Consumer medicine information

Chemists' Own Paracetamol Extra

Paracetamol; Caffeine

BRAND INFORMATION

Brand name

Chemists' Own Paracetamol Extra

Active ingredient

Paracetamol; Caffeine

Schedule

S2

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Chemists' Own Paracetamol Extra.

SUMMARY CMI

CHEMISTS' OWN PARACETAMOL EXTRA

Consumer Medicine Information (CMI) summary

The full CMI on the next page has more details. If you are worried about using this medicine, speak to your doctor or pharmacist.

1. Why am I using Chemists' Own Paracetamol Extra?

This medicine contains the active ingredients paracetamol and caffeine. This medicine is used for the temporary relief of pain and discomfort associated with headache, tension headache, migraine headache, osteoarthritis, arthritis, cold & flu symptoms, toothache, dental procedures, muscular aches, sore throat and period pain. Reduces fever.

For more information, see Section 1. Why am I using Chemists' Own Paracetamol Extra? in the full CMI.

2. What should I know before I use Chemists' Own Paracetamol Extra?

Do not use if you have ever had an allergic reaction to paracetamol, caffeine or any of the ingredients listed at the end of the CMI.

Talk to your doctor or pharmacist if you have any other medical conditions, take any other medicines, or are pregnant or plan to become pregnant or are breastfeeding. For more information, see Section 2. What should I know before I use Chemists' Own Paracetamol Extra? in the full CMI.

3. What if I am taking other medicines?

Some medicines may interfere with Chemists' Own Paracetamol Extra and affect how it works.

A list of these medicines is in Section 3. What if I am taking other medicines? in the full CMI.

4. How do I use Chemists' Own Paracetamol Extra?

  • The label on the pack will tell you how to take your medicine and how often. If you are unsure about the directions ask your pharmacist or doctor.

More instructions can be found in Section 4. How do I use Chemists' Own Paracetamol Extra? in the full CMI.

5. What should I know while using Chemists' Own Paracetamol Extra?

Things you should do
  • Take this medicine exactly as directed.
  • Remind any doctor, dentist or pharmacist you visit that you are using this medicine.
Things you should not do
  • Do not take more than the recommended dose unless your doctor tells you to.
  • Adults – Do not take this medicine for longer than a few days at a time unless advised to do so by a doctor.
  • In children and adolescents, do not give this medicine for longer than 48 hours unless advised to do so by a doctor.
  • Adults and Children 12 years of age and over – Take 2 tablets every 4 to 6 hours (as required) with water. Do not take more than 8 tablets in 24 hours.
  • Children under 12 years: Not recommended for children under 12 years of age
Drinking alcohol
  • Only drink small quantities of alcohol (beer, wine or spirits) while using paracetamol.
  • Drinking large quantities of alcohol while taking paracetamol may increase the risk of liver side effects.
Looking after your medicine
  • Store below 25°C.
  • Keep your tablets in the blister pack until it is time to take them.

For more information, see Section 5. What should I know while using Chemists' Own Paracetamol Extra? in the full CMI.

6. Are there any side effects?

  • Less serious side effects include nausea and stomach pain.
  • Tell your doctor or pharmacist immediately if you notice any of the following side effects shortness of breath, wheezing or difficulty breathing, swelling of the face, lips, tongue, or other parts of the body, rash, itching or hives on the skin. This may be the signs of an allergic reaction.

For more information, including what to do if you have any side effects, see Section 6. Are there any side effects? in the full CMI.



FULL CMI

CHEMISTS' OWN PARACETAMOL EXTRA

Active ingredients: Paracetamol and caffeine


Consumer Medicine Information (CMI)

This leaflet provides important information about using this medicine. You should also speak to your doctor or pharmacist if you would like further information or if you have any concerns or questions about using this medicine.

Where to find information in this leaflet:

1. Why am I using Chemists' Own Paracetamol Extra?
2. What should I know before I use Chemists' Own Paracetamol Extra?
3. What if I am taking other medicines?
4. How do I use Chemists' Own Paracetamol Extra?
5. What should I know while using Chemists' Own Paracetamol Extra?
6. Are there any side effects?
7. Product details

1. Why am I using Chemists' Own Paracetamol Extra?

This medicine contains the active ingredients paracetamol and caffeine. Paracetamol is an analgesic. Analgesics provide effective temporary relief from pain. Caffeine acts as an analgesic adjuvant which enhances the effect of paracetamol.

