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Overview: Acetaminophen/caffeine/dihydrocodeine is a combination medicine used to treat moderate to severe pain. Common side effects may include lightheadedness and dizziness, drowsiness, headache, nausea and vomiting, constipation, and restlessness. Acetaminophen/caffeine/dihydrocodeine may cause serious breathing problems that can be life-threatening, especially in certain people. Get emergency help right away if you notice your skin turning bluish, along with shortness of breath, slow or shallow breathing, fainting, or changes in your heart rhythm.

Uses

What is acetaminophen/caffeine/dihydrocodeine used for?

Acetaminophen/caffeine/dihydrocodeine is commonly used to treat moderate to severe pain.

Acetaminophen/caffeine/dihydrocodeine may also be used for other conditions as determined by your health care provider.

Note: FDA-approved forms of acetaminophen/caffeine/dihydrocodeine have been discontinued and are no longer available in the US.

How does acetaminophen/caffeine/dihydrocodeine work (mechanism of action)?

Acetaminophen and caffeine may block pain signals from getting to your brain. They may also block certain chemicals (prostaglandins) from being made that contribute to pain. Dihydrocodeine attaches to specific receptors in the body to reduce the feeling of pain.

How is acetaminophen/caffeine/dihydrocodeine supplied (dosage forms)?

Brands and other names

  • Panlor DC
  • Panlor SS
  • Trezix
  • Zerlor

Dosage forms and strengths

  • 320.5 mg/30 mg/16 mg oral capsules

How should I store acetaminophen/caffeine/dihydrocodeine?

Acetaminophen/caffeine/dihydrocodeine should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place.

Side Effects

What are the most common side effects of acetaminophen/caffeine/dihydrocodeine?

The most common side effects of acetaminophen/caffeine/dihydrocodeine are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Lightheadedness and dizziness
  • Drowsiness and tiredness
  • Headache
  • Nausea and vomiting
  • Constipation
  • Trouble sleeping (especially when taken later in the day or close to bedtime)
  • Nervousness, restlessness, or irritability

There may be other side effects of acetaminophen/caffeine/dihydrocodeine that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of acetaminophen/caffeine/dihydrocodeine?

While less common, the most serious side effects of acetaminophen/caffeine/dihydrocodeine are described below, along with what to do if they happen.

Severe Allergic Reactions. Acetaminophen/caffeine/dihydrocodeine may cause allergic reactions, which can be serious. Stop taking acetaminophen/caffeine/dihydrocodeine and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching or skin rash
  • Bumps on the skin called hives that can be red, pink, white, or brown depending on your skin tone
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Severe Skin Reactions. Acetaminophen/caffeine/dihydrocodeine can cause severe skin reactions, called Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which can lead to death if not treated. If you get a rash, stop taking acetaminophen/caffeine/dihydrocodeine and call your health care provider right away. Get emergency help if you have any of the following symptoms of SJS or TEN.

  • Painful red or purple skin that looks burned and peels off
  • Flat red rash or blisters on your skin, mouth, nose, and genitals
  • Red, painful, watery eyes
  • Flu-like symptoms, including fever, chills, and muscle aches

Liver Damage. Liver damage, also called hepatotoxicity, can happen when taking acetaminophen/caffeine/dihydrocodeine and may be life-threatening. Risk factors for liver damage include taking too much of this medicine, drinking alcohol while taking it, or taking it with other medicines that contain acetaminophen. Call your health care provider right away if you think you may have taken too much of this medicine or if you have any of the following symptoms of liver damage.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine (pee)
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Breathing Problems. Acetaminophen/caffeine/dihydrocodeine may cause slow or shallow breathing — especially if you have breathing problems from another condition or take other medicines that can slow your breathing. Some people also have certain genes that can cause increased blood levels of the medicine, raising the risk of breathing problems. Ask your health care provider if you have any questions. Tell your health care provider if you develop severe sleepiness or trouble breathing, especially when you start acetaminophen/caffeine/dihydrocodeine or when your dose is increased. Get emergency help if you have any of the following symptoms.

  • Changes in the color of your skin, including a bluish color to your lips and fingernails
  • Confusion
  • Shortness of breath
  • Feeling dizzy, lightheaded, or fainting
  • Changes in your heart rate or rhythm, such as a fast, slow, pounding, or skipping heartbeat
  • Slow or shallow breathing
  • Excessive sleepiness or trouble staying awake

Decreased Alertness or Coordination. Acetaminophen/caffeine/dihydrocodeine can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how acetaminophen/caffeine/dihydrocodeine affects you.

Low Blood Pressure Upon Standing (Orthostatic Hypotension). Acetaminophen/caffeine/dihydrocodeine may cause a sudden drop in blood pressure when standing up from a seated or lying position. To help prevent this, be careful not to get up too quickly. If you feel dizzy, sit or lie down right away until the dizziness stops, then take your time getting up again. Tell your health care provider right away if you have any of the following symptoms of orthostatic hypotension.

