxycodone, morphine, tramadol)

Avoid taking acetaminophen/caffeine/dihydrocodeine with these medications. Combining them increases your risk for drowsiness, physical and mental slowing, and trouble breathing. When the drugs are used together, your doctor may reduce the dose of one or both drugs.

MAOI antidepressants

Avoid taking acetaminophen/caffeine/dihydrocodeine with monoamine oxidase inhibitors (MAOIs). MAOIs can increase your risk for anxiety, confusion, breathing problems and coma.

Examples of MAOIs are:

  • isocarboxazid (Marplan)
  • phenelzine (Nardil)
  • tranylcypromine (Parnate)
  • selegiline (Emsam, Eldepryl, Zelapar)

Certain pain medications

Examples are:

  • pentazocine
  • nalbuphine
  • butorphanol
  • buprenorphine

Avoid taking acetaminophen/caffeine/dihydrocodeine with these other medications. The combination can decrease how well the pain medication works, which will cause you to feel more pain. 

Anticonvulsants

Avoid taking acetaminophen/caffeine/dihydrocodeine with these medications. The combination can increase your risk of serious liver problems. Caffeine may also cause phenobarbital to leave your body faster, which makes phenobarbital less effective.

Examples are:

  • phenytoin
  • phenobarbital
  • carbamazepine

Tuberculosis drug
  • isoniazid

Avoid taking acetaminophen/caffeine/dihydrocodeine with this medication. The combination can increase your risk of serious liver problems. 

Respiratory drugs

Taking respiratory drugs with caffeine may increase your heart rate.

Examples are:

  • albuterol
  • levalbuterol
  • terbutaline
  • salmeterol (Serevent, Advair)
  • formoterol (Foradil, Symbicort)

Alcohol abuse drug
  • disulfiram 

This medication may increase the time it takes caffeine to leave your body. This may increase the effects of acetaminophen/caffeine/dihydrocodeine.

Aspirin

Combining aspirin with medications that contain caffeine may cause aspirin to leave your body faster. This makes aspirin less effective.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Acetaminophen/caffeine/dihydrocodeine Warnings
drug abuse
People with history of drug abuse

Dihydrocodeine can be habit forming. If you have a history of drug or alcohol abuse, use this drug with caution.

low blood pressure
People with very low blood pressure

This medication can make low blood pressure worse. This may make you feel lightheaded or cause you to faint.

breathing problems
People with life-threatening breathing problems

This drug may lead to serious, life-threatening, or fatal inability to breathe. This is especially possible in people with asthma or COPD. This is because the medication decreases the amount of breaths you can take and the amount of air you can breathe in.

liver or kidney disease
People with liver or kidney disease

If you have severe liver or kidney disease, you may be more likely to experience serious side effects. These include breathing problems or liver injury.

head injury
People with head injury

Dihydrocodeine may increase pressure in your brain and cause an increased risk of breathing problems if you have a head injury. You also may not be able to tell if your head injury is getting better or worse.

pregnant women
Pregnant women

Acetaminophen/caffeine/dihydrocodeine is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Acetaminophen is generally safe to take during pregnancy, but caffeine and dihydrocodeine may cause side effects. If you take more than 500 mg of caffeine a day, your baby could have irregular heartbeats, which could be fatal. Newborns can also experience caffeine and opiate withdrawal.

breastfeeding
Women who are breast-feeding

This medication is passed through breast milk in different amounts, depending on the dose you’re taking. This drug can cause serious side effects in a breastfeeding child.

You and your doctor need to decide if you’ll take this drug or breastfeed.

for seniors
For Seniors

Your doctor may give you a lower dose of this medication if you’re over 65 years old. As you age, your organs, such as your liver and kidneys, don’t work as well as they once did. This may make you more sensitive to the drug’s side effects. Your doctor may recommend a lower starting dose to avoid certain side effects.

for children
For Children

Dihydrocodeine has been associated with cases of breathing problems and death in children who received the medication after certain surgeries. This medication shouldn’t be used in children after surgery to have their tonsils or adenoids removed.

