AC&C
Patient Counselling
Usual dose:
For mild to moderate pain relief: 1 to 2 tablets orally every 4 to 6 hours as needed
Side Effects1,2,3,4:
● Cardiovascular: Angina, bradycardia
● Dermatologic: Rash, urticaria
● Gastrointestinal: Constipation, nausea, vomiting, gastritis, diarrhea, ulcers, dyspepsia
● Hematologic: Anemia, bleeding, coagulopathy
● Neurologic: Dizziness, agitation, headache, insomnia, tremor
● Respiratory: Bronchospasm, dyspnea
● Other: Angioedema, allergic reaction, diaphoresis
Contraindications1,2,3,4:
● Hypersensitivity to codeine, other opioid analgesics, salicylates, other NSAIDs, or any other component of the formulation
● Asthma
● Children < 16 years of age with viral infections (risk of Reye’s disorder)
● Postoperative pain management in children who have undergone tonsillectomy and/or adenoidectomy
● Bleeding disorders
● Severe CNS/respiratory depression
Special Populations1,2,3,4:
● Pregnancy Risk Factor:
- Aspirin: D
- Codeine: C
- Caffeine: C
● Breastfeeding: Avoid
● Caution in renal impairment; dosage adjustment may be required
● Caution in elderly population due to possible CNS depression (codeine)
Counselling Points4:
● Patients should be warned that due to the risk of Reye's syndrome, this medication should not be used in children without speaking to a healthcare professional. AC&C should never be used in children and teenagers with chickenpox, influenza, or other viral symptoms.
● Patients should avoid activities requiring mental alertness or coordination until the central nervous system effects of this medication are established and understood.
● AC&C may cause nausea, vomiting, dizziness, or angioedema (deep swelling around eyes and lips and sometimes hands and feet).
● Patients should be advised to report any signs and symptoms of respiratory depression.
● Patients should be instructed to monitor for constipation, especially if using AC&C for long durations.
● Patient should take AC&C with food and/or a full glass of water/milk to minimize gastric irritation.
● Patients who have taken drug consistently for several weeks should be advised to avoid abrupt discontinuation, as this may precipitate the unpleasant signs and symptoms accompanied by withdrawal.
● Additional aspirin or aspirin-containing products should be avoided by patients who are using this AC&C, unless this has been prescribed or discussed by a healthcare professional.
● Alcohol should be avoided/limited by patients taking AC&C.
References:
1. Lexi-Comp – Aspirin. Retrieved March 12, 2014, from http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/patch_f/6388
2. Lexi-Comp - Caffeine. Retrieved March 12, 2014, from http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/patch_f/6497
3. Lexi-Comp - Codeine. Retrieved March 12, 2014, from http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/patch_f/6653#f_warnings-and-precautions
4. Truven Health Products: Aspirin/Codeine. Retrieved March 12, 2014, from http://www.micromedexsolutions.com/micromedex2/librarian/ND_T/evidencexpert/ND_PR/evidencexpert/CS/2CD323/ND_AppProduct/evidencexpert/DUPLICATIONSHIELDSYNC/40E203/ND_PG/evidencexpert/ND_B/evidencexpert/ND_P/evidencexpert/PFActionId/evidencexpert.IntermediateToDocumentLink?docId=046920&contentSetId=100&title=Aspirin%2FCodeine+Phosphate&servicesTitle=Aspirin%2FCodeine+Phosphate