Aspirin Butalbital Caffeine Codeine

Aspirin Butalbital Caffeine Codeine Brand Names- Ascomp | Fiorinal with Codeine

What is Aspirin Butalbital Caffeine Codeine

Aspirin butalbital caffeine codeine are used together in an oral preparation to treat occasional tension headaches, migraines, and mild to moderate pain, especially when antianxiety or relaxant effects are needed.

Treatment of multiple recurrent headaches with this combination has not been well studied; long-term use is not recommended.

According to published guidelines for the acute management of migraine, the use of butalbital-containing analgesics should be limited and carefully monitored due to concerns of overuse, medication-overuse headache, and withdrawal.

Aspirin is a salicylate analgesic with similar analgesic potency to NSAIDs. Butalbital is a short-to-intermediate acting barbiturate that is used in this combination for its sedative and relaxant effects.

Caffeine is found in many analgesic formulations and may be beneficial in some vascular headaches such as tension and cluster headaches and migraines. Codeine is an oral semisynthetic opiate agonist derived from the opioid alkaloid, thebaine.

Codeine is a prodrug that is hepatically metabolized to morphine. Codeine metabolism is highly variable and unpredictable, particularly in children younger than 12 years; therapeutic response to recommended doses can range from lack of effect in poor metabolizers to fatality in ultra-rapid metabolizers.

Codeine use is contraindicated in pediatric patients younger than 12 years.

The American Academy of Pediatrics (AAP) recommends against the use of codeine and codeine-containing products in all pediatric patients for any indication.

Indications

  • headache
  • migraine
  • mild pain
  • moderate pain

For the treatment of occasional tension headache, occasional migraine† or co-existing migraine† and tension-type headaches

Side Effects

  1. abdominal pain
  2. adrenocortical insufficiency
  3. agitation
  4. amenorrhea
  5. anaphylactic shock
  6. anemia
  7. anorexia
  8. anxiety
  9. appetite stimulation
  10. chest pain (unspecified)
  11. constipation
  12. depression
  13. diarrhea
  14. diuresis
  15. dizziness
  16. drowsiness
  17. dysuria
  18. edema
  19. epistaxis
  20. erythema
  21. erythema multiforme
  22. esophagitis
  23. exfoliative dermatitis
  24. fatigue
  25. fever
  26. flushing
  27. gonadal suppression
  28. hallucinations
  29. headache
  30. hemolytic anemia
  31. hepatitis
  32. hiccups
  33. hyperactivity
  34. hyperglycemia
  35. hyperhidrosis
  36. hypersalivation
  37. hyponatremia
  38. hypotension
  39. impotence (erectile dysfunction)
  40. infertility
  41. insomnia
  42. lethargy
  43. libido decrease
  44. miosis
  45. musculoskeletal pain
  46. nasal congestion
  47. nausea
  48. neonatal opioid withdrawal syndrome
  49. nephrotoxicity
  50. palpitations
  51. peptic ulcer
  52. physiological dependence
  53. prolonged bleeding time
  54. pruritus
  55. psychological dependence
  56. psychosis
  57. pyrosis (heartburn)
  58. rash
  59. respiratory arrest
  60. respiratory depression
  61. Reye’s syndrome
  62. serotonin syndrome
  63. SIADH
  64. sinus tachycardia
  65. syncope
  66. tinnitus
  67. toxic epidermal necrolysis
  68. urticaria
  69. vertigo
  70. vomiting
  71. weakness
  72. xerostomia

