Aspirin, Sodium Bicarbonate, and Citric Acid (Systemic)

Brand Names : Alka-Seltzer Effervescent Pain Reliever and Antacid, Flavored Alka-Seltzer Effervescent Pain Reliever and Antacid, acetylsalicylic acid, ASA

Before Using This Medicine

If you are taking this medicine without a prescription, carefully read and follow any precautions on the label. For aspirin, sodium bicarbonate, and citric acid combination, the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to aspirin or other salicylates, including methyl salicylate (oil of wintergreen), or to any of the following medicines:

• Diclofenac (e.g., Voltaren)
• Diflunisal (e.g., Dolobid)
• Etodolac (e.g., Lodine)
• Fenoprofen (e.g., Nalfon)
• Floctafenine (e.g., Idarac)
• Flurbiprofen, oral (e.g., Ansaid)
• Ibuprofen (e.g., Motrin)
• Indomethacin (e.g., Indocin)
• Ketoprofen (e.g., Orudis)
• Ketorolac (e.g., Toradol)
• Meclofenamate (e.g., Meclomen)
• Mefenamic acid (e.g., Ponstel)
• Nabumetone (e.g., Relafen)
• Naproxen (e.g., Naprosyn)
• Oxaprozin (e.g., Daypro)
• Oxyphenbutazone (e.g., Tandearil)
• Phenylbutazone (e.g., Butazolidin)
• Piroxicam (e.g., Feldene)
• Sulindac (e.g., Clinoril)
• Suprofen (e.g., Suprol)
• Tenoxicam (e.g., Mobiflex)
• Tiaprofenic acid (e.g., Surgam)
• Tolmetin (e.g., Tolectin)
• Zomepirac (e.g., Zomax)

Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Diet - Make certain your health care professional knows if you are on any special diet, such as a low-sodium or low-sugar diet. This medicine contains a large amount of sodium (more than 500 mg in each tablet).

Pregnancy - Studies in humans have not shown that aspirin causes birth defects in humans. However, it has been shown to cause birth defects in animal studies.

Do not take aspirin during the last 3 months of pregnancy unless it has been ordered by your doctor . Some reports have suggested that too much use of aspirin late in pregnancy may cause a decrease in the newborn's weight and possible death of the fetus or newborn infant. However, the mothers in these reports had been taking much larger amounts of aspirin than are usually recommended. Studies of mothers taking aspirin in the doses that are usually recommended did not show these unwanted effects. However, there is a chance that regular use of aspirin late in pregnancy may cause unwanted effects on the heart or blood flow in the fetus or in the newborn infant.

Use of aspirin during the last 2 weeks of pregnancy may cause bleeding problems in the fetus before or during delivery or in the newborn infant. Also, too much use of aspirin during the last 3 months of pregnancy may increase the length of pregnancy, prolong labor, cause other problems during delivery, or cause severe bleeding in the mother before, during, or after delivery.

The sodium in this combination medicine can cause your body to hold water. This may result in swelling and weight gain. Therefore, you should not use this combination medicine if you tend to hold body water.

Breast-feeding - Aspirin passes into the breast milk. However, aspirin (in the amounts used to relieve pain or prevent blood clots), sodium bicarbonate, and citric acid have not been reported to cause problems in nursing babies.

Children - Do not give any medicine containing aspirin to a child with fever or other symptoms of a virus infection, especially flu or chickenpox, without first discussing its use with your child's doctor . This is very important because aspirin may cause a serious illness called Reye's syndrome in children with fever caused by a virus infection, especially flu or chickenpox. Children who do not have a virus infection may also be more sensitive to the effects of aspirin, especially if they have a fever or have lost large amounts of body fluid because of vomiting, diarrhea, or sweating. This may increase the chance of side effects during treatment.

Adolescents - Teenagers with fever or other symptoms of a virus infection, especially flu or chickenpox, should check with a doctor before taking this medicine . The aspirin in this combination medicine may cause a serious illness called Reye's syndrome in teenagers with fever caused by a virus infection, especially flu or chickenpox.

Older adults - People 60 years of age and older are especially sensitive to the effects of aspirin. This may increase the chance of side effects during treatment. Also, the sodium in this combination medicine can be harmful to some elderly people, especially if large amounts of the medicine are taken regularly. Therefore, it is best that older people not use this medicine for more than 5 days in a row, unless otherwise directed by their doctor.

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 this combination medicine, it is especially important that your health care professional know if you are taking any of the following:

• Anticoagulants (blood thinners) or
• Carbenicillin by injection (e.g., Geopen) or
• Cefamandole (e.g., Mandol) or
• Cefoperazone (e.g., Cefobid) or
• Cefotetan (e.g., Cefotan) or
• Dipyridamole (e.g., Persantine) or
• Divalproex (e.g., Depakote) or
• Heparin or
• Pentoxifylline (e.g., Trental) or
• Plicamycin (e.g., Mithracin) or
• Ticarcillin (e.g., Ticar) or
• Valproic acid (e.g., Depakene) - Use of these medicines together with aspirin may increase the chance of bleeding

• Antidiabetics, oral (diabetes medicine you take by mouth) - Aspirin may increase the effects of these medicines; a change in dose may be needed

• Ciprofloxacin (e.g., Cipro) or
• Enoxacin (e.g., Penetrex) or
• Itraconazole (e.g., Sporanox) or
• Ketoconazole (e.g., Nizoral) or
• Lomefloxacin (e.g., Maxaquin) or
• Methenamine (e.g., Mandelamine) or
• Norfloxacin (e.g., Noroxin) or
• Ofloxacin (e.g., Floxin) or
• Tetracyclines (medicine for infection), taken by mouth - Sodium bicarbonate can keep these medicines from working properly

• Mecamylamine (e.g., Inversine) - Sodium bicarbonate may increase the chance of unwanted effects by causing mecamylamine to stay in your body longer than usual

• Medicine for pain and/or inflammation (except narcotics) or
• Methotrexate (e.g., Mexate) or
• Vancomycin (e.g., Vancocin) - The chance of serious side effects may be increased

• Probenecid (e.g., Benemid) or
• Sulfinpyrazone (e.g., Anturane) - Aspirin can keep these medicines from working properly when they are used to treat gout

Other medical problems - The presence of other medical problems may affect the use of this combination medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Anemia or
• Stomach ulcer or other stomach problems - Aspirin can make these conditions worse

• Appendicitis (symptoms of, such as stomach or lower abdominal pain, cramping, bloating, soreness, nausea, or vomiting) - Sodium bicarbonate can make your condition worse; also, people who may have appendicitis need medical attention and should not try to treat themselves

• Asthma, allergies, and nasal polyps (history of) or
• Kidney disease or
• Liver disease - The chance of serious side effects may be increased

• Edema (swelling of face, fingers, feet, or lower legs caused by too much water in the body) or
• Heart disease or
• High blood pressure or
• Toxemia of pregnancy - The sodium in this combination medicine can make these conditions worse

• Gout - Aspirin can make this condition worse and can also keep some medicines used to treat gout from working properly

• Hemophilia or other bleeding problems - Aspirin increases the chance of serious bleeding