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Trezix

Generic Name: acetaminophen, caffeine, and dihydrocodeine (a SEET a MIN oh fen, KAF een, dye HYE droe KOE deen)
Brand Name: Dvorah, Panlor Tablet, Trezix
Physician reviewed Trezix patient information - includes Trezix description, dosage and directions.
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Drug Information:
Trezix is a combination medicine used to relieve moderate to severe pain. Trezix contains dihydrocodeine, an opioid (narcotic) medicine, and may be habit-forming. Trezix may also be used for purposes not listed in this medication guide. MISUSE OF OPIOID MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medication in a place where others cannot get to it. Do not give this medicine to anyone younger than 12 years old, or anyone under 18 who recently had surgery to remove the tonsils or adenoids. Learn more

Trezix Side Effects

Trezix Side Effects

Note: This document contains side effect information about acetaminophen / caffeine / dihydrocodeine. Some of the dosage forms listed on this page may not apply to the brand name Trezix.

For the Consumer

Applies to acetaminophen/caffeine/dihydrocodeine: oral capsule, oral tablet

Warning

Oral route (Capsule)

Addiction, Abuse, and Misuse

Acetaminophen/caffeine/dihydrocodeine bitartrate expose patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient's risk prior to prescribing acetaminophen / caffeine / dihydrocodeine bitartrate, and monitor all patients regularly for the development of these behaviors or conditions.

Life-Threatening Respiratory Depression

Serious, life-threatening, or fatal respiratory depression may occur with use of acetaminophen / caffeine / dihydrocodeine bitartrate. Monitor for respiratory depression, especially during initiation of acetaminophen / caffeine / dihydrocodeine bitartrate or following a dose increase.

Accidental Ingestion

Accidental ingestion of even one dose of acetaminophen / caffeine / dihydrocodeine bitartrate, especially by children, can result in a fatal overdose of acetaminophen / caffeine / dihydrocodeine bitartrate.

Ultra-Rapid Metabolism of Codeine and Other Risk Factors for Life-Threatening Respiratory Depression in Children

Life-threatening respiratory depression and death have occurred in children who received codeine. Most of the reported cases occurred following tonsillectomy and/or adenoidectomy, and many of the children had evidence of being an ultra-rapid metabolizer of codeine due to a CYP2D6 polymorphism. Acetaminophen / caffeine / dihydrocodeine bitartrate is contraindicated in children younger than 12 years of age and in children younger than 18 years of age following tonsillectomy and/or adenoidectomy. Avoid the use of acetaminophen / caffeine / dihydrocodeine bitartrate in adolescents 12 to 18 years of age who have other risk factors that may increase their sensitivity to the respiratory depressant effects of codeine.

Neonatal Opioid Withdrawal Syndrome

Prolonged use of acetaminophen / caffeine / dihydrocodeine bitartrate during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.

Interactions with Drug Affecting Cytochrome P450 Isoenzymes

The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with codeine are complex. Use of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with acetaminophen / caffeine / dihydrocodeine bitartrate requires careful consideration of the effects on the parent drug, codeine, and the active metabolite, morphine.HepatotoxicityAcetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant and death. Most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed 4,000 milligrams per day, and often involve more than one acetaminophen-containing product.

Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants

Concomitant use of opioids with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of acetaminophen / caffeine / dihydrocodeine bitartrate and benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation.

Along with its needed effects, acetaminophen / caffeine / dihydrocodeine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking acetaminophen / caffeine / dihydrocodeine:

More common

  • Bleeding gums
  • blood in the urine or stools
  • bloody, black, or tarry stools
  • chest pain
  • chills
  • clay colored stools
  • cough
  • dark urine
  • decreased appetite
  • dizziness
  • drowsiness
  • fever
  • headache
  • high fever
  • itching or skin rash
  • lightheadedness
  • loss of appetite
  • nausea
  • painful or difficult urination
  • pale skin
  • pinpoint red spots on the skin
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • stomach pain or tenderness
  • swelling of the feet or lower legs
  • swollen glands
  • unexplained or unusual bleeding or bruising
  • unusual tiredness or weakness
  • vomiting
  • yellow eyes or skin

Rare

  • Agitation
  • confusion
  • decreased urine output
  • difficulty with swallowing
  • fast heartbeat
  • hives
  • hostility
  • irritability
  • loss of consciousness
  • muscle twitching
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • rapid weight gain
  • seeing, hearing, or feeling things that are not there
  • seizures
  • stupor
  • swelling of the face, ankles, or hands
  • tightness in the chest
  • unusual drowsiness, dullness, or feeling of sluggishness

