Usage
- This combination medication is prescribed for the short-term relief of pain associated with muscle spasms. It combines the muscle relaxant properties of carisoprodol with the analgesic and antipyretic effects of paracetamol (acetaminophen), enhanced by the stimulant caffeine. It is commonly used for conditions such as back pain, strains, sprains and other musculoskeletal injuries.
- Pharmacological Classification: This is a combination product containing a skeletal muscle relaxant (carisoprodol), a non-opioid analgesic (paracetamol), and a central nervous system stimulant (caffeine).
- Mechanism of Action: Carisoprodol’s mechanism is not fully understood but is believed to act centrally in the brain and spinal cord to inhibit multisynaptic reflexes involved in muscle spasms. Paracetamol inhibits prostaglandin synthesis, reducing pain and fever. Caffeine potentiates the analgesic effect of paracetamol and acts as a stimulant.
Alternate Names
- While there isn’t one single international non-proprietary name (INN) for the combination, the components are internationally recognized as paracetamol (acetaminophen in the US), carisoprodol, and caffeine.
- Brand Names: This combination is marketed under various brand names such as Somadril Comp., Tandrilax, and various others depending on the region. PCC (Paracetamol, Caffeine, Carisoprodol) is a commonly used abbreviation, especially in some regions.
How It Works
- Pharmacodynamics: Carisoprodol acts centrally to reduce muscle spasm. Its metabolite, meprobamate, has anxiolytic and sedative properties. Paracetamol reduces pain and fever through central and peripheral mechanisms, primarily by inhibiting COX enzymes in the brain. Caffeine acts as a central nervous system stimulant and increases the effectiveness of paracetamol.
- Pharmacokinetics: Carisoprodol is rapidly absorbed orally and is metabolized by the liver, primarily by CYP2C19, to meprobamate. Both carisoprodol and meprobamate are excreted renally. Paracetamol is rapidly absorbed orally and metabolized by the liver, with excretion primarily in the urine. Caffeine is readily absorbed and distributed throughout the body, metabolized by the liver, and excreted in urine.
- Mode of Action/Receptor Binding, Enzyme Inhibition or Neurotransmitter Modulation: Carisoprodol acts on GABAergic receptors, which may contribute to its muscle relaxant effects. Paracetamol inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. Caffeine acts as an adenosine receptor antagonist.
- Elimination Pathways: Primarily renal excretion for all three components. Carisoprodol is metabolized to meprobamate before renal excretion.
Dosage
Standard Dosage
Adults:
- The usual adult dose is 250-350 mg of carisoprodol, combined with 300-500 mg of paracetamol and 30-60 mg of caffeine, taken three times a day and at bedtime. Treatment duration should not exceed 2-3 weeks.
Children:
- This combination is generally not recommended for children under 16 years of age due to a lack of safety and efficacy data. For older adolescents, dosage should be carefully determined by a physician, considering the child’s weight and medical condition.
Special Cases:
- Elderly Patients: Elderly patients should be started on lower doses and monitored closely for side effects like confusion, dizziness, and drowsiness.
- Patients with Renal Impairment: Caution is advised. Dose adjustments may be necessary.
- Patients with Hepatic Dysfunction: Dose reductions should be considered due to the hepatic metabolism of the drugs.
- Patients with Comorbid Conditions: Caution should be exercised in patients with a history of substance abuse, seizures, porphyria, or other medical conditions.
Clinical Use Cases
- This combination medication is not typically used in the clinical settings mentioned (Intubation, Surgical Procedures, Mechanical Ventilation, ICU Use, Emergency Situations). Its primary indication is for short-term relief of musculoskeletal pain associated with muscle spasms.
Dosage Adjustments
- Dose adjustments should be made for patients with renal or hepatic impairment. Dosage should be reduced for elderly patients. Concomitant use with CYP2C19 inhibitors may necessitate lower doses of carisoprodol.
Side Effects
Common Side Effects
- Dizziness, drowsiness, headache, nervousness, irritability, indigestion, nausea.