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • abrupt discontinuation
  • accidental exposure
  • acute bronchospasm
  • acute myocardial infarction
  • adenoidectomy
  • adrenal insufficiency
  • agranulocytosis
  • alcoholism
  • anemia
  • angina
  • angioedema
  • anticoagulant therapy
  • ascites
  • Asian patients
  • asthma
  • barbiturate hypersensitivity
  • Black patients
  • bladder obstruction
  • bone marrow suppression
  • breast-feeding
  • carbamazepine hypersensitivity
  • cardiac arrhythmias
  • cardiac disease
  • Caucasian patients
  • children
  • chronic obstructive pulmonary disease (COPD)
  • CNS depression
  • coadministration with other CNS depressants
  • coagulopathy
  • constipation
  • dehydration
  • depression
  • diabetes mellitus
  • driving or operating machinery
  • endocarditis
  • esophagitis
  • ethanol ingestion
  • ethanol intoxication
  • G6PD deficiency
  • gastritis
  • geriatric
  • GI bleeding
  • GI disease
  • GI obstruction
  • gout
  • head trauma
  • heart failure
  • hematological disease
  • hemolytic anemia
  • hemophilia
  • hepatic disease
  • hepatic encephalopathy
  • hepatitis
  • Hispanic patients
  • hydantoin hypersensitivity
  • hypertension
  • hypoprothrombinemia
  • hypotension
  • hypothyroidism
  • hypovolemia
  • ileus
  • immunosuppression
  • increased intracranial pressure
  • infants
  • infection
  • inflammatory bowel disease
  • influenza
  • intracranial bleeding
  • intramuscular injections
  • labor
  • MAOI therapy
  • mental status changes
  • myxedema
  • nasal polyps
  • neonatal opioid withdrawal syndrome
  • neonates
  • neuromuscular disease
  • neutropenia
  • NSAID hypersensitivity
  • obesity
  • obstetric delivery
  • oliguria
  • opiate agonist hypersensitivity
  • osteomalacia
  • osteoporosis
  • pain
  • peptic ulcer disease
  • pericarditis
  • porphyria
  • potential for overdose or poisoning
  • pregnancy
  • prostatic hypertrophy
  • pulmonary disease
  • renal disease
  • renal failure
  • renal impairment
  • respiratory depression
  • respiratory infection
  • Reye’s syndrome
  • salicylate hypersensitivity
  • seizure disorder
  • seizures
  • sleep apnea
  • sodium restriction
  • status asthmaticus
  • status epilepticus
  • substance abuse
  • suicidal ideation
  • surgery
  • systemic lupus erythematosus (SLE)
  • tartrazine dye hypersensitivity
  • thrombocytopenia
  • thrombolytic therapy
  • thrombotic thrombocytopenic purpura (TTP)
  • thyroid disease
  • tobacco smoking
  • tonsillectomy
  • urethral stricture
  • urinary retention
  • urticaria
  • varicella
  • viral infection
  • vitamin K deficiency
  • von Willebrand’s disease