  • Dizziness, feeling lightheaded, or fainting upon standing
  • Blurred vision
  • Confusion
  • Feeling weak

Risk of Misuse and Addiction. Misusing acetaminophen/caffeine/dihydrocodeine can lead to serious side effects like coma or death. Misuse means taking a medicine in a way other than how it was prescribed. Take acetaminophen/caffeine/dihydrocodeine exactly as prescribed. Tell your health care provider if you feel that the medicine is not working. Call your health care provider right away or go to the nearest emergency room if you have any of the following serious symptoms.

  • Sudden confusion or feeling disoriented
  • Feeling paranoid
  • Suicidal thoughts or actions
  • Seizures
  • Trouble breathing

Sphincter of Oddi Spasm. The sphincter of Oddi is a muscular valve in your body that controls the flow of bile and digestive juices from the pancreas into the small intestine. When this valve spasms, it may feel like getting a tight muscle cramp, causing pain and blocking the flow of these juices, which can lead to discomfort and digestive problems. This is more likely to happen if you do not have a gallbladder. Stop taking acetaminophen/caffeine/dihydrocodeine and get emergency help if you have new or worse stomach pain or pain in the upper right side of your stomach area that travels to your back or shoulder, with or without nausea and vomiting.

Warnings & Precautions

Who should not use acetaminophen/caffeine/dihydrocodeine?

Allergies to Ingredients. People who are allergic to any of the following should not take acetaminophen/caffeine/dihydrocodeine.

  • Acetaminophen
  • Caffeine
  • Codeine
  • Dihydrocodeine
  • Trezix
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific acetaminophen/caffeine/dihydrocodeine products they stock.

Children Undergoing Surgeries. Acetaminophen/caffeine/dihydrocodeine should not be taken by children who have undergone certain surgeries. If you have a child who takes this medicine, tell their health care provider if you have any planned surgeries for your child.

Breathing Problems. Acetaminophen/caffeine/dihydrocodeine should not be taken if you have breathing problems (respiratory depression), severe asthma, or other lung problems. Taking acetaminophen/caffeine/dihydrocodeine can worsen any breathing problems you have and lead to death.

Slowed Gut Movement. Acetaminophen/caffeine/dihydrocodeine should not be taken if you have paralytic ileus. This is when your intestines are unable to move food through them. Acetaminophen/caffeine/dihydrocodeine can worsen this.

What should I know about acetaminophen/caffeine/dihydrocodeine before using it?

Do not take acetaminophen/caffeine/dihydrocodeine unless it has been prescribed to you by a health care provider. Take it as prescribed.

Do not share acetaminophen/caffeine/dihydrocodeine with other people, even if they have the same condition as you. It may harm them.

Keep acetaminophen/caffeine/dihydrocodeine out of the reach of children. Acetaminophen/caffeine/dihydrocodeine is a controlled substance because it can be misused or lead to dependence. Store acetaminophen/caffeine/dihydrocodeine in a safe place to protect it from theft. It is illegal to sell or give away this medicine.

Acetaminophen/caffeine/dihydrocodeine contains acetaminophen. Acetaminophen (Tylenol) is a medicine used for pain or fever. It can be found in many medicines that you can buy over the counter (OTC). Taking too much acetaminophen can be harmful. To avoid taking too much acetaminophen, talk to your health care provider before you take any other medicine with acetaminophen in it.

Acetaminophen/caffeine/dihydrocodeine can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how acetaminophen/caffeine/dihydrocodeine affects you.

People who are 65 and older or who have certain conditions can be at greater risk of some side effects from acetaminophen/caffeine/dihydrocodeine. Talk to your health care provider about your risks if you are in this age group.

Acetaminophen/caffeine/dihydrocodeine contains dihydrocodeine. Some people have certain genes that cause them to metabolize dihydrocodeine faster than normal, which can lead to serious breathing problems that may be life-threatening, especially in children. Ask your health care provider if you have any questions.

Acetaminophen/caffeine/dihydrocodeine contains caffeine. Caffeine is found in many foods and drinks. Your body handles caffeine the same way whether you eat it, drink it, or take it as a medicine or supplement. Keep track of all sources of caffeine to make sure you are not getting too much. Too much caffeine can be harmful.

Talk to your health care provider about a medicine called naloxone. Naloxone is a medicine that can be used as an emergency treatment for an opioid overdose, including accidental overdoses.

If you have been taking acetaminophen/caffeine/dihydrocodeine regularly, do not stop taking it without talking to your health care provider. Stopping too quickly may cause certain side effects. If you stopped taking acetaminophen/caffeine/dihydrocodeine, call your health care provider right away if you notice any of the following symptoms.

  • Irritability, restlessness, nervousness, or anxiety
  • Trouble sleeping
  • Sweating a lot
  • Feeling of skipped heartbeats
  • Headaches
  • Dizziness

What should I tell my health care provider before using acetaminophen/caffeine/dihydrocodeine?