This medicine is used for the temporary relief of pain and discomfort associated with headache, tension headache, migraine headache, osteoarthritis, arthritis, cold & flu symptoms, toothache, dental procedures, muscular aches, sore throat and period pain. This medicine also reduces fever.

2. What should I know before I use Chemists' Own Paracetamol Extra?

Warnings

Do not use this medicine if:

  • you are allergic to paracetamol, caffeine or any of the ingredients listed at the end of this leaflet.
    The symptoms of an allergic reaction may include:
    - shortness of breath wheezing or difficulty breathing
    - swelling of the face, lips, tongue or other parts of the body
    - rash, itching or hives on the skin
  • Always check the ingredients to make sure you can use this medicine.
  • Do not take this medicine if you have liver or kidney problems.
  • Do not take this medicine if you have glucose-6-phosphatedehydrogenase deficiency (an enzyme deficiency).
  • You are under 12 years.
  • You are taking any other medicines containing paracetamol or caffeine.
  • You are pregnant, except on medical advice.
  • Do not use this medicine if the packaging is torn or shows signs of tampering.
  • Do not use this medicine after the expiry date (EXP) printed on the pack. If it has expired or is damaged, return it to your pharmacist for disposal.

If you are not sure whether you should start taking this medicine, talk to your pharmacist or doctor.

Check with your doctor or pharmacist if you:

  • Have allergies to any ingredients listed under Product Details at the end of this leaflet
  • Have allergies to aspirin or any other NSAID medicine
  • Have liver or kidney problems
  • Have low glutathione reserves
  • Have Gilbert's syndrome
  • Have acute breathing difficulties such as bronchitis,
  • unstable asthma or emphysema
  • Drink large quantities of alcohol
  • Take any medicines for any other condition

During treatment, you may be at risk of developing certain side effects. It is important you understand these risks and how to monitor for them. See additional information under Section 6. Are there any side effects?

Pregnancy and breastfeeding

Check with your doctor or pharmacist if you are pregnant or intend to become pregnant or if you are breastfeeding or intend to breastfeed.

Your pharmacist or doctor will discuss the benefits and possible risks of taking this medicine during pregnancy.

Consider taking the lowest effective dose for the shortest period of time.

3. What if I am taking other medicines?

Tell your doctor or pharmacist if you are taking any other medicines, including any medicines, vitamins or supplements that you buy without a prescription from your pharmacy, supermarket or health food shop.

Some medicines may interfere with Chemists' Own Paracetamol Extra and affect how it works.

These include:

  • Any medicines which thin the blood, for example warfarin
  • Metoclopramide or domperidone, medicines used to control nausea and vomiting
  • Medicines used to treat epilepsy or fit
  • Propantheline, a drug used to treat stomach ulcers
  • Other pain relief medication
  • Alcohol and medicines containing alcohol (ethanol) e.g. some cough syrups
  • Medicines used to treat depression
  • Medicines used to aid sleep
  • Chloramphenicol, an antibiotic used to treat ear and eye infections
  • Flucloxacillin, zidovudine and rifampicin, drugs used to treat infections
  • Probenecid, a drug used to treat high uric acid levels in the blood associated with gout
  • Cholestyramine, a drug used to reduce blood cholesterol
  • Chelating resin

Check with your doctor or pharmacist if you are not sure about what medicines, vitamins or supplements you are taking and if these affect this medicine.

4. How do I use Chemists' Own Paracetamol Extra?

How much to take

Adults and children aged 12 years and over:

Take 2 tablets every 4 to 6 hours (as required) with water.

Do not take more than 8 tablets in 24 hours.

Do not take for more than a few days at a time in adults and more than 48 hours in children aged 12-17, except on medical advice.

Do not exceed the stated dose and do not take more frequently than every 4 hours.

Do not take this product with any other product containing paracetamol.

