Acetaminophen: Substrate (minor) of CYP1A2, 2A6, 2C8/9, 2D6, 2E1, 3A4; Inhibits CYP3A4 (weak)
Aspirin: Substrate (minor) of CYP2C8/9
Caffeine: Substrate of CYP1A2 (major), 2C8/9 (minor), 2D6 (minor), 2E1 (minor), 3A4 (minor); Inhibits CYP1A2 (weak), 3A4 (moderate)
Also see individual monographs for Acetaminophen and Aspirin.
Oral: Adults: Analgesic:
Based on acetaminophen component:
Mild to moderate pain: 325-650 mg every 4-6 hours as needed; do not exceed 4 g/day
Mild to moderate pain associated with migraine headache: 500 mg/dose (in combination with 500 mg aspirin and 130 mg caffeine) every 6 hours while symptoms persist; do not use for longer than 48 hours
Based on aspirin component:
Mild to moderate pain: 325-650 mg every 4-6 hours as needed; do not exceed 4 g/day
Mild to moderate pain associated with migraine headache: 500 mg/dose (in combination with 500 mg acetaminophen and 130 mg caffeine) every 6 hours; do not use for longer than 48 hours
Product labeling:
Excedrin® Extra Strength, Excedrin® Migraine: Children >12 years and Adults: 2 doses every 6 hours (maximum: 8 doses/24 hours)
Note: When used for migraine, do not use for longer than 48 hours
Goody's® Extra Strength Headache Powder: Children >12 years and Adults: 1 powder, placed on tongue or dissolved in water, every 4-6 hours (maximum: 4 powders/24 hours)
Goody's® Extra Strength Pain Relief Tablets: Children >12 years and Adults: 2 tablets every 4-6 hours (maximum: 8 tablets/24 hours)
Vanquish® Extra Strength Pain Reliever: Children >12 years and Adults: 2 tablets every 4 hours (maximum: 12 tablets/24 hours)
Caplet:
Excedrin® Extra Strength, Excedrin® Migraine: Acetaminophen 250 mg, aspirin 250 mg, and caffeine 65 mg
Vanquish® Extra Strength Pain Reliever: Acetaminophen 194 mg, aspirin 227 mg, and caffeine 33 mg
Geltab (Excedrin® Extra Strength, Excedrin® Migraine): Acetaminophen 250 mg, aspirin 250 mg, and caffeine 65 mg
Powder (Goody's® Extra Strength Headache Powder): Acetaminophen 260 mg, aspirin 520 mg, and caffeine 32.5 mg [contains lactose]
Tablet:
Excedrin® Extra Strength, Excedrin® Migraine, Genaced™, Pain-Off: Acetaminophen 250 mg, aspirin 250 mg, and caffeine 65 mg
Fem-Prin®: Acetaminophen 194.4 mg, aspirin 226.8 mg, and caffeine 32.4 mg
Goody's® Extra Strength Pain Relief: Acetaminophen 130 mg, aspirin 260 mg, and caffeine 16.25 mg
Barker JD Jr, de Carle DJ, and Anuras S, "Chronic Excessive Acetaminophen Use in Liver Damage,"Ann Intern Med, 1977, 87(3):299-301.
Desjardins PJ, Cooper SA, Gallegos TL, et al, "The Relative Analgesic Efficacy of Propiram Fumarate, Codeine Aspirin, and Placebo in Post-Impaction Dental Pain,"J Clin Pharmacol, 1984, 24(1):35-42.
Dionne RA, Campbell RA, Cooper SA, et al, "Suppression of Postoperative Pain by Preoperative Administration of Ibuprofen in Comparison to Placebo, Acetaminophen, and Acetaminophen Plus Codeine,"J Clin Pharmacol, 1983, 23(1):37-43.
Forbes JA, Butterworth GA, Burchfield WH, et al, "Evaluation of Ketorolac, Aspirin, and an Acetaminophen-Codeine Combination in Postoperative Oral Surgery Pain,"Pharmacotherapy, 1990, 10(6 Pt 2):77S-93S.
Forbes JA, Keller CK, Smith JW, et al, "Analgesic Effect of Naproxen Sodium, Codeine, a Naproxen-Codeine Combination and Aspirin on the Postoperative Pain of Oral Surgery,"Pharmacotherapy, 1986, 6(5):211-8.
Licht H, Seeff LB, and Zimmerman HJ, "Apparent Potentiation of Acetaminophen Hepatotoxicity by Alcohol,"Ann Intern Med, 1980, 92(4):511.
Mokhlesi B, Leikin JB, Murray P, et al, "Adult Toxicology in Critical Care: Part II: Specific Poisonings,"Chest, 2003, 123(3):897-922.
