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acetaminophen/dichloralphenazone/isometheptene (Midrin, Isocom, Amidrine)
65 mg isometheptene mucate + 100 mg dichloraphenazone + 325 mg acetaminophen. DEA-controlled substance: class 4.
Indications:
1) tension headaches
2) vascular (migraine) headaches
Contraindications:
1) glaucoma
2) severe renal disease
3) hypertension
4) heart disease
5) hepatic disease
6) concurrent MAO inhibitor therapy
pregnancy-category ?
safety in lactation ?
Dosage:
1) migraine:
a) 2 tabs PO followed by 1/h until relief
b) up to 5/12 hours, 8/day; 15/week; 40/month
2) tension headache:
a) 1-2 capsules every 4 hours
b) max: 8/day; 15/week; 40/month
Pharmacokinetics: elimination: liver.
Adverse effects:
1) transient dizziness
2) rash
3) drowsiness
4) hepatic impairment with chronic use
5) less GI distress than ergotamine
Drug interactions:
- concurrent use of MAO inhibitor may result in hypertensive crisis
Mechanism of action:
1) isometheptene constricts dilated cranial & cerebral arterioles
2) dichloralphenazone is a mild sedative
3) acetaminophen is an analgesic
Interactions
drug interactions
General
antimigraine combination
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998 - not on National VA formulary
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
Components
acetaminophen (Tylenol, Paracematol, Panadol, Tempra, Datril, APAP, non-Aspirin)
dichloralphenazone (Kloralfenazon)
isometheptene