Incidence not known

  • Cold sweats
  • darkening of the skin
  • decrease in the frequency of urination
  • decrease in the urine volume
  • difficult or troubled breathing
  • difficulty in passing urine (dribbling)
  • dizziness, faintness, or lightheadedness when getting up from lying or sitting position
  • fainting
  • irregular, fast or slow, or shallow breathing
  • overactive reflexes
  • pale or blue lips, fingernails, or skin
  • poor coordination
  • shivering
  • talking or acting with excitement you cannot control
  • trembling or shaking

Some side effects of acetaminophen / caffeine / dihydrocodeine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Difficulty having a bowel movement
  • relaxed and calm feeling
  • sleepiness

Incidence not known

  • Constricted, pinpoint, or small pupils (black part of the eye)
  • diarrhea
  • dry mouth
  • gas in the stomach
  • heartburn

For Healthcare Professionals

Applies to acetaminophen / caffeine / dihydrocodeine: oral capsule, oral tablet

General

The most frequently expected adverse reactions based on the individual components may include lightheadedness, dizziness, drowsiness, sedation, nausea, vomiting, constipation, pruritus and skin reactions.

Hepatic

Acetaminophen:

Frequency not reported: Hepatotoxicity

Respiratory

Dihydrocodeine:

Frequency not reported: Respiratory depression, cough suppression

Psychiatric

Dihydrocodeine:

Frequency not reported: Confusion, physical and psychological dependence, hallucinations vivid dreams

Caffeine:

Frequency not reported: Anxiety, anxiety neurosis, excitement, insomnia, irritability, restlessness, tenseness

Dermatologic

Dihydrocodeine:

Frequency not reported: Sweating, pruritus, skin reactions

Acetaminophen:

Rare (less than 0.1%): Serious skin reactions such as acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN)

Caffeine:

Frequency not reported: Urticaria

Hypersensitivity

Dihydrocodeine:

Frequency not reported: Anaphylactoid reactions, hypersensitivity reactions

Acetaminophen:

Rare (less than 0.1%): Anaphylactoid reactions

Frequency not reported: Hypersensitivity reactions including urticarial or erythematous skin reactions, laryngeal edema, angioedema

Nervous system

Postmarketing reports: Serotonin syndrome

Dihydrocodeine:

Rare (less than 0.1%): Narcosis

Frequency not reported: Lightheadedness, dizziness, drowsiness, sedation, headache

Caffeine:

Frequency not reported: Headaches, lightheadedness, tremor

Renal

Dihydrocodeine:

Rare (less than 0.1%): Acute renal failure

Frequency not reported: Granulomatous interstitial nephritis

Caffeine:

Frequency not reported: Diuresis

Cardiovascular

Dihydrocodeine:

Frequency not reported: Orthostatic hypotension

Caffeine:

Frequency not reported: Extrasystoles, palpitations, tachycardia

Endocrine

Postmarketing reports: Adrenal insufficiency

Opioids:

Frequency not reported: Androgen deficiency

Chronic opioid use may influence the hypothalamic-pituitary-gonadal axis and lead to androgen deficiency; however, the causal role of opioids is unknown due to the lack of studies into the many medical, physical, lifestyle, and psychological stressors that influence gonadal hormone levels.

Gastrointestinal

Dihydrocodeine:

Frequency not reported: Nausea, vomiting, constipation, abdominal pain, diarrhea, dry mouth, indigestion, spasm of biliary tract

Caffeine:

Frequency not reported: Diarrhea, nausea, stomach pain, vomiting

Genitourinary

Dihydrocodeine:

Frequency not reported: Urinary retention

Hematologic

Acetaminophen:

Frequency not reported: Thrombocytopenia, leukopenia, pancytopenia, neutropenia, thrombocytopenic purpura, agranulocytosis

Metabolic

Dihydrocodeine:

Frequency not reported: Anorexia

Ocular

Dihydrocodeine:

Frequency not reported: Miosis

Caffeine:

Frequency not reported: Scintillating scotoma

Other

Dihydrocodeine:

Frequency not reported: Fatigue

Caffeine:

Frequency not reported: Tinnitus

Editorial References and Review

Medically reviewed by USARx EDITORIAL TEAM Last updated on 1/1/2020.

Source: Drugs.com Trezix (www.drugs.com/mtm/trezix.html).