DVORAH
  • DVORAH (Generic for ACETAMIN-CAFF-DIHYDROCODEINE)

  • QTY 16 • 325-30-16 • Tablet • Near 77381

ACETAMINOPHEN; CAFFEINE; DIHYDROCODEINE (a set a MEE noe fen; KAF een; dye hye droe KOE deen) is a pain reliever. It is used to treat moderate to severe pain.

DVORAH (Generic for ACETAMIN-CAFF-DIHYDROCODEINE) Lifestyle Interactions

Acetaminophen 325mg, Caffeine 30mg, Dihydrocodeine Bitartrate 16mg, Oral tablet

Tobacco

· Severity: Moderate

· Notes for Consumers: If you are a tobacco smoker, use of Acetaminophen can increase the risk of liver side effects. Immediately tell your doctor if you get severe abdominal pain, nausea, vomiting, or yellowing of the skin. Do not exceed 4 g acetaminophen/day in adults. Tell your doctor if Acetaminophen does not help your headache or other pain. Tobacco smoke may reduce the effectiveness of Acetaminophen.

· Notes for Professionals: Tobacco smoking induces the cytochrome P450 isoenzyme CYP1A2 and may potentially increase the risk for acetaminophen-induced hepatotoxicity during overdose via enhanced generation of acetaminophen's hepatotoxic metabolite, NAPQI. In one study, current tobacco smoking was found to be very frequent in patients admitted with acetaminophen poisoning. Tobacco smoking appears to be an independent risk factor of severe hepatotoxicity, acute liver failure and death following acetaminophen overdose.

Acetaminophen 325mg, Caffeine 30mg, Dihydrocodeine Bitartrate 16mg, Oral tablet

Alcohol

· Severity: Major

· Notes for Consumers: Do not drink alcohol while taking this medication. Drinking alcohol while taking this medication increases the risk of an opioid overdose. Symptoms of an overdose may include slow or shallow breathing, difficulty staying awake, or the inability to respond or wake up. Call emergency services right away if you experience these symptoms. Talk to your care team about naloxone, a medication for the emergency treatment of opioid overdose.

· Notes for Professionals: Advise patients to avoid alcohol consumption while taking opioids. Alcohol consumption may result in additive CNS depression and may increase the risk for opioid overdose. Consider the patient's use of alcohol when prescribing opioid medications. If the patient is unlikely to be compliant with avoiding alcohol, consider prescribing naloxone especially if additional risk factors for opioid overdose are present.

Acetaminophen 325mg, Caffeine 30mg, Dihydrocodeine Bitartrate 16mg, Oral tablet

Grapefruit juice

· Severity: Moderate

· Notes for Consumers: It is recommended that you limit and do not significantly alter your intake of grapefruit or grapefruit juice while taking dihydrocodeine. Side effects from dihydrocodeine may get worse if you increase your intake of grapefruit juice. Talk to your doctor first. Contact your doctor right away if you have symptoms of dihydrocodeine side effects such as slurred speech, confusion, weakness, or trouble breathing. Do not drive or operate machinery until you know how codeine affects you.

· Notes for Professionals: Patients should not significantly alter their intake of grapefruit or grapefruit juice during therapy with dihydrocodeine. Grapefruit juice, a CYP3A4 inhibitor, may increase plasma concentrations of dihydrocodeine, a CYP3A4 substrate. This may increase or prolong dihydrocodeine-related toxicities including respiratory depression. Advise patients accordingly; patient monitoring and dosage adjustments may be necessary if grapefruit is consumed regularly.

Acetaminophen 325mg, Caffeine 30mg, Dihydrocodeine Bitartrate 16mg, Oral tablet

Tobacco

· Severity: Moderate

· Notes for Consumers: Tobacco smoke contains substances that may speed the removal of Caffeine from the body. If you start smoking Caffeine may become less effective. Tobacco smokers often drink several caffeinated beverages daily. Just the opposite occurs when someone stops smoking tobacco; if you stop smoking this may increase the amount of Caffeine in the blood and side effects from Caffeine may get worse. Too much Caffeine can cause nausea, nervousness, or sleeplessness, and occasionally other effects like tremor. If you stop smoking tobacco, you may need to lower your Caffeine intake.

