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Acetaminophen, Isometheptene, and Dichloralphenazone


Pronunciation

 (a seet a MIN oh fen, eye soe me THEP teen, & dye KLOR al FEN a zone)


U.S. Brand Names

 I.D.A.; Midrin®; Migrin-A


Synonyms

 Acetaminophen, Dichloralphenazone, and Isometheptene; Dichloralphenazone, Acetaminophen, and Isometheptene; Dichloralphenazone, Isometheptene, and Acetaminophen; Isometheptene, Acetaminophen, and Dichloralphenazone; Isometheptene, Dichloralphenazone, and Acetaminophen


Generic Available

 Yes


Use

 Relief of migraine and tension headache


Restrictions

 C-IV


Lactation

 Excretion in breast milk unknown/use caution


Contraindications

 Hypersensitivity to acetaminophen, isometheptene, dichloralphenazone, or any component of the formulation; glaucoma; severe renal disease; hypertension; organic heart disease; hepatic disease; MAO inhibitor therapy


Adverse Reactions

 Frequency not defined.

Central nervous system: Transient dizziness

Dermatological: Rash


Drug Interactions

Based on acetaminophen component: Substrate (minor) of CYP1A2, 2A6, 2C8/9, 2D6, 2E1, 3A4; Inhibits CYP3A4 (weak)

Decreased effect: Barbiturates, carbamazepine, hydantoins, rifampin, sulfinpyrazone may decrease the analgesic effect of acetaminophen; cholestyramine may decrease acetaminophen absorption (separate dosing by at least 1 hour)

Increased toxicity: Barbiturates, carbamazepine, hydantoins, isoniazid, rifampin, sulfinpyrazone may increase the hepatotoxic potential of acetaminophen; chronic ethanol abuse increases risk for acetaminophen toxicity; effect of warfarin may be enhanced


Ethanol/Nutrition/Herb Interactions

 Ethanol: Excessive intake of ethanol may increase the risk of acetaminophen-induced hepatotoxicity. Avoid ethanol or limit to <3 drinks/day.


Dosage

 Oral: Adults:

Migraine headache: 2 capsules to start, followed by 1 capsule every hour until relief is obtained (maximum: 5 capsules/12 hours)

Tension headache: 1-2 capsules every 4 hours (maximum: 8 capsules/24 hours)


Patient Education

 Breast-feeding precaution: Consult prescriber if breast-feeding.


Dental Health: Effects on Dental Treatment

 No significant effects or complications reported


Dental Health: Vasoconstrictor/Local Anesthetic Precautions

 No information available to require special precautions


Mental Health: Effects on Mental Status

 May cause drowsiness or dizziness


Mental Health: Effects on Psychiatric Treatment

 Contraindicated with MAO inhibitor


Dosage Forms

 Capsule: Acetaminophen 325 mg, isometheptene mucate 65 mg, dichloralphenazone 100 mg


References

Barker JD Jr, de Carle DJ, and Anuras S, "Chronic Excessive Acetaminophen Use in Liver Damage," Ann Intern Med , 1977, 87(3):299-301.

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.

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.


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