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Aspirin/caffeine/dihydrocodeine (By mouth)

Aspirin (AS-pir-in), Caffeine (KAF-een), Dihydrocodeine Bitartrate (dye-hye-droe-KOE-deen bye-TAR-trate)

Treats moderate to severe pain. Dihydrocodeine is a narcotic pain reliever.

Brand Name(s):

There may be other brand names for this medicine.

When This Medicine Should Not Be Used:

This medicine is not right for everyone. Do not use it if you had an allergic reaction to aspirin, caffeine, codeine, dihydrocodeine, or other NSAIDs, or if you have severe lung or breathing problems, hemophilia, Reye syndrome, and stomach blockage (including paralytic ileus).

How to Use This Medicine:


  • Take your medicine as directed. Your dose may need to be changed several times to find what works best for you.
  • An overdose can be dangerous. Follow directions carefully so you do not get too much medicine at one time.
  • It is best to take this medicine with food or milk.
  • This medicine is not for long-term use.
  • This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.
  • Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Drop off any unused narcotic medicine at a drug take-back location right away. If you do not have a drug take-back location near you, flush any unused narcotic medicine down the toilet. Check your local drug store and clinics for take-back locations. You can also check the DEA web site for locations. Here is the link to the FDA safe disposal of medicines web site:

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

  • Do not use this medicine if you are using or have used an MAO inhibitor within the past 14 days.
  • Some medicines can affect how this medicine works. Tell your doctor if you are using any of the following:
    • Acetazolamide, amiodarone, amphotericin B, bacitracin, carbamazepine, cisplatin, cyclosporine, erythromycin, foscarnet, ketoconazole, methazolamide, methotrexate, mirtazapine, phenytoin, probenecid, quinidine, rifampin, ritonavir, tramadol, trazodone, valproic acid, or vancomycin
    • Aminoglycoside antibiotic
    • Blood pressure medicine
    • Blood thinner (including apixaban, clopidogrel, enoxaparin, heparin, prasugrel, rivaroxaban, warfarin)
    • Diuretic (water pill)
    • Insulin or other diabetes medicine (including glimepiride, glipizide)
    • Medicine for depression (including bupropion, fluoxetine, paroxetine)
    • Other NSAID medicine (including diclofenac, ibuprofen, ketorolac, naproxen)
    • Phenothiazine medicine
    • Steroid medicine (including dexamethasone, hydrocortisone, methylprednisolone, prednisone)
  • Do not drink alcohol while you are using this medicine. Alcohol combined with this medicine may cause life-threatening problems.
  • Tell your doctor if you use anything else that makes you sleepy. Some examples are allergy medicine, narcotic pain medicine, and alcohol. Tell your doctor if you are also using buprenorphine, butorphanol, nalbuphine, pentazocine, or a muscle relaxer.

Warnings While Using This Medicine:

  • Tell your doctor if you are pregnant, or if you have kidney disease, liver disease, blood clotting problems, breathing problems (such as COPD, sleep apnea), heart disease, low blood pressure, gallbladder or pancreas problems, stomach ulcers, or a history of alcohol or drug abuse, brain tumor, head injury, depression, mental health problems, or seizures.
  • Do not breastfeed while you are using this medicine, unless you have your doctor's permission to do so.
  • This medicine may cause the following problems:
    • High risk of overdose, which can lead to death
    • Respiratory depression (serious breathing problem that can be life-threatening)
  • This medicine may make you dizzy, drowsy, or lightheaded. Do not drive or do anything that could be dangerous until you know how this medicine affects you. Sit or lie down if you feel dizzy. Stand up carefully.
  • This medicine can be habit-forming. Do not use more than your prescribed dose. Call your doctor if you think your medicine is not working.
  • Do not stop using this medicine suddenly. Your doctor will need to slowly decrease your dose before you stop it completely.
  • This medicine may cause constipation, especially with long-term use. Ask your doctor if you should use a laxative to prevent and treat constipation.
  • This medicine could cause infertility. Talk with your doctor before using this medicine if you plan to have children.
  • Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:

Call your doctor right away if you notice any of these side effects:

  • Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
  • Extreme dizziness, drowsiness, or weakness, shallow breathing, slow or uneven heartbeat, seizure, sweating, cold, clammy skin
  • Severe confusion
  • Severe constipation, stomach pain, or vomiting
  • Tremors or muscle cramps
  • Trouble breathing or slow breathing

If you notice these less serious side effects, talk with your doctor:

  • Mild constipation, nausea, vomiting

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088

Last Updated: 5/1/2020

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