carisoprodol, aspirin, and codeine

Action and Spectrum

Actions and spectrum: 

carisoprodol, aspirin, and codeine is a combination medication used for the relief of pain associated with musculoskeletal conditions. carisoprodol is a skeletal muscle relaxant which acts centrally, aspirin is a NSAID (nonsteroidal anti-inflammatory drug), and codeine is an opioid pain reliever. 

carisoprodol works by blocking nerve impulses or pain sensations that are sent to the brain. aspirin works by reducing inflammation and pain in the body, while codeine acts by changing the way nervous system and brain respond to pain. 

This combination medication is typically used for short-term treatment (2-3 weeks) of acute painful musculoskeletal conditions, such as muscle spasms, sprains, and strains. It is not recommended for long-term use or for the treatment of chronic pain. 

Drug Interaction

Adverse Reaction

Frequency defined 

>10% 

codeine 

• Drowsiness 
• Constipation 

carisoprodol 

• Drowsiness (13-17%)

1-10% 

codeine 

• Hypotension 
• confusion 
• false feeling of well being 
• lightheadedness 
• paradoxical CNS stimulation 
• rash 
• anorexia 
• vomiting 
• ureteral spasm 
• LFT’s increased 
• weakness 
• Dyspnea 
• tachycardia or bradycardia 
• dizziness 
• Headache 
• malaise 
• Restlessness 
• Urticaria 
• Nausea 
• Xerostomia 
• urination decreased 
• burning at injection site 
• blurred vision 
• histamine release

carisoprodol 

• Headache (3-5%) 
• Dizziness (7-8%)

Frequency not defined 

carisoprodol 

Cardiovascular: syncope, orthostatic hypotension, tachycardia 

allergic reactions: rash, pruritus, dizziness 

central nervous system: irritability, agitation, depression 

gastrointestinal: N/V, weakness, epigastric distress, facial flushing  

aspirin 

stomach pain, nausea, dyspepsia, rash, heartburn, vomiting, tinnitus, urticaria

Black Box Warning

Black Box Warning:  

carisoprodol carries a warning regarding its potential for abuse, dependence, and withdrawal. aspirin carries a warning regarding the risk of bleeding, including gastrointestinal bleeding, and the potential for Reye’s syndrome in children and adolescents with certain viral illnesses.

Codeine carries warnings regarding its potential for abuse, dependence, and respiratory depression, especially in those who are ultra-rapid metabolizers of codeine. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

• Hypersensitivity or allergy to carisoprodol, aspirin, codeine, or any of the other components of the medication 
• Respiratory depression, severe bronchial asthma, or hypercarbia 
• Paralytic ileus 
• Concurrent use of monoamine oxidase (MAO) inhibitors or use within 14 days of discontinuation of these agents 
• Gastrointestinal obstruction, including paralytic ileus 
• Bleeding disorders, coagulation defects, or thrombocytopenia 
• Severe hepatic or renal impairment 
• Pregnancy and breastfeeding.

Caution: 

• Respiratory depression: The combination of aspirin, carisoprodol, and codeine can cause respiratory depression, which can be fatal, especially when taken in high doses or in combination with other CNS depressants. 
• Sedation: aspirin, carisoprodol, and codeine can cause sedation, which can impair mental and physical abilities. Patients should avoid driving or operating heavy machinery till they gets reacted to the medication. 
• Abuse and dependence: carisoprodol and codeine have a high potential for abuse and dependence. Prolonged use or high doses can lead to physical and psychological dependence. 
• Hypotension: The combination of aspirin, carisoprodol, and codeine can cause hypotension, especially in patients with pre-existing hypotension or in those taking other antihypertensive medications. 
• Renal and hepatic impairment: aspirin, carisoprodol, and codeine should be used under caution in patients with renal or hepatic impairment as these conditions can affect the metabolism and excretion of the drugs. 
• Allergic reactions: Patients with a history of hypersensitivity to aspirin or codeine should avoid using this medication combination. 
• Pregnancy and lactation: carisoprodol, aspirin, and codeine should be used under caution during pregnancy and lactation as they can cross the placenta and are excreted in breast milk. The risks and benefits of using this medication combination should be weighed carefully in these populations.

