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ACETAMINOPHEN AND SALICYLATES (Systemic)
Some commonly used brand names are:
In the U.S.—
Acetaminophen and salicylate combination medicines relieve pain and reduce fever. They may be used to relieve occasional pain caused by mild inflammation or arthritis (rheumatism). The acetaminophen, aspirin, and caffeine combination also may be used to relieve pain associated with migraine headaches.
Neither acetaminophen nor salicylamide is as effective as aspirin for treating chronic or severe pain, or other symptoms, caused by inflammation or arthritis. Some of these combination medicines do not contain any aspirin. Even those that do contain aspirin may not contain enough to be effective in treating these conditions.
A few reports have suggested that acetaminophen and salicylates used together may cause kidney damage or cancer of the kidney or urinary bladder. This may occur if large amounts of both medicines are taken together for a very long time. However, taking usual amounts of these combination medicines for a short time has not been shown to cause these unwanted effects. Also, these effects are not likely to occur with either acetaminophen or a salicylate used alone, even if large amounts have been taken for a long time. Therefore, for long-term use, it may be best to use either acetaminophen or a salicylate, but not both, unless you are under a doctor"s care.
Before giving any of these combination medicines to a child, check the package label very carefully. Some of these medicines are too strong for use in children . If you are not certain whether a specific product can be given to a child, or if you have any questions about the amount to give, check with your health care professional.
These medicines are available without a prescription. However, your doctor may have special instructions on the proper dose of these medicines for your medical condition.
These medicines are available in the following dosage forms:
Before Using This Medicine
If you are taking this medicine without a prescription, carefully read and follow any precautions on the label. For acetaminophen and salicylate combinations, the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to acetaminophen, aspirin or other salicylates including methyl salicylate (oil of wintergreen), or to any of the following medicines:
Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.
Older adults—Elderly people may be more likely than younger adults to develop serious kidney problems if they take large amounts of these combination medicines for a long time. Therefore, it is best that elderly people not take this medicine for more than 5 days in a row unless they are under a doctor"s care.
Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking an acetaminophen and salicylate combination, it is especially important that your health care professional know if you are taking any of the following:
Other medical problems—The presence of other medical problems may affect the use of acetaminophen and salicylate combinations. Make sure you tell your doctor if you have any other medical problems, especially:
Proper Use of This Medicine
Take this medicine with food or a full glass (8 ounces) of water to lessen the chance of stomach upset.
Unless otherwise directed by your doctor:
Check with your doctor before taking one of these combination medicines to treat severe or chronic inflammation or arthritis (rheumatism) . These combination medicines may not relieve the severe pain, redness, swelling, or stiffness caused by these conditions unless very large amounts are taken for a long time. It is best not to take acetaminophen and salicylate combination medicines in large amounts for a long time unless you are under a doctor"s care.
If a combination medicine containing aspirin has a strong vinegar-like odor, do not use it . This odor means the medicine is breaking down. If you have any questions about this, check with your pharmacist.
Dosing—The dose of acetaminophen and salicylate combination medicines will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses of these combination medicines. If your dose is different, do not change it unless your doctor tells you to do so.
The number of capsules, tablets (including caplets), or packets of oral powders that you take depends on the total amount of acetaminophen and salicylate (aspirin and/or salicylamide) in one capsule, tablet, or packet of oral powder. Also, the number of doses you take each day and the time allowed between doses depend on the strength of the medicine.
Storage—To store this medicine:
Precautions While Using This Medicine
If you will be taking this medicine for a long time, or in high doses, your doctor should check your progress at regular visits . This is especially important for elderly people, who may be more likely than younger adults to develop serious kidney problems if they take large amounts of this medicine for a long time.
Check with your doctor:
Do not take any of the combination medicines containing aspirin for 5 days before any surgery, including dental surgery, unless otherwise directed by your medical doctor or dentist. Taking aspirin during this time may cause bleeding problems.
Check the label of all over-the-counter (OTC), nonprescription, and prescription medicines you now take . If any of them contain acetaminophen, aspirin, other salicylates such as bismuth subsalicylate (e.g., Pepto Bismol) or magnesium salicylate (e.g., Nuprin Backache Caplets), or salicylic acid (present in some shampoos and skin products), check with your health care professional. Using any of them together with this medicine may cause an overdose .
Stomach problems may be more likely to occur if you drink three or more alcoholic beverages while you are taking aspirin. Also, liver damage may be more likely to occur if you drink three or more alcoholic beverages while you are taking acetaminophen.