Limit the use of caffeine containing products (including tea and coffee) when taking Chemists' Own Paracetamol Extra.

Not recommended in children under the age of 12 years.

You should follow the instructions on the label unless your doctor advises otherwise.

This preparation is for the relief of minor and temporary ailments and should be used strictly as directed. Prolonged use without medical supervision could be harmful. Do not give to children.

If symptoms persist or worsen, please consult your doctor.

When to take this medicine

  • The label on the pack will tell you how to take your medicine and how often. If you are unsure about the directions ask your pharmacist or doctor.

Your doctor may ask you to take a different dose. If so, you should follow the doctor's instructions.

If you are unsure what dose to take ask your pharmacist.

If you forget to use this medicine

If you miss a dose, take it as soon as you remember.

If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to.

Do not take a double dose to make up for the dose you missed. Your next dose should be taken in 4 hours if you think you need it.

If you use too much medicine

If you think that you have used too much medicine, you may need urgent medical attention.

You should immediately:

  • phone the Poisons Information Centre
    (by calling 13 11 26), or
  • contact your doctor, or
  • go to the Emergency Department at your nearest hospital.

You should do this even if there are no signs of discomfort or poisoning.

5. What should I know while using Chemists' Own Paracetamol Extra?

Things you should do

  • Take this medicine exactly as directed.

Remind any doctor, dentist or pharmacist you visit that you are using this medicine.

Things you should not do

  • Do not take more than the recommended dose unless your doctor tells you to.
  • Give this medicine to anyone else, even if their symptoms seem similar to yours
  • Take your medicine to treat any other complaints unless your doctor or pharmacist tells you to.

Children 12 to 17 years:

  • Do not give this medicine for more than 48 hours unless a doctor has told you to.

Adults:

  • Do not take for more than a few days at a time unless your doctor tells you to.

Drinking alcohol

Only drink small quantities of alcohol (beer, wine or spirits) while using paracetamol.

Drinking large quantities of alcohol while taking paracetamol may increase the risk of liver side effects.

Looking after your medicine

  • Keep your tablets in the pack until it is time to take them.
  • If you take the tablets out of the pack they will not keep well.
  • Store below 25°C.

Follow the instructions on the pack on how to take care of your medicine properly.

Store it in a cool dry place away from moisture, heat or sunlight; for example, do not store it:

  • in the bathroom or near a sink, or
  • in the car or on window sills.

Keep it where young children cannot reach it.

Getting rid of any unwanted medicine

If you no longer need to use this medicine or it is out of date, take it to any pharmacy for safe disposal.

Do not use this medicine after the expiry date.

6. Are there any side effects?

All medicines can have side effects. If you do experience any side effects, most of them are minor and temporary. However, some side effects may need medical attention.

See the information below and, if you need to, ask your doctor or pharmacist if you have any further questions.

Less serious side effects

Less serious side effectsWhat to do
General
  • Nausea and vomiting
  • Sweating
Gut related
  • Stomach pain
  • Indigestion

If you have drinks or food containing caffeine while you are taking this medicine, you may experience caffeine-related side effects such as:

  • Sleeplessness
  • Restlessness
  • Anxiety
  • Irritability
  • Headaches
  • Stomach upsets
  • Fast heartbeat
Speak to your doctor or pharmacist if you have any of these less serious side effects and they worry you.

Serious side effects

Serious side effectsWhat to do
Skin related
  • Skin rashes
  • Painful red areas with blisters and peeling layers of skin which may be accompanied by fever and/or chills
Liver related:
  • Hepatitis (symptoms include loss of appetite, itching, yellowing of the skin and eyes, light coloured bowel motions, dark coloured urine)
Metabolism Related
  • Symptoms of rapid breathing, rapid heart rate and changes in consciousness caused by pyroglutamic acidosis (an accumulation of pyroglutamic acid due to low levels of a protein called glutathione).
Allergic reaction
  • Shortness of breath
  • wheezing or difficulty breathing
  • swelling of the face, lips, tongue or other parts of the body
  • Severe blisters and bleeding in the lips, eyes, mouth, nose and genitals
  • Rash, itching or hives on the skin
Call your doctor straight away, or go straight to the Emergency Department at your nearest hospital if you notice any of these serious side effects.

