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What is APAP/caffeine/dihydrocodeine?

Dihydrocodeine is in a group of drugs called narcotic pain relievers.

Acetaminophen is a less potent pain reliever that increases the effects of dihydrocodeine.

Caffeine is a central nervous system stimulant. It relaxes muscle contractions in blood vessels to improve blood flow.

The combination of acetaminophen, caffeine, and dihydrocodeine is used to relieve moderate to severe pain.

Acetaminophen, caffeine, and dihydrocodeine may also be used for purposes other than those listed in this medication guide.

Precautions

Instructions

Side-effects

Interactions

Precautions

Do not use this medication if you are allergic to acetaminophen (Tylenol) or dihydrocodeine, or if you have a stomach condition called paralytic ileus, or severe or uncontrolled asthma.

Dihydrocodeine may be habit-forming and should be used only by the person it was prescribed for. This medicine should never be given to another person, especially someone who has a history of drug abuse or addiction. Keep the medicine in a secure place where others cannot get to it.

Before using acetaminophen, caffeine, and dihydrocodeine, tell your doctor if you are allergic to any drugs, or if you have:

• sleep apnea or other breathing disorders;
• liver or kidney disease;
• a history of head injury or brain tumor;
• epilepsy or other seizure disorder;
• low blood pressure;
• a stomach or intestinal disorder;
• underactive thyroid;
• a pancreas disorder;
• Addison's disease or other adrenal gland disorder;
• enlarged prostate, urination problems;
• curvature of the spine;
• mental illness; or
• a history of drug or alcohol addiction.

If you have any of these conditions, you may not be able to use this medication, or you may need a dosage adjustment or special tests during treatment.

Tell your doctor if you drink more than three alcoholic beverages per day or if you have ever had alcoholic liver disease (cirrhosis). You may not be able to take medication that contains acetaminophen.

FDA pregnancy category C. This medication may be harmful to an unborn baby, and could cause breathing problems or addiction/withdrawal symptoms in a newborn. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Dihydrocodeine can pass into breast milk and may harm a nursing baby. The use of this medication by some nursing mothers may lead to life-threatening side effects in the baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Older adults may be more sensitive to the effects of this medicine.

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Do not use any other over-the-counter cough, cold, allergy, or pain medication without first asking your doctor or pharmacist. Acetaminophen and caffeine are contained in many medicines available over the counter. If you take certain products together you may accidentally take too much of a certain drug. Read the label of any other medicine you are using to see if it contains acetaminophen or caffeine.

Avoid drinking alcohol while taking this medication. Alcohol may increase your risk of liver damage while taking acetaminophen.

While you are taking this medication, avoid taking diet pills, caffeine pills, or other stimulants (such as ADHD medications) without your doctor’s advice.

Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, antidepressants, or seizure medication can add to sleepiness caused by dihydrocodeine, or could slow your breathing. Tell your doctor if you need to use any of these other medicines while you are taking acetaminophen, caffeine, and dihydrocodeine.

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Instructions

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of acetaminophen, caffeine, and dihydrocodeine can be fatal.

Overdose symptoms may include extreme drowsiness or insomnia, restless feeling, tremors, fast heart rate, sweating, pinpoint pupils, nausea, vomiting, dark urine, jaundice (yellowing of the skin or eyes), confusion, fainting, weak pulse, seizure (convulsions), coma, blue lips, shallow breathing, or no breathing.

Since this medication is taken as needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not use extra medicine to make up the missed dose.

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Side-effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• shallow breathing, slow heartbeat;
• fast or pounding heart rate, feeling light-headed, fainting;
• confusion, hallucinations, unusual thoughts or behavior;
• muscle twitching;
• problems with urination;
• easy bruising or bleeding; or
• nausea, stomach pain, loss of appetite, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious side effects include:

• feeling dizzy or drowsy, shaky or agitated;
• mild nausea, vomiting, upset stomach; constipation, diarrhea;
• mood changes, sleep problems (insomnia);
• sweating, urinating more than usual;
• ringing in your ears, blurred vision; or
• dry mouth.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

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Interactions

Before taking this medication, tell your doctor if you use any of the following drugs:

• ciprofloxacin (Cipro);
• atropine (Donnatal, and others), benztropine (Cogentin), dimenhydrinate (Dramamine), glycopyrrolate (Robinul), isoniazid, mepenzolate (Cantil), methscopolamine (Pamine), or scopolamine (Transderm-Scop);
• bladder or urinary medications such as oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare);
• a blood thinner such as warfarin (Coumadin);
• a bronchodilator such as ipratropium (Atrovent) or tiotropium (Spiriva);
• irritable bowel medications such as dicyclomine (Bentyl), hyoscyamine (Anaspaz, Levsin, and others), or propantheline (Pro-Banthine);
• seizure medicine such as carbamazepine (Tegretol) or phenytoin (Dilantin); or
• an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

This is not a complete list and there may be other drugs that can interact with acetaminophen, caffeine, and dihydrocodeine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

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