Taking certain other medicines together with acetaminophen and salicylates may increase the chance of unwanted effects. The risk will depend on how much of each medicine you take every day, and on how long you take the medicines together. If your medical doctor or dentist directs you to take these medicines together on a regular basis, follow his or her directions carefully. However, do not take any of the following medicines together with any of these combination medicines for more than a few days unless your doctor has directed you to do so and is following your progress :
The antacid present in buffered forms of these combination medicines can keep other medicines from working properly. If you need to take a buffered form of this medicine, and you are also taking one of the following medicines, be sure to take the buffered acetaminophen and salicylate combination medicine :
If you are taking a laxative containing cellulose, do not take it within 2 hours of taking this medicine. Taking the laxative and this medicine close together may make this medicine less effective by preventing the salicylate in it from being absorbed by your body.
Acetaminophen and salicylate combinations may interfere with the results of some medical tests. Before you have any medical tests, tell the person in charge if you have taken any of these combination medicines within the past 3 or 4 days. If possible, it is best to call the laboratory where the test will be done about 4 days ahead of time to find out whether the medicine may be taken during the 3 or 4 days before the test.
For patients with diabetes:
For patients taking one of the products that contain caffeine :
If you think that you or anyone else may have taken an overdose of this medicine, get emergency help at once . Taking an overdose of a salicylate may cause unconsciousness or death. The first symptom of an aspirin overdose may be ringing or buzzing in the ears. Other signs include convulsions (seizures), hearing loss, confusion, severe drowsiness or tiredness, severe excitement or nervousness, and unusually fast or deep breathing. Signs of severe acetaminophen overdose may not appear until 2 to 4 days after the overdose is taken, but treatment to prevent liver damage or death must be started within 24 hours or less after the overdose is taken.
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur :
Less common or rare
Coughing; difficulty in swallowing; dizziness, lightheadedness, or feeling faint (severe); flushing, redness, or other change in skin color; shortness of breath, troubled breathing, tightness in chest, or wheezing; sudden decrease in amount of urine; swelling of eyelids, face, or lips
Signs and symptoms of overdose
Agitation, anxiety, excitement, irritability, nervousness, or restlessness; any loss of hearing; bloody urine; confusion or delirium; convulsions (seizures); diarrhea (severe or continuing); dizziness or lightheadedness; drowsiness (severe); fast or deep breathing; fast or irregular heartbeat (for medicines containing caffeine); fever; frequent urination (for medicines containing caffeine); hallucinations (seeing, hearing, or feeling things that are not there); headache (severe or continuing); increased sensitivity to touch or pain (for medicines containing caffeine); increased sweating; increased thirst; loss of appetite; muscle trembling or twitching (for medicines containing caffeine); nausea or vomiting (continuing, sometimes with blood); ringing or buzzing in ears (continuing); seeing flashes of “zig-zag” lights (for medicines containing caffeine); stomach cramps or pain (severe or continuing); swelling, pain, or tenderness in the upper abdomen or stomach area; trouble in sleeping (for medicines containing caffeine); uncontrollable flapping movements of the hands, especially in elderly patients; unexplained fever; vision problems
Signs of overdose in children
Changes in behavior; drowsiness or tiredness (severe); fast or deep breathing
Also, check with your doctor as soon as possible if any of the following side effects occur:
Less common or rare
Bloody or black, tarry stools; bloody or cloudy urine; fever with or without chills (not present before treatment and not caused by the condition being treated); pain in lower back and/or side (severe and/or sharp); pinpoint red spots on skin; skin rash, hives, or itching; sores, ulcers, or white spots on lips or in mouth; sore throat (not present before treatment and not caused by the condition being treated); stuffy nose; swelling of face, fingers, feet, or lower legs; unusual bleeding or bruising; unusual tiredness or weakness; vomiting of blood or material that looks like coffee grounds; weight gain; yellow eyes or skin
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
Heartburn or indigestion (for medicines containing aspirin); nausea, vomiting, or stomach pain (for medicines containing aspirin)
Drowsiness (for medicines containing salicylamide); trouble in sleeping, nervousness, or jitters (for medicines containing caffeine)
Some side effects may occur after you have stopped taking these combination medicines, especially if you have taken large amounts of them for a long time. Check with your doctor immediately if any of these side effects occur after you have stopped taking these medicines:
Bloody or cloudy urine; decreased urination; swelling of face, fingers, feet, or lower legs; weight gain
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.
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