TREZIX (DIHYDROCODEINE BITARTRATE/ACETAMINOPHEN/CAFFEINE)

Contraindicated



• Depade
• dipyridamole
• naltrexone
• naltrexone microspheres
• Revia
• Vivitrol

Severe



• Acid Reducer (cimetidine)
• Acid Relief (cimetidine)
• Adenocard
• Adenoscan
• adenosine
• adenosine (diagnostic)
• cimetidine
• Heartburn Relief
• Lexiscan
• regadenoson
• sodium oxybate
• Tagamet Hb
• Xyrem

Contraindicated



• 30 day risk period post-myocardial infarction
• Acetaminophen overdose
• Acute hepatic failure
• Acute hepatitis C
• Adenoidectomy in pediatric patient
• Lactating mother
• Respiratory depression
• Sleep apnea
• Tonsillectomy in pediatric patient

Severe



• Acute asthma attack
• Acute pancreatitis
• Asthma
• Chronic obstructive pulmonary disease
• CYp2d6 poor metabolizer
• CYp2d6 ultrarapid metabolizer
• Disease of liver
• Drug abuse
• Gastrointestinal obstruction
• History of opioid overdose
• Intracranial hypertension
• Kidney disease with likely reduction in GFR
• Necrotizing enterocolitis
• Obstructive sleep apnea syndrome
• Peptic ulcer
• Protein-calorie malnutrition
• Severe renal impairment
• Shock
• Systemic mastocytosis

Contraindicated

Codeine (analgesic)

Increased risk of CNS and respiratory depression. Contraindicated age < 12 years. Respiratory depression and death reported in CYP2D6 ultra-rapid metabolizers post tonsillectomy or adenoidectomy. Risk increases with obesity, asthma, obstructive sleep apnea or other underlying lung or breathing problem. With any opioid, access to naloxone for emergency reversal can mitigate risk from accidental ingestion/overdose.

• 1 Day – 12 Years
• 1 Increased risk of CNS and respiratory depression. Contraindicated age < 12 years. Respiratory depression and death reported in CYP2D6 ultra-rapid metabolizers post tonsillectomy or adenoidectomy. Risk increases with obesity, asthma, obstructive sleep apnea or other underlying lung or breathing problem. With any opioid, access to naloxone for emergency reversal can mitigate risk from accidental ingestion/overdose.

Severe Precaution

Codeine (analgesic)

Risk of life-threatening respiratory depression, death. Contraindicated post-tonsillectomy and post-adenoidectomy. Avoid in patients with obesity, obstructive sleep apnea, asthma or other underlying breathing problems. Avoid in CYP2D6 ultra-rapid metabolizers. Analgesic use not recommended without prior CYP2D6 testing. Not recommended for cough because benefit does not outweigh risk. With any opioid, access to naloxone for emergency reversal can mitigate risk from accidental ingestion/overdose.

• 12 Years – 18 Years
• Risk of life-threatening respiratory depression, death. Contraindicated post-tonsillectomy and post-adenoidectomy. Avoid in patients with obesity, obstructive sleep apnea, asthma or other underlying breathing problems. Avoid in CYP2D6 ultra-rapid metabolizers. Analgesic use not recommended without prior CYP2D6 testing. Not recommended for cough because benefit does not outweigh risk. With any opioid, access to naloxone for emergency reversal can mitigate risk from accidental ingestion/overdose.

Management or Monitoring Precaution

Acetaminophen (oral,rectal)

Use weight based dosing in children less than 12 years.

Caution in infants with seizure disorder, cardiovascular disease, renal impairment, or hepatic impairment.

Adverse CNS effects (e.g. insomnia, restlessness, nervousness, and mild delirium) may be more severe in children.

• 1 Day – 12 Years
• Use weight based dosing in children less than 12 years.
• 1 Day – 364 Days
• Use weight based dosing in children less than 12 years.
• 1 Years – 13 Years
• Use weight based dosing in children less than 12 years.

Caffeine

Use weight based dosing in children less than 12 years.

Caution in infants with seizure disorder, cardiovascular disease, renal impairment, or hepatic impairment.

Adverse CNS effects (e.g. insomnia, restlessness, nervousness, and mild delirium) may be more severe in children.

• 1 Day – 12 Years
• Caution in infants with seizure disorder, cardiovascular disease, renal impairment, or hepatic impairment.
• Adverse CNS effects (e.g. insomnia, restlessness, nervousness, and mild delirium) may be more severe in children.
• 1 Day – 364 Days
• Caution in infants with seizure disorder, cardiovascular disease, renal impairment, or hepatic impairment.
• Adverse CNS effects (e.g. insomnia, restlessness, nervousness, and mild delirium) may be more severe in children.
• 1 Years – 13 Years
• Caution in infants with seizure disorder, cardiovascular disease, renal impairment, or hepatic impairment.
• Adverse CNS effects (e.g. insomnia, restlessness, nervousness, and mild delirium) may be more severe in children.