· Notes for Professionals: Inducers of the hepatic CYP450 isoenzyme CYP1A2 may induce the hepatic oxidative metabolism of caffeine. Tobacco smoke contains hydrocarbons that induce hepatic CYP450 microsomal enzymes (e.g., CYP1A1, CYP1A2, CYP2E1). The increased clearance of caffeine by smokers may contribute to the higher consumption of caffeinated beverages reported to occur in this group. Because the effect on hepatic microsomal enzymes is not related to the nicotine component of tobacco, the sudden cessation of tobacco smoking may result in a reduced clearance of caffeine, despite the initiation of a nicotine replacement product. Following several days of abstinence from chronic tobacco smoking, caffeine clearance may decrease by roughly 40%, leading to the possible occurrence of caffeine-related side effects like nausea, nervousness, irritability, tremors, or insomnia, if caffeine use remains the same.

Acetaminophen 325mg, Caffeine 30mg, Dihydrocodeine Bitartrate 16mg, Oral tablet

Marijuana

· Severity: Major

· Notes for Consumers: Discuss marijuana use with your care team. The effects of your medication may be altered if used with marijuana. Call emergency services right away if you experience slow or shallow breathing, difficulty staying awake, or are unable to respond or wake up.

· Notes for Professionals: Advise patients to avoid marijuana use while taking CNS depressants due to the risk for additive CNS depression and potential for other cognitive adverse reactions.

Acetaminophen 325mg, Caffeine 30mg, Dihydrocodeine Bitartrate 16mg, Oral tablet

Alcohol

· Severity: Major

· Notes for Consumers: Do not drink alcohol while taking this medication. Drinking alcohol while taking this medication increases the risk of liver injury. Contact your care team right away if you have right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, or unusual weakness or fatigue.

· Notes for Professionals: The risk of developing hepatotoxicity from acetaminophen appears to be increased in patients who regularly consume alcohol. Patients who drink more than 3 alcohol-containing drinks a day and take acetaminophen are at increased risk of developing hepatotoxicity. Acute or chronic alcohol use increases acetaminophen-induced hepatotoxicity by inducing CYP2E1 leading to increased formation of the hepatotoxic metabolite of acetaminophen. Also, chronic alcohol use can deplete liver glutathione stores. Administration of acetaminophen should be limited or avoided altogether in patients with alcoholism or patients who consume alcohol regularly.

Acetaminophen 325mg, Caffeine 30mg, Dihydrocodeine Bitartrate 16mg, Oral tablet

Caffeine-containing Foods/Beverages

· Severity: Moderate

· Notes for Consumers: While taking Caffeine-containing medicines, limit the use of foods, beverages (examples: coffee, tea, colas), herbs (examples: guarana, green tea) and other products that contain additional caffeine, such as chocolate and some non-prescription medications or dietary supplements for headache, insomnia, or weight loss. Too much Caffeine can cause effects like nausea, nervousness, or sleeplessness. Some drug products for adults that contain caffeine have about as much caffeine as a cup of coffee.

· Notes for Professionals: Certain foods that contain high amounts of caffeine or theobromine should be limited during the therapeutic use of caffeine in order to limit additive methylxanthine effects. While taking Caffeine-containing medicines, limit the use of foods, beverages (examples: coffee, tea, colas), herbs (examples: guarana, green tea) and other products that contain additional caffeine, such as chocolate and some non-prescription medications or dietary supplements for headache, insomnia, or weight loss. Too much Caffeine can cause effects like nausea, nervousness, or sleeplessness. Some drug products for adults that contain caffeine have about as much caffeine as a cup of coffee.

Acetaminophen 325mg, Caffeine 30mg, Dihydrocodeine Bitartrate 16mg, Oral tablet

Grapefruit juice

· Severity: Mild

· Notes for Consumers: Do not significantly alter your grapefruit juice intake while taking medicines containing caffeine. Some reports suggest that intake of grapefruit juice can increase side effects from caffeine. Too much Caffeine can cause effects like nausea, tremor, nervousness, or sleeplessness. If these occur, consider ingesting less caffeine daily.

· Notes for Professionals: Data are limited and conflicting as to whether grapefruit juice significantly alters the serum concentrations and/or AUC of caffeine. Caffeine is primarily a CYP1A2 substrate, and grapefruit juice appears to have but a small effect on this enzyme in vivo. One report suggests that grapefruit juice decreases caffeine elimination by inhibition of flavin-containing monooxygenase, a P450 independent system. This interaction might increase caffeine levels and mildly potentiate the clinical effects and common side effects of caffeine. If side effects appear, patients may need to limit either caffeine or grapefruit juice intake.

<b>DISCLAIMER:</b><em> This drug information content is provided for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Patients should always consult their physician with any questions regarding a medical condition and to obtain medical advice and treatment. Drug information is sourced from GSDD (Gold Standard Drug Database ) provided by Elsevier.</em>

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