Rare but Serious Side Effects
- Allergic reactions (rash, itching, swelling, severe dizziness, difficulty breathing), seizures, dependence, withdrawal symptoms.
Long-Term Effects
- Tolerance and physical dependence can occur with prolonged use of carisoprodol.
Adverse Drug Reactions (ADR)
- Severe allergic reactions, seizures, withdrawal symptoms upon discontinuation (anxiety, tremors, insomnia).
Contraindications
- Hypersensitivity to any component of the medication, acute intermittent porphyria, history of seizures, concomitant use of MAO inhibitors.
Drug Interactions
- Alcohol, CNS depressants (benzodiazepines, opioids), CYP2C19 inhibitors (omeprazole, fluoxetine), CYP2C19 inducers (rifampin).
Pregnancy and Breastfeeding
- Pregnancy Safety Category: C (animal studies show adverse effects, but no adequate studies in humans). Use only if the benefits outweigh the risks.
- Fetal Risks: Potential for fetal harm.
- Breastfeeding: Carisoprodol and its metabolite meprobamate are excreted in breast milk. May cause drowsiness in nursing infants. Use with caution.
Drug Profile Summary
- Mechanism of Action: Muscle relaxant (carisoprodol), analgesic/antipyretic (paracetamol), CNS stimulant (caffeine).
- Side Effects: Dizziness, drowsiness, headache, irritability. Rarely: allergic reactions, seizures, dependence.
- Contraindications: Hypersensitivity, porphyria, seizures, concomitant MAOI use.
- Drug Interactions: Alcohol, CNS depressants, CYP2C19 inhibitors/inducers.
- Pregnancy & Breastfeeding: Use with caution. Potential for fetal harm and neonatal drowsiness.
- Dosage: 250-350 mg carisoprodol, 300-500 mg paracetamol, 30-60 mg caffeine, TID and HS. Not to exceed 2-3 weeks.
- Monitoring Parameters: Monitor for signs of CNS depression, allergic reactions, and dependence.
Popular Combinations
- This combination itself is a popular formulation. Sometimes prescribed with other analgesics or muscle relaxants depending on specific patient needs, though caution is needed to avoid additive side effects.
Precautions
- General Precautions: Evaluate patients for history of substance abuse, allergies, renal or hepatic impairment, and other medical conditions.
- Specific Populations: Use with caution in elderly patients, pregnant or breastfeeding women, and patients with renal or hepatic impairment.
- Lifestyle Considerations: Avoid alcohol and operating heavy machinery. Limit caffeine intake from other sources.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Caffeine + Carisoprodol + Paracetamol?
A: The standard adult dose is 250-350 mg of carisoprodol, 300-500 mg of paracetamol, and 30-60 mg of caffeine, taken three times a day and at bedtime. Treatment should not exceed 2-3 weeks.
Q2: Is this combination safe for use in children?
A: Generally not recommended for children under 16. For older children, dosing should be carefully determined by a doctor.
Q3: Can this medication be used during pregnancy or breastfeeding?
A: It should be used cautiously during pregnancy and breastfeeding, only if the potential benefits outweigh the risks. Consult a doctor before use.
Q4: What are the common side effects?
A: Dizziness, drowsiness, headache, and irritability are common side effects.
Q5: Are there any serious side effects to be aware of?
A: Rarely, serious side effects like allergic reactions and seizures can occur. Dependence is also possible.
Q6: What are the contraindications for this medication?
A: Contraindications include hypersensitivity to any component, porphyria, a history of seizures, and concomitant use of MAO inhibitors.
Q7: What other medications might interact with this combination?
A: Avoid alcohol and CNS depressants. Be cautious with CYP2C19 inhibitors and inducers.
Q8: What precautions should be taken when prescribing this medication to elderly patients?
A: Start with lower doses and monitor closely for side effects like confusion, dizziness, and drowsiness.
Q9: How long should a patient typically take this medication?
A: Treatment should generally not exceed 2-3 weeks due to the risk of dependence associated with carisoprodol.
