acetylsalicylic acid + caffeine + paracetamol: clinical use

Prescribing considerations

• Exclude duplicate paracetamol, aspirin, NSAID and caffeine exposure.
• Assess gastrointestinal, bleeding, renal, hepatic and cardiovascular risk, including planned surgery or dental procedures.
• Consider sodium content in people with heart failure, hypertension, renal impairment or prescribed sodium restriction.
• Use particular caution with asthma, nasal polyps, chronic respiratory disease, gout, G6PD deficiency, diabetes, alcoholism, malnutrition or glutathione depletion.

Contraindications and cautions

• Hypersensitivity to aspirin, salicylates, paracetamol, caffeine or excipients
• Previous aspirin- or NSAID-triggered asthma, rhinitis, urticaria or other hypersensitivity reaction
• Active or previous peptic ulcer
• Bleeding disorders such as haemophilia
• Severe renal, hepatic or cardiac failure; severe cardiovascular disease or uncontrolled hypertension
• Third trimester of pregnancy or breastfeeding
• Relevant concurrent methotrexate therapy
• Age under 16 unless specifically indicated by a doctor

Monitoring

• Investigate persistent symptoms or suspected toxicity.
• Monitor for bleeding, gastrointestinal injury, bronchospasm, renal deterioration and hepatic dysfunction in higher-risk patients.
• Consider INR monitoring with regular paracetamol exposure and warfarin or another coumarin.
• When combined with flucloxacillin in a high-risk patient, monitor for high anion gap metabolic acidosis as clinically indicated.

Clinical pharmacology

Aspirin irreversibly inhibits cyclo-oxygenase and reduces prostaglandin and thromboxane formation; paracetamol provides central analgesic and antipyretic activity; caffeine is a non-selective adenosine-receptor antagonist.

Formulation and product differences

• The selected preparation is an effervescent tablet dissolved in water before ingestion.
• It contains sodium hydrogen carbonate and citric acid and has clinically relevant sodium content.
• Warm water speeds dissolution.