Interactions

  • Abciximab
  • Abemaciclib
  • Abiraterone
  • Acetaminophen
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Diphenhydramine
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Propoxyphene
  • Acetaminophen; Pseudoephedrine
  • Acetaminophen; Tramadol
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  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
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  • Calcifediol
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  • Calcium Carbonate
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  • Canagliflozin
  • Canagliflozin; Metformin
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  • Cannabidiol
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  • Captopril
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  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbetapentane; Pyrilamine
  • Carbidopa; Levodopa; Entacapone
  • Carbinoxamine
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Cardiac glycosides
  • Cariprazine
  • Carisoprodol
  • Cefixime
  • Cefotetan
  • Celecoxib
  • Cenobamate
  • Ceritinib
  • Cetirizine
  • Cetirizine; Pseudoephedrine
  • Cevimeline
  • Chlophedianol; Dexbrompheniramine
  • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
  • Chlophedianol; Guaifenesin; Phenylephrine
  • Chloral Hydrate
  • Chlorambucil
  • Chloramphenicol
  • Chlorcyclizine
  • Chlordiazepoxide
  • Chlordiazepoxide; Clidinium
  • Chloroprocaine
  • Chlorothiazide
  • Chlorpheniramine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorpromazine
  • Chlorpropamide
  • Chlorthalidone
  • Chlorthalidone; Clonidine
  • Chlorzoxazone
  • Choline Salicylate; Magnesium Salicylate
  • Cidofovir
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  • Clarithromycin
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  • Codeine; Phenylephrine; Promethazine
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  • COMT inhibitors
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  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Guaifenesin
  • Dextromethorphan; Guaifenesin; Phenylephrine
  • Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
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  • Hydralazine; Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ; Irbesartan
  • Hydrochlorothiazide, HCTZ; Lisinopril
  • Hydrochlorothiazide, HCTZ; Losartan
  • Hydrochlorothiazide, HCTZ; Methyldopa
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Olmesartan
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Hydrochlorothiazide, HCTZ; Telmisartan
  • Hydrochlorothiazide, HCTZ; Triamterene
  • Hydrochlorothiazide, HCTZ; Valsartan
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Hydroxyzine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibritumomab Tiuxetan
  • Ibrutinib
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Idelalisib
  • Ifosfamide
  • Iloperidone
  • Iloprost
  • Imatinib
  • Imipramine
  • Immune Globulin IV, IVIG, IGIV
  • Incretin Mimetics
  • Indacaterol
  • Indacaterol; Glycopyrrolate
  • Indapamide
  • Indinavir
  • Indomethacin
  • Inotersen
  • Insulins
  • Intravenous Lipid Emulsions
  • Iron Sucrose, Sucroferric Oxyhydroxide
  • Isavuconazonium
  • Isocarboxazid
  • Isoflurane
  • Isoniazid, INH
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Isoproterenol
  • Isradipine
  • Istradefylline
  • Itraconazole
  • Ivabradine
  • Ixabepilone
  • Ketamine
  • Ketoconazole
  • Ketoprofen
  • Ketorolac
  • Lamivudine; Tenofovir Disoproxil Fumarate
  • Lansoprazole
  • Lansoprazole; Naproxen
  • Lapatinib
  • Larotrectinib
  • Lasmiditan
  • Lefamulin
  • Lemborexant
  • Lesinurad
  • Lesinurad; Allopurinol
  • Letermovir
  • Leucovorin
  • Levalbuterol
  • Levobupivacaine
  • Levocetirizine
  • Levoleucovorin
  • Levomilnacipran
