Aspirin combination preparations

Nu-Seals Aspirin (Lilly) Post MI (Ashbourne) numerous combination preparations... 

As discussed in Chapter 2, the primary medical uses of codeine are for the relief of pain, cough suppression, and to control diarrhea. Codeine is commercially produced as tablets, either alone (Schedule II), in combination with aspirin or acetaminophen (Schedule III), or as a liquid preparation for suppressing cough suppressant (Schedule V). 

The drugs like ibuprofen, flurbiprofen, ketoprofen etc. possess antiinflammatory property similar to aspirin but toxicity and adverse effects are fewer and of lesser intensity. These preparations alone and in combination with other NSAIDs are used for treatment of inflammatory disorders. 

Since most codeine is dispensed as part of a compound preparation, potential side effects of the other drug(s) must also be considered. For instance, someone with stomach ulcers should not take codeine that is combined with a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin or ibuprofen. Another type of risk from a compound preparation relates to codeine abuse. For instance, a person who abuses codeine might routinely take a dose of 100-200 mg of codeine to produce noticeable euphoria. Using Tylenol 3 to obtain this dose would also mean ingesting 1,000-2,000 mg of acetaminophen. Taking that amount of acetaminophen for any extended period presents a risk for liver damage, especially in combination with alcohol. 

Nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful for early and mild headache. NSAIDs include acetaminophen, ibuprofen, naproxen, and others. A recent study concluded that a combination of acetaminophen, aspirin, and caffeine could effectively relieve symptoms for many migraine patients. One such over-the-counter preparation is available as Exedrin Migraine. 

Aspirin absorption may be delayed when overdose quantities are consumed, especially of enteric-coated or slow-release preparations. This must be considered when interpreting serum salicylate values, especially for specimens obtained earlier than 6 hours after ingestion. Repeat testing within 2 to 3 hours is recommended to ensure that absorption is complete subsequent testing provides an indication of effectiveness of therapeutic intervention. Because of the aforementioned complications, proper assessment of salicylate intoxication requires sound clinical evaluation in combination with serum salicylate levels. 

Codeine is combined with aspirin, paracetamol and ibuprofen in many OTC analgesic products, and also in the formulary preparations co-codamol (with paracetamol) and co-codaprin (with aspirin). Dihydrocodeine is included with paracetamol in one OTC product, and at a higher dose in co-dydramol tablets, which are prescription-only medicines (POM). 

Analgesic preparations are all based on one of three drugs - aspirin, paracetamol and ibuprofen - sometimes in combination with the ancillary analgesics codeine or dihydrocodeine, or with other constituents that are claimed to increase effectiveness. (Author s note please check and amend at proof stage An application has been made for P classification for naproxen for PD, and it may be reclassified before the book is published.)... 

The combination of a modified preparation procedure yielding a very anhydrous lyophilized salt (French Demande 2 115 060, August 11, 1972) on one hand, and working under controlled atmosphere on the other hand, allowed the industrial production of the racemic lysine salt. This compound is a white crystalline powder which is freely soluble in water, odorless and tasteless. It allowed for the first time to prepare injectable preparations of aspirin. 

Caution Codeine doses above 65 mg often are not appropriate due to diminishing incremental analgesia with increasing doses but continually increasing constipation and other side effects. Caution Doses of aspirin and acetaminophen in combination opioid/NSAID preparations must also be adjusted to die patient s body weight. Maximum acetaminophen dose 4 gm/day in adults,... 

Simethicone, a surfactant that may decrease foaming and hence esophageal reflux, is included in many antacid preparations. However, other fixed combinations that are marketed for acid indigestion , particularly those with aspirin, are potentially unsafe in patients predisposed to gastroduodenal ulcers and should not be used. 

Aspirin as a single drug is very effective as a painkiller but causes stomach irritation or ulceration. Therefore, to minimize the side effects a combination with antacids is generally prescribed. An appropriate example of multiherbal formulations is seen in most hepatopro-tective preparations. Among the few prescribed herbal preparations in the market, Liv-52, a mixture of more than 20 medicinal plants, is effective in the treatment of common liver disorders. Here a single drug may not be that effective, as liver toxicity may be a manifestation of several metabolic disorders caused by toxins and pollutants. 

Ajun W, Yan S, Li G, HuiU L. Preparation of aspirin and probucol in combination loaded chitosan nanoparticles and in vitro release study. Carbohydr Polym. 2009 75(4) 566-74. 

Proprietary Names (1) combined with acetaminophen (multiple different preparations in tablet, capsule, and elixir form) Vicodin , Lortab , Norco , and numerous generic formulations (2) combined with aspirin or ibuprofen Damason-P , Vicoprofen ... 

Hydrocodone bitartrate is absolutely contraindicated in patients with known hypersensitivity reactions to hydrocodone. Commercial preparations may also contain sulfite compounds that can produce allergic reactions, including bronchospasm and anaphylaxis, in certain susceptible individuals, particularly asthmatic patients. In addition, the dye tartrazine is present in one preparation of hydrocodone bitartrate, combined with chlorpheniramine maleate and phenylephrine hydrochloride, that is used as an antitussive and expectorant agent (Vanex). Also known as FD C yellow No. 5, tartrazine can cause asthmatic and other allergic reactions in some susceptible patients, especially those with aspirin sensitivities. 

The most common side effects of hydrocodone include CNS reactions (dizziness, lightheadedness, sedation) and GI disturbances (nausea and vomiting), both of which can be exacerbated in ambulatory versus recumbent patients and possibly ameliorated by adopting the supine position. Other adverse reactions include constipation, urinary retention, dysphoria and/or euphoria, rash, and pruritus. Patients should also be advised that the use of hydrocodone may impair the performance of certain daily activities that require increased physical coordination or mental acuity, such as driving or operating machinery. Because hydrocodone is only available in commercial preparations combining it with other medications, such as aspirin, ibuprofen, or acetominophen, observation of the precautions associated with those adjunct agents is obviously also warranted. 

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