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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