  • Levorphanol
  • Lidocaine
  • Lidocaine; Prilocaine
  • Linagliptin
  • Linagliptin; Metformin
  • Lincosamides
  • Linezolid
  • Lisdexamfetamine
  • Lisinopril
  • Lithium
  • Lofexidine
  • Loop diuretics
  • Loperamide
  • Loperamide; Simethicone
  • Lopinavir; Ritonavir
  • Loratadine; Pseudoephedrine
  • Lorazepam
  • Lorlatinib
  • Lovastatin
  • Lovastatin; Niacin
  • Low Molecular Weight Heparins
  • Loxapine
  • Lumacaftor; Ivacaftor
  • Lumateperone
  • Lurasidone
  • Lurbinectedin
  • Macimorelin
  • Magnesium Salicylate
  • Magnesium Salts
  • Mannitol
  • Maprotiline
  • Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
  • Mebendazole
  • Meclizine
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Mefloquine
  • Meglitinides
  • Melatonin
  • Meloxicam
  • Meperidine
  • Meperidine; Promethazine
  • Mephobarbital
  • Mepivacaine
  • Mepivacaine; Levonordefrin
  • Meprobamate
  • Mestranol; Norethindrone
  • Metaproterenol
  • Metaxalone
  • Metformin
  • Metformin; Pioglitazone
  • Metformin; Repaglinide
  • Metformin; Rosiglitazone
  • Metformin; Saxagliptin
  • Metformin; Sitagliptin
  • Methadone
  • Methamphetamine
  • Methazolamide
  • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
  • Methocarbamol
  • Methohexital
  • Methotrexate
  • Methscopolamine
  • Methsuximide
  • Methyclothiazide
  • Methyldopa
  • Methylene Blue
  • Methylphenidate
  • Methylprednisolone
  • Methylsulfonylmethane, MSM
  • Metoclopramide
  • Metolazone
  • Metronidazole
  • Metyrapone
  • Metyrosine
  • Mexiletine
  • Midazolam
  • Midodrine
  • Mifepristone
  • Milnacipran
  • Minocycline
  • Mirabegron
  • Mirtazapine
  • Mitotane
  • Modafinil
  • Moexipril
  • Molindone
  • Monoamine oxidase inhibitors
  • Morphine
  • Morphine; Naltrexone
  • Muromonab-CD3
  • Mycophenolate
  • Nabilone
  • Nabumetone
  • Nafcillin
  • Nalbuphine
  • Naloxone
  • Naltrexone
  • Nanoparticle Albumin-Bound Paclitaxel
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Naratriptan
  • Nateglinide
  • Nefazodone
  • Nelfinavir
  • Neratinib
  • Nesiritide, BNP
  • Netupitant, Fosnetupitant; Palonosetron
  • Nevirapine
  • Niacin; Simvastatin
  • Nicardipine
  • Nifedipine
  • Nilotinib
  • Nimodipine
  • Nintedanib
  • Nisoldipine
  • Nitazoxanide
  • Nitroglycerin
  • Non-Ionic Contrast Media
  • Norepinephrine
  • Nortriptyline
  • Obeticholic Acid
  • Octreotide
  • Olanzapine
  • Olaparib
  • Olodaterol
  • Omacetaxine
  • Ombitasvir; Paritaprevir; Ritonavir
  • Omeprazole
  • Omeprazole; Amoxicillin; Rifabutin
  • Omeprazole; Sodium Bicarbonate
  • Ondansetron
  • Oritavancin
  • Orphenadrine
  • Osilodrostat
  • Oxacillin
  • Oxaprozin
  • Oxazepam
  • Oxybutynin
  • Oxycodone
  • Oxymorphone
  • Ozanimod
  • Paclitaxel
  • Palbociclib
  • Paliperidone
  • Palonosetron
  • Panobinostat
  • Papaverine
  • Paroxetine
  • Peginterferon Alfa-2b
  • Pegvisomant
  • Pemigatinib
  • Pemoline
  • Penicillin G
  • Penicillin G Benzathine
  • Penicillin G Benzathine; Penicillin G Procaine
  • Penicillin G Procaine
  • Penicillin V
  • Penicillins
  • Pentazocine
  • Pentazocine; Naloxone
  • Pentobarbital
  • Pentosan
  • Pentoxifylline
  • Perampanel
  • Perindopril
  • Perindopril; Amlodipine
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phendimetrazine
  • Phenelzine
  • Phenobarbital
  • Phenothiazines
  • Phentermine
  • Phentermine; Topiramate
  • Phenylephrine
  • Phenylephrine; Promethazine
  • Phenytoin
  • Phosphorated Carbohydrate Solution
  • Phosphorus
  • Photosensitizing agents (topical)
  • Pimavanserin
  • Pimozide
  • Pioglitazone
  • Piperacillin
  • Piperacillin; Tazobactam
  • Pirbuterol
  • Piroxicam
  • Pneumococcal Vaccine, Polyvalent
  • Polymyxins
  • Pomalidomide
  • Posaconazole
  • Potassium Bicarbonate
  • Potassium Chloride
  • Potassium Citrate
