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Acetylsalicylic Acid (375 Mg), Codeine Phosphate (15 Mg), Caffeine (15 Mg*) Tablets

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Acetylsalicylic Acid (375 Mg), Codeine Phosphate (15 Mg), Caffeine (15 Mg*) Tablets Prescribing Information INCLUDING PATIENT MEDICATION INFORMATION N.282® Acetylsalicylic Acid (375 mg), Codeine Phosphate (15 mg), Caffeine (15 mg*) Tablets *equivalent to 30 mg caffeine citrate N.292® Acetylsalicylic acid (375 mg), Codeine Phosphate (30 mg), Caffeine (15 mg*) Tablets *equivalent to 30 mg caffeine citrate ANALGESIC - ANTIPYRETIC PENDOPHARM, Division of Pharmascience Inc. Date of Revision: 6111 Royalmount Ave., Suite 100 Montréal, Québec November 23, 2016 H4P 2T4 Submission Control No.: 195437 282 and 292 are registered trademarks of Pharmascience Inc. TABLE OF CONTENT PART I: HEALTH PROFESSIONAL INFORMATION ......................................................... 3 SUMMARY PRODUCT INFORMATION ........................................................................ 3 INDICATIONS AND CLINICAL USE .............................................................................. 3 CONTRAINDICATIONS ................................................................................................... 4 WARNINGS AND PRECAUTIONS .................................................................................. 5 ADVERSE REACTIONS ................................................................................................. 12 DRUG INTERACTIONS .................................................................................................. 14 DOSAGE AND ADMINISTRATION .............................................................................. 15 OVERDOSAGE ................................................................................................................ 17 ACTION AND CLINICAL PHARMACOLOGY ............................................................ 18 STORAGE AND STABILITY .......................................................................................... 19 DOSAGE FORMS, COMPOSITION AND PACKAGING ............................................. 19 PART II: SCIENTIFIC INFORMATION ............................................................................... 20 PHARMACEUTICAL INFORMATION ......................................................................... 20 PART III: CONSUMER MEDICATION INFORMATION ................................................. 22 282® and 292® Prescribing Information Page 2 of 28 N.282® Acetylsalicylic Acid (375 mg), Codeine Phosphate (15 mg), Caffeine (15 mg*) Tablets *equivalent to 30 mg caffeine citrate N.292® Acetylsalicylic acid (375 mg), Codeine Phosphate (30 mg), Caffeine (15 mg*) Tablets *equivalent to 30 mg caffeine citrate PART I: HEATLH PROFESSIONAL INFORMATION SUMMARY PRODUCT INFORMATION Route of Dosage Form / Strength Administration Nonmedicinal Ingredients Oral 282 tablets Corn starch, disodium EDTA, ethylcellulose, Acetylsalicylic acid 375 mg FD&C Yellow No. 6 and D&C Yellow No. Caffeine 15 mg (equivalent to 10, guar gum, hydrogenated vegetable oil, 30 mg caffeine citrate) monopotassium citrate, sodium lauryl sulfate Codeine phosphate 15 mg 292 tablets Corn starch, disodium EDTA, ethylcellulose, Acetylsalicylic acid 375 mg FDC Yellow No. 6 Lake, guar gum, Caffeine 15 mg (equivalent to hydrogenated vegetable oil, monosodium 30 mg caffeine citrate) citrate, and sodium lauryl sulfate. Codeine phosphate 30 mg INDICATIONS AND CLINICAL USE Adults 282 and 292 (Acetylsalicylic acid, Codeine Phosphate, Caffeine) are indicated for the symptomatic relief of mild to severe pain, fever and inflammation. 282 and 292 are not indicated as an as-needed (prn) analgesic. 282® and 292® Prescribing Information Page 3 of 28 Geriatrics (> 65 years of age) In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, concomitant disease or other drug therapy (see ACTION AND CLINICAL PHARMACOLOGY, Special Populations and Conditions, Geriatrics). Pediatrics (< 18 years of age) The safety and efficacy of 282 and 292 has not been studied in the pediatric population. Therefore the use of 282 and 292 is not recommended in patients under 18 years of age. CONTRAINDICATIONS • Patients who are hypersensitive to the actives substances acetylsalicylic acid (ASA), codeine, caffeine or other opioid analgesics or to any ingredient in the formulation. For a complete listing, see the DOSAGE FORMS, COMPOSITION AND PACKAGING section of the Product Monograph. • Patients with gastrointestinal ulceration • In patients with known or suspected mechanical