Comorbidities: 

• Respiratory disorders: Codeine is a narcotic that can depress respiration. Patients with respiratory disorders such as asthma, COPD, or sleep apnea may be at increased risk of respiratory depression when taking carisoprodol, aspirin, and codeine. 
• Liver and kidney disease: aspirin and codeine are metabolized by liver and excreted by the kidneys. Patients with liver or kidney disease may be at increased risk of toxicity or adverse effects. 
• History of substance abuse: carisoprodol, aspirin, and codeine all have potential for abuse and addiction. Patients with a history of substance abuse should be closely monitored when taking this medication. 
• Cardiovascular disease: aspirin can increase the risk of bleeding, which may be a concern for patients with cardiovascular disease, particularly those taking anticoagulant medications. 
• Pregnancy and breastfeeding: The safety of carisoprodol, aspirin, and codeine during pregnancy and breastfeeding is not well established. It should be used with caution and only if the benefits outweigh the risks. 
• Older adults: older adults are more susceptible to the side effects of carisoprodol, aspirin, and codeine, particularly respiratory depression, and sedation. Dosing should be adjusted accordingly, and close monitoring is recommended. 

Pregnancy / Lactation

Pregnancy consideration: pregnancy category D drug. 

Lactation: not recommended as its gets excreted into breast milk.  

Pregnancy category: 

• Category A: Satisfactory and well-controlled studies show no risk to the fetus in the first or later trimester. 
• Category B: There is no evidence of risk to the fetus found in animal reproduction studies and there are not enough studies on pregnant women. 
• Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for an effect in humans, care must be taken for potential risks in pregnant women 
• Category D: There is adequate data available with sufficient evidence of human fetal risk from various platforms, but despite potential risks may be used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh risks over benefits These category drugs should be prohibited for pregnant women. 
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

• carisoprodol, aspirin, and codeine is a combination medication used for the relief of pain associated with acute, painful musculoskeletal conditions. 
• carisoprodol is a centrally acting muscle relaxant that acts by blocking pain sensations between the nerves and the brain.
• aspirin is a NSAID (nonsteroidal anti-inflammatory drug) that reduces inflammation, fever, and pain by blocking prostaglandins, which are chemicals that cause inflammation in the body.
• Codeine is a narcotic pain reliever that acts by binding to opioid receptors, which results in a reduction of pain perception.  

Pharmacodynamics: 

carisoprodol, aspirin, and codeine are combination drugs that work through their individual pharmacodynamic effects. carisoprodol is a skeletal muscle relaxant which acts centrally that works by inhibiting the interneuronal activity in the descending reticular formation and spinal cord.

It produces sedation and alters pain perception. aspirin, on the other hand, is a nonsteroidal anti-inflammatory drug (NSAID) that acts as an inhibitor of cyclooxygenase enzyme, which is responsible for the production of prostaglandins. Codeine is an opioid agonist that works by binding to mu-opioid receptors in the central nervous system, which results in analgesia, sedation, and a decrease in cough reflex.  

Pharmacokinetics: 

carisoprodol 

• Absorption: Rapidly absorbed from the gastrointestinal tract. 
• Distribution: Widely distributed to body tissues, including the CNS. 
• Metabolism: Metabolized in the liver to its active metabolite meprobamate, which is also a muscle relaxant and can cause CNS depression. 
• Elimination: Eliminated in the urine as meprobamate. 

aspirin 

• Absorption: Rapidly absorbed from the gastrointestinal tract. 
• Distribution: Widely distributed to body tissues, including the CNS. 
• Metabolism: Metabolized in the liver to salicylic acid. 
• Elimination: Eliminated in the urine as salicylic acid. 

codeine 

• Absorption: Rapidly absorbed from the gastrointestinal tract. 
• Distribution: Widely distributed to body tissues, including the CNS. 
• Metabolism: Metabolized in the liver to its active metabolite morphine, which is responsible for its analgesic effects. 
• Elimination: Eliminated in the urine as morphine. 

Adminstartion

Administration: 

carisoprodol, aspirin, and codeine is available in tablet form and is typically taken orally every 4-6 hours as needed for pain. The medication should be taken with food or milk to reduce the risk of gastrointestinal side effects. It should not be taken with alcohol or other sedative medications.

The dose should be adjusted based on individual response and should not exceed the maximum recommended daily dose. It is important to follow the prescribing instructions and consult with a healthcare provider before taking this medication. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: carisoprodol, aspirin, and codeine 

Pronounced: [ kar-EYE-soe-PROE-dol, AS-pir-in, and-KOE-deen ]  

Why do we use carisoprodol, aspirin, and codeine? 

carisoprodol, aspirin, and codeine is a combination medication used to treat pain and discomfort caused by muscle spasms. Codeine is an opioid pain medication that acts by binding to opioid receptors and reducing pain perception.

aspirin is a NSAID (nonsteroidal anti-inflammatory drug) that acts by blocking the production of prostaglandins, which are chemicals that cause pain and inflammation in the body. carisoprodol is a muscle relaxant that acts by blocking pain sensations between the nerves and brain.