  • Potassium Phosphate
  • Potassium Phosphate; Sodium Phosphate
  • Potassium-sparing diuretics
  • Pralidoxime
  • Pramipexole
  • Pramlintide
  • Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
  • Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
  • Prasugrel
  • Prednisolone
  • Prednisone
  • Pregabalin
  • Prilocaine
  • Prilocaine; Epinephrine
  • Primidone
  • Probenecid
  • Procarbazine
  • Prochlorperazine
  • Progestins
  • Promethazine
  • Propafenone
  • Propofol
  • Protriptyline
  • Pseudoephedrine
  • Psyllium
  • Quazepam
  • Quetiapine
  • Quinapril
  • Quinidine
  • Quinine
  • Rabeprazole
  • Racepinephrine
  • Ramelteon
  • Ramipril
  • Ranolazine
  • Rasagiline
  • Red Yeast Rice
  • Regadenoson
  • Remifentanil
  • Repaglinide
  • Reserpine
  • Ribociclib
  • Ribociclib; Letrozole
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Rifaximin
  • Rilpivirine
  • Riluzole
  • Rimegepant
  • Risperidone
  • Ritodrine
  • Ritonavir
  • Rituximab; Hyaluronidase
  • Rivaroxaban
  • Rizatriptan
  • Roflumilast
  • Rolapitant
  • Romidepsin
  • Ropinirole
  • Ropivacaine
  • Rosiglitazone
  • Rotigotine
  • Rucaparib
  • Safinamide
  • Salicylates
  • Salicylic Acid
  • Salmeterol
  • Salsalate
  • Saquinavir
  • Saxagliptin
  • Scopolamine
  • Secobarbital
  • Segesterone Acetate; Ethinyl Estradiol
  • Selective serotonin reuptake inhibitors
  • Selegiline
  • Selpercatinib
  • Selumetinib
  • Serotonin norepinephrine reuptake inhibitors
  • Serotonin-Receptor Agonists
  • Serotonin-Receptor Antagonists
  • Sertraline
  • Sevoflurane
  • Sibutramine
  • Sildenafil
  • Simvastatin
  • Simvastatin; Sitagliptin
  • Siponimod
  • Sirolimus
  • Sitagliptin
  • Skeletal Muscle Relaxants
  • Sodium Bicarbonate
  • Sodium Hyaluronate, Hyaluronic Acid
  • Sodium Lactate
  • Sodium Oxybate
  • Sodium Thiosulfate; Salicylic Acid
  • Solifenacin
  • Solriamfetol
  • Spironolactone
  • St. John’s Wort, Hypericum perforatum
  • Streptogramins
  • Sufentanil
  • Sulfinpyrazone
  • Sulfonamides
  • Sulfonylureas
  • Sulindac
  • Sumatriptan
  • Sunitinib
  • Suvorexant
  • Tacrolimus
  • Tapentadol
  • Tasimelteon
  • Tazemetostat
  • Telavancin
  • Telithromycin
  • Telotristat Ethyl
  • Temazepam
  • Tenofovir Alafenamide
  • Tenofovir, PMPA
  • Terbinafine
  • Terbutaline
  • Teriflunomide
  • Tetrabenazine
  • Tetracaine
  • Thalidomide
  • Theophylline, Aminophylline
  • Thiabendazole
  • Thiazide diuretics
  • Thiazolidinediones
  • Thiopental
  • Thioridazine
  • Thiothixene
  • Thrombin Inhibitors
  • Thrombolytic Agents
  • Thyroid hormones
  • Ticagrelor
  • Ticarcillin
  • Ticarcillin; Clavulanic Acid
  • Ticlopidine
  • Tinzaparin
  • Tiotropium; Olodaterol
  • Tipranavir
  • Tirofiban
  • Tizanidine
  • tobacco
  • Tolazamide
  • Tolbutamide
  • Tolcapone
  • Tolmetin
  • Tolterodine
  • Topiramate
  • Torsemide
  • Tramadol
  • Trandolapril
  • Trandolapril; Verapamil
  • Tranylcypromine
  • Trastuzumab; Hyaluronidase
  • Trazodone
  • Treprostinil
  • Tretinoin, ATRA
  • Triamcinolone
  • Triamterene
  • Triazolam
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trimethobenzamide
  • Trimetrexate
  • Trimipramine
  • Triprolidine
  • Tromethamine
  • Trospium
  • Tucatinib
  • Ubrogepant
  • Ulipristal
  • Umeclidinium; Vilanterol
  • Valbenazine
  • Valerian, Valeriana officinalis
  • Valproic Acid, Divalproex Sodium
  • Vancomycin
  • Varicella-Zoster Virus Vaccine, Live
  • Venlafaxine
  • Verapamil
  • Verteporfin
  • Vigabatrin
  • Vilazodone
  • Vincristine
  • Vincristine Liposomal
  • Vorapaxar
  • Voriconazole
  • Vortioxetine
  • Voxelotor
  • Warfarin
  • Yohimbine
  • Zafirlukast
  • Zaleplon
  • Zanubrutinib
  • Ziconotide
  • Zileuton
  • Ziprasidone
  • Zolmitriptan
  • Zolpidem
  • Zonisamide
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