gastrointestinal obstruction (e.g., bowel obstruction or strictures) or any diseases/conditions that affect bowel transit (e.g., ileus of any type). • Patients with suspected surgical abdomen (e.g., acute appendicitis or pancreatitis). • Patients with mild pain that can be managed with other pain medications. • Patients with acute or severe bronchial asthma, chronic obstructive airway, or status asthmaticus. • Patients with acute respiratory depression, elevated carbon dioxide levels in the blood and cor pulmonale. • Patients with acute alcoholism, delirium tremens, and convulsive disorders. • Patients with severe CNS depression, increased cerebrospinal or intracranial pressure, and head injury. • Patients taking monoamine oxidase (MAO) inhibitors (or within 14 days of such therapy). • Women who are breast-feeding, pregnant or during labour and delivery. Pediatric patients (<18 years of age) who have undergone tonsillectomy and/or adenoidectomy for obstructive sleep apnoea syndrome • Patients with history of blood coagulation defects or receiving anticoagulant drugs or with severe anemia. • Patients who had generalized urticaria, angioedema, severe rhinitis, laryngeal edema or shock precipitated by ASA or other NSAID’s. 282® and 292® Prescribing Information Page 4 of 28 WARNINGS AND PRECAUTIONS SERIOUS WARNINGS AND PRECAUTIONS Limitations of Use Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the risks of overdose and death with immediate release opioid formulations, 282 and 292 (Acetylsalicylic acid, Codeine Phosphate, Caffeine tablets) should only be used in patients for whom alternative treatment options (e.g., non-opioid analgesics) are ineffective, not tolerated, or would be otherwise inadequate to provide appropriate management of pain (see DOSAGE AND ADMINISTRATION). Addiction, Abuse, and Misuse 282 and 292 pose risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Each patient’s risk should be assessed prior to prescribing 282 and 292, and all patients should be monitored regularly for the development of these behaviours or conditions (see WARNINGS AND PRECAUTIONS). 282 and 292 should be stored securely to avoid theft or misuse. Life-threatening Respiratory Depression Serious, life-threatening, or fatal respiratory depression may occur with use of 282 and 292. Patients should be monitored for respiratory depression, especially during initiation of 282 and 292 or following a dose increase. 282 and 292 must be swallowed whole. Cutting, breaking, crushing, chewing, or dissolving 282 and 292 can lead to dangerous adverse events including death (see WARNINGS AND PRECAUTIONS). Accidental Exposure Accidental ingestion of even one dose of 282 and 292, especially by children, can result in a fatal overdose of Codeine Phosphate (see DOSAGE AND ADMINISTRATION, Disposal, for instructions on proper disposal). Neonatal Opioid Withdrawal Syndrome Prolonged maternal use of 282 and 292 during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening (see WARNINGS AND PRECAUTIONS). Interaction with Alcohol The co-ingestion of alcohol with 282 and 292 should be avoided as it may result in dangerous additive effects, causing serious injury or death (see WARNINGS AND PRECAUTIONS and DRUG INTERACTIONS). Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death (see WARNINGS AND PRECAUTIONS, Neurologic and DRUG INTERACTIONS). 282® and 292® Prescribing Information Page 5 of 28 SERIOUS WARNINGS AND PRECAUTIONS Reserve concomitant prescribing of 282 and 292 and benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation General Patients should be instructed not to give 282 and 292 (Acetylsalicylic acid, Codeine Phosphate, Caffeine ) tablets to anyone other than the patient for whom it was prescribed, as such inappropriate use may have severe medical consequences, including death. 282 and 292 should be stored securely to avoid theft or misuse. 282 and 292 should only be prescribed by persons knowledgeable in the continuous administration of potent opioids, in the management of patients receiving potent opioids for the treatment of pain, and in the detection and management of respiratory depression, including the use of opioid antagonists. Patients should be cautioned not to consume alcohol while taking 282 and 292 as it may increase the chance of experiencing serious adverse events, including death. Hyperalgesia that will not respond to a further dose increase of Codeine Phosphate can occur at particularly high doses. A Codeine Phosphate dose reduction or change in opioid may be required. Excessive and prolonged
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