aspirin + caffeine citrate + paracetamol: clinical use

Prescribing considerations

• Confirm that no other paracetamol, aspirin or systemic NSAID is being used.
• Assess gastrointestinal bleeding, bleeding-disorder, asthma or NSAID-hypersensitivity history.
• Use additional caution in older people and in dehydration, uncontrolled hypertension, diabetes, gout, G6PD deficiency, alcohol dependence, malnutrition, sepsis, or hepatic or renal impairment.
• Consider caffeine exposure and susceptibility to insomnia, anxiety or palpitations.

Contraindications and cautions

• Hypersensitivity to an active ingredient or excipient
• Previous aspirin- or NSAID-induced asthma, bronchospasm, angioedema, urticaria or acute rhinitis
• Current or previous peptic ulceration
• Previous NSAID-related upper gastrointestinal bleeding or perforation
• Haemophilia, hypothrombinaemia or another clotting disorder
• Renal failure or hepatic failure
• Third trimester of pregnancy
• Breastfeeding
• Age under 16 unless specifically medically indicated

Monitoring

• Investigate unusual or prolonged bleeding.
• Where interacting diuretics or antihypertensives are unavoidable, consider blood pressure, renal function, hydration and potassium monitoring as appropriate.
• Monitor relevant concentrations or toxicity markers when used with phenytoin, valproate, methotrexate or anticoagulants.
• Consider pyroglutamic acidosis in an unwell, high-risk patient with otherwise unexplained high-anion-gap metabolic acidosis.

Clinical pharmacology

Aspirin irreversibly inhibits cyclo-oxygenase and reduces prostaglandin and thromboxane production. Paracetamol provides predominantly central analgesic and antipyretic activity. Caffeine stimulates the central nervous system and acts as an analgesic adjunct.

Formulation and product differences

• The selected preparation is a soluble oral tablet that must be dissolved in water.
• It contains aspartame, a source of phenylalanine, and is unsuitable for people with phenylketonuria without appropriate assessment.
• It contains lactose and is essentially sodium-free.