Tell your health care provider about all of your health conditions and any prescription or OTC medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if acetaminophen/caffeine/dihydrocodeine is right for you.

In particular, make sure that you discuss any of the following.

Other Medicines and Supplements. Acetaminophen/caffeine/dihydrocodeine may interact with other medicines and supplements. Before using/taking acetaminophen/caffeine/dihydrocodeine, tell your health care provider about any prescription or OTC medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Substance Use Disorder or Alcohol Use Disorder. Talk to your health care provider if you have ever had a problem with alcohol, prescription medicines, or street drugs or live with someone who has this problem. Acetaminophen/caffeine/dihydrocodeine has a risk of being misused.

Other Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • Liver, kidney, or adrenal gland problems
  • Head injuries or increased pressure in your skull
  • History of seizures or brain tumor
  • Pancreas or gallbladder problems
  • Breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD)
  • Low blood pressure
  • Thyroid problems
  • Problems peeing or prostate problems
  • Live with someone who misuses alcohol, street drugs, or prescription medicines

Pregnancy. It is not known if or how acetaminophen/caffeine/dihydrocodeine could affect pregnancy or harm an unborn baby. Tell your health care provider if you are pregnant or plan to become pregnant.

Breastfeeding. Acetaminophen/caffeine/dihydrocodeine passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will let you know if you should stop breastfeeding or stop acetaminophen/caffeine/dihydrocodeine. If you are breastfeeding while taking acetaminophen/caffeine/dihydrocodeine, watch your baby for drowsiness and slowed breathing, and get help right away if you notice these things. Your baby may be at higher risk of these problems if you have a certain gene that causes you to metabolize the dihydrocodeine in acetaminophen/caffeine/dihydrocodeine faster than normal. Ask your health care provider if you have any questions.

Interactions

Does acetaminophen/caffeine/dihydrocodeine interact with foods or drinks?

Acetaminophen/caffeine/dihydrocodeine contains caffeine. Caffeine is found in many foods and drinks, including coffee, tea, soda, protein bars, chocolate, and many other products. Your body handles caffeine the same way whether you eat it, drink it, or take it as a medicine or supplement. Keep track of all of your caffeine sources to make sure you are not getting too much. Too much caffeine can be harmful. 

You should not drink alcohol while taking acetaminophen/caffeine/dihydrocodeine. The combination of alcohol and acetaminophen/caffeine/dihydrocodeine can increase your risk of serious side effects, including death.

Does acetaminophen/caffeine/dihydrocodeine interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or OTC medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before taking acetaminophen/caffeine/dihydrocodeine.

  • An opioid, such as codeine, fentanyl, morphine, or oxycodone, which is a medicine used to treat certain types of pain
  • Any medicine that causes dizziness and sleepiness, such as sleep medicines, muscle relaxants, or medicines for anxiety (including benzodiazepines)
  • A medicine used to treat or prevent nausea and vomiting, such as granisetron (Sancuso, Sustol), ondansetron, or palonosetron (Posfrea)
  • A phenothiazine, such as chlorpromazine or prochlorperazine (Compro and others), which is a medicine that may be used to treat certain mental health conditions or severe nausea and vomiting
  • A monoamine oxidase inhibitor (MAOI), which is a medicine usually used for depression or Parkinson’s disease
  • A mixed agonist/antagonist or partial agonist opioid analgesic, such as buprenorphine (Butrans, Sublocade), butorphanol, nalbuphine, pentazocine, and others, which is a medicine used to treat certain types of pain or opioid use disorder
  • Carbamazepine (Carbatrol, Tegretol, and others) or phenytoin (Dilantin, Phenytek, and others), which are medicines used to control seizures
  • A barbiturate, such as butalbital, phenobarbital, or primidone, which is a medicine that may be used to treat insomnia, migraines, or seizures
  • Isoniazid, which is a medicine used to treat an infection called tuberculosis
  • Disulfiram, which is a medicine commonly used to help treat alcohol use disorder
  • A beta-2 agonist, such as albuterol, arformoterol (Brovana), formoterol (Perforomist), levalbuterol (Xopenex HFA), olodaterol (Striverdi), or salmeterol (Serevent), which is a medicine commonly used for asthma or COPD
  • Aspirin, which is in many prescription and OTC products, including those for pain, swelling, and fever

Many other medicines may alter the blood levels of acetaminophen/caffeine/dihydrocodeine and vice versa. Tell your health care provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with acetaminophen/caffeine/dihydrocodeine. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much acetaminophen/caffeine/dihydrocodeine?

If you or someone else has used too much acetaminophen/caffeine/dihydrocodeine, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of acetaminophen/caffeine/dihydrocodeine?

Acetaminophen/caffeine/dihydrocodeine is meant to be used only when needed. Use it as your health care provider recommends. Do not take double or extra doses.