Narcotic Analgesics and Aspirin (Systemic)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For narcotic analgesic and aspirin combinations, the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to a narcotic analgesic, aspirin or other salicylates, including methyl salicylate (oil of wintergreen), or 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.

Pregnancy -

• For aspirin : Studies in humans have not shown that aspirin causes birth defects. However, studies in animals have shown that aspirin causes birth defects.
  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 baby. 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 effects. However, regular use of aspirin late in pregnancy may cause unwanted effects on the heart or blood flow in the fetus or in the newborn baby. Also, 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 baby.
  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. Do not take aspirin during the last 3 months of pregnancy unless it has been ordered by your doctor .
• For narcotic analgesics : Although studies on birth defects with narcotic analgesics have not been done in pregnant women, they have not been reported to cause birth defects. However, hydrocodone caused birth defects in animal studies when given in very large doses. Codeine did not cause birth defects in animals, but it caused slower development of bones and other toxic or harmful effects on the fetus. Pentazocine and propoxyphene did not cause birth defects in animals. There is no information about whether dihydrocodeine or oxycodone causes birth defects in animals.
  Too much use of a narcotic during pregnancy may cause the fetus to become dependent on the medicine. This may lead to withdrawal side effects in the newborn baby. Also, some of these medicines may cause breathing problems in the newborn baby if taken just before or during delivery.
• For caffeine : Studies in humans have not shown that caffeine (contained in some of these combination medicines) causes birth defects. However, studies in animals have shown that caffeine causes birth defects when given in very large doses (amounts equal to those present in 12 to 24 cups of coffee a day).

Breast-feeding - These combination medicines have not been reported to cause problems in nursing babies. However, aspirin, caffeine, codeine, and propoxyphene pass into the breast milk. It is not known whether dihydrocodeine, hydrocodone, oxycodone, or pentazocine passes into the breast milk.

Children - Do not give a medicine containing aspirin to a child or a teenager with a 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.

The narcotic analgesic in this combination medicine can cause breathing problems, especially in children younger than 2 years of age. These children are usually more sensitive than adults to the effects of narcotic analgesics. Also, unusual excitement or restlessness may be more likely to occur in children receiving these medicines.

Older adults - Elderly people are especially sensitive to the effects of aspirin and of narcotic analgesics. This may increase the chance of side effects, especially breathing problems caused by narcotic analgesics, during treatment.

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 a narcotic analgesic and aspirin combination, 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
• Medicine for inflammation or pain, except narcotics, or
• Pentoxifylline (e.g., Trental) or
• Plicamycin (e.g., Mithracin) or
• Ticarcillin (e.g., Ticar) or
• Valproic acid (e.g., Depakene) - Taking 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 the antidiabetic medicine; a change in the dose of the antidiabetic medicine may be needed if aspirin is taken regularly

• Carbamazepine (e.g., Tegretol) - Propoxyphene can increase the blood levels of carbamazepine, which increases the chance of serious side effects

• Central nervous system (CNS) depressants or
• Diarrhea medicine or
• Methotrexate (e.g., Mexate) or
• Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil]) or
• Vancomycin (e.g., Vancocin) - The chance of side effects may be increased

• Naltrexone (e.g., Trexan) - Naltrexone keeps narcotic analgesics from working to relieve pain; people taking naltrexone should use pain relievers that do not contain a narcotic

• Probenecid (e.g., Benemid) or
• Sulfinpyrazone (e.g., Anturane) - Aspirin can keep these medicines from working as well for treating gout; also, use of sulfinpyrazone and aspirin together may increase the chance of bleeding

• Urinary alkalizers (medicine that makes the urine less acid, such as acetazolamide [e.g., Diamox], calcium- and/or magnesium-containing antacids, dichlorphenamide [e.g., Daranide], methazolamide [e.g., Neptazane], potassium or sodium citrate and/or citric acid, sodium bicarbonate [baking soda]) - These medicines may make aspirin less effective by causing it to be removed from the body more quickly

• Zidovudine (e.g., AZT, Retrovir) - Higher blood levels of zidovudine and an increased chance of serious side effects may occur

Other medical problems - The presence of other medical problems may affect the use of narcotic analgesic and aspirin combinations. Make sure you tell your doctor if you have any other medical problems, especially:

• Alcohol and/or other drug abuse, or history of, or
• Asthma, allergies, and nasal polyps (history of) or
• Brain disease or head injury or
• Colitis or
• Convulsions (seizures), history of, or
• Emotional problems or mental illness or
• Emphysema or other chronic lung disease or
• Kidney disease or
• Liver disease or
• Underactive thyroid - The chance of serious side effects may be increased

• Anemia or
• Overactive thyroid or
• Stomach ulcer or other stomach problems - Aspirin may make these conditions worse

• Enlarged prostate or problems with urination or
• Gallbladder disease or gallstones - Narcotic analgesics have side effects that may be dangerous if these medical problems are present

• Gout - Aspirin can make this condition worse and can also lessen the effects of some medicines used to treat gout

• Heart disease - Large amounts of aspirin and caffeine (present in some of these combination medicines) can make some kinds of heart disease worse

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