Special Kid Safety:

Always store acetaminophen/caffeine/dihydrocodeine in containers with childproof lids that are securely closed.

Keep your medication in a secure place, like a locked medicine cabinet, even if you don't think your child can reach it.

allergies
Allergies

Acetaminophen/caffeine/dihydrocodeine can cause a severe allergic reaction. Symptoms may include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives
  • rash
  • itching
  • blistered or peeling skin

Don’t take this medication again if you’ve ever had an allergic reaction to it. Taking it again could be fatal.

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How to Take acetaminophen-caffeine-dihydrocodeine (Dosage)

Oral capsule

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What Are You Taking This Medication For?

Moderate to severe pain
Form: Oral capsule
Strengths: 320.5 mg acetaminophen/30 mg caffeine/16 mg dihydrocodeine
Adult Dosage (ages 18 years and older)
  • The usual dose is 2 capsules taken every 4 hours as needed.
  • Your dose should be adjusted according to the severity of your pain.
  • Don’t take more than 4,000 mg of acetaminophen per day.
  • Don’t take more than 2 capsules in a 4-hour period.
  • Don’t take more than 10 capsules per day.
Child Dosage (ages 0-17 years)

The safety and effectiveness of this drug haven’t been established in children younger than 18 years old.

Special Considerations

Liver disease: Use caution if you have liver disease. Your doctor will take blood tests to check your liver to make sure this medication isn’t harming you. If you have or develop liver problems, your dose may need to be reduced.

Kidney disease: Use caution if you have kidney disease. Your doctor will take blood tests to check your kidneys to make sure this medication isn’t harming you. If you have or develop kidney problems, your dose may need to be reduced.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

This medication comes with risks if you don’t take it as prescribed.

If You Stop Taking It Suddenly

If you take it on a schedule and then suddenly stop taking it, you may experience opiate withdrawal symptoms such as agitation, anxiety, insomnia, muscle or stomachaches, nausea, vomiting, and diarrhea.

If You Take Too Much

You may experience nausea, vomiting, breathing problems, loss of consciousness, seizures, excessive sweating, and extreme fatigue. Symptoms of liver toxicity may not appear for 2–3 days following ingestion. These may include low blood sugar, easy bleeding, and swelling of your liver.

What to Do If You Miss a Dose

This medication is taken as needed for pain, so you may not be taking it on a schedule. If you’re taking it regularly and miss a dose, take the missed dose as soon as you can. Skip the missed dose if it’s almost time for your next scheduled dose. Don’t use extra medicine to make up the missed dose. This could result in toxic side effects.

How to Tell If the Drug Is Working

You may be able to tell this medication is working if you feel less pain.

Acetaminophen/caffeine/dihydrocodeine may be a short-term or long-term drug treatment.

How long you take this medication depends on the nature of your pain. Your doctor will tell you when and how to stop taking this medication.

Important Considerations for Taking Acetaminophen/caffeine/dihydrocodeine

Take this drug with food to avoid upset stomach

You don’t have to take this drug with food. But taking it with food could help prevent upset stomach.

Store this drug at room temperature

Keep it at 68–77°F (20–25°C). Don’t freeze this medication.

Keep it away from light and high temperature.

Keep your drugs away from areas where they could get wet, such as bathrooms. Store them away from moisture and damp locations.

Travel

When traveling with your medication:

  • Always carry it with you or in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt this medication.
  • You may need to show your pharmacy’s preprinted label to identify the medication. Keep the original prescription-labeled box with you when traveling.
  • Since this is a controlled substance, you may not have refills from your doctor. Be sure to check that you have enough medication before you leave on your trip. 

Clinical Monitoring

Kidneys: Your doctor may take a blood test to check your kidneys if you have kidney problems. This is to make sure this medication is okay for you to take.

Liver: Your doctor may take a blood test to check your liver if you have liver problems. This is to make sure this medication is okay for you to take.

Insurance

Many insurance companies will require a prior authorization before they approve the prescription and pay for acetaminophen/caffeine/dihydrocodeine.

Are There Any Alternatives?

There are several drugs that can treat pain. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.


Show Sources

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on July 17, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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