Codeine/Aspirin/Carisoprodol

DEA Class;  Rx, schedule III

Common Brand Names; Soma Compound with Codeine 

Analgesic and opioids combos

Combination of a salicylate, central-acting muscle relaxant, and opiate agonist

Used for pain and muscle spasm relief and limited mobility associated with musculoskeletal conditions

Risk of dependence/abuse; limit therapy to 2 to 3 weeks; use in patients younger than 12 years is contraindicated

For the treatment of acute, painful musculoskeletal conditions (e.g., musculoskeletal pain, muscle spasm).

Hypersensitivity

Children younger than 16 years old because of potential for Reye syndrome

Bronchospastic reaction to aspirin

Peptic ulcer disease

Repeated administration in patients with anemia, cardiovascular, pulmonary, or renal disease

Porphyria

Postoperative use in children following tonsillectomy and/or adenoidectomy (see Black Box Warnings)

>10%

Codeine

Constipation

Drowsiness

Carisoprodol

Drowsiness (13-17%)

1-10%

Codeine

Hypotension, tachycardia or bradycardia, confusion, dizziness, false feeling of well being, headache, lightheadedness, malaise, paradoxical CNS stimulation, restlessness, rash, urticaria, anorexia, nausea, vomiting, xerostomia, ureteral spasm, urination decreased, LFT’s increased, burning at injection site, weakness, blurred vision, dyspnea, histamine release

Carisoprodol

Dizziness (7-8%)

Headache (3-5%)

Aspirin

Stomach pain, heartburn, nausea, vomiting, dyspepsia, tinnitus (high or chronic dose), rash, urticaria

Particular caution in patients with history of GI bleed, alcoholism, or bleeding disorders

Avoid driving car or operating machinery

Avoid in severe renal impairment (ie, CrCl <10 mL/min)

May increase respiratory depressant effects; caution with head injury, COPD, or other conditions with decreased respiratory drive

Codeine and carisoprodol may cause tolerance/dependency

Pregnancy

Pregnancy category: D; avoid during pregnancy, particularly in third trimester because of risk for premature closure of the ductus arteriosus because of aspirin component; codeine may prolong delivery and cause respiratory depression/withdrawal symptoms in newborn

Lactation: excreted in breast milk; do not breast feed

Adults

1,600 mg/day PO carisoprodol, 2,600 mg/day PO aspirin, and 128 mg/day PO codeine (8 tablets/day PO).

Geriatric

1,600 mg/day PO carisoprodol, 2,600 mg/day PO aspirin, and 128 mg/day PO codeine (8 tablets/day PO).

Adolescents

Safety and efficacy have not been established.

Children

12 years: Safety and efficacy have not been established.

1 to 11 years: Use is contraindicated.

Infants

Use is contraindicated.

codeine/aspirin/carisoprodol

Tablet: Schedule III

16mg/325mg/200mg