Tell your doctor or pharmacist if you notice anything else that may be making you feel unwell.

Other side effects not listed here may occur in some people.

Reporting side effects

After you have received medical advice for any side effects you experience, you can report side effects to the Therapeutic Goods Administration online at www.tga.gov.au/reporting-problems. By reporting side effects, you can help provide more information on the safety of this medicine.

7. Product details

This medicine is available over-the-counter without a doctor's prescription.

What Chemists' Own Paracetamol Extra contains

Active ingredients
(main ingredients)
  • Paracetamol 500mg
  • Caffeine 65 mg
Other ingredients
(inactive ingredients)
  • Croscarmellose sodium
  • Maize starch
  • Potassium sorbate
  • Povidone
  • Purified talc
  • Stearic acid
  • Hypromellose
  • Propylene glycol
  • Macrogol 6000
  • Titanium dioxide
Potential allergens
  • Potassium sorbate

Do not take this medicine if you are allergic to any of these ingredients.

What Chemists' Own Paracetamol Extra looks like

CHEMISTS' OWN PARACETAMOL EXTRA is white colour, capsule shaped film coated tablets debossed “PC 65” on one side and scored on other side (AUST R 255294).

Who distributes Chemists' Own Paracetamol Extra

Arrotex Pharmaceuticals Pty Ltd
15-17 Chapel Street
Cremorne, Victoria 3121
www.arrotex.com.au

This leaflet was prepared in May 2024.

Published by MIMS April 2025

BRAND INFORMATION

Brand name

Chemists' Own Paracetamol Extra

Active ingredient

Paracetamol; Caffeine

Schedule

S2

 

1 Name of Medicine

Paracetamol and caffeine.

2 Qualitative and Quantitative Composition

Each tablet contains paracetamol 500 mg and caffeine 65 mg.

Excipients with known effect.

Potassium sorbate.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

White colour, capsule shaped film coated tablets debossed "PC 65" on one side and scored on other side.

4 Clinical Particulars

4.1 Therapeutic Indications

For the temporary relief of pain and discomfort associated with headache, tension headache, migraine headache, osteoarthritis, arthritis, cold and flu symptoms, toothache, dental procedures, muscular aches, sore throat and period pain. Reduces fever.

4.2 Dose and Method of Administration

Dosage.

For adults and children 12 years and older.
2 tablets every 4 to 6 hours (as required) with water. Maximum of 8 tablets in 24 hours. Not recommended in children under the age of 12 years.

4.3 Contraindications

This medication is contraindicated in patients who are hypersensitive to paracetamol, caffeine or to any of the excipients of this medicine. It must not be used in patients with known glucose-6-phosphate-dehydrogenace deficiency. This medicine must not be used in patients with impaired liver function.

4.4 Special Warnings and Precautions for Use

This medication may be dangerous when used in large amounts or for long periods. Hepatotoxicity may occur with paracetamol even at therapeutic doses, after short treatment duration and in patients without pre-existing liver dysfunction. Hepatotoxicity may develop following as little as 10 to 15 g of paracetamol and hepatic failure is known to occur occasionally with long term use of paracetamol.

To avoid the risk of overdose.

Check that paracetamol is absent from the composition of other medicinal products taken concomitantly.
Patients with known analgesic intolerance or known bronchial asthma must only use this medication after having consulted a physician (hypersensitivity reactions including bronchospasm possible).
Caution is advised in patients with underlying sensitivity to aspirin and/or to non-steroidal anti-inflammatory drugs (NSAIDs).

Severe cutaneous adverse reactions (SCARs).

Life threatening cutaneous reactions Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) have been reported with the use of paracetamol. Patients should be advised of the signs and symptoms and monitored closely for skin reactions. If symptoms or signs of SJS and TEN (e.g. progressive skin rash often with blisters or mucosal lesions) occur, patients should stop paracetamol treatment immediately and seek medical advice.
Paracetamol should be used upon medical advice in patients with:
severe renal insufficiency;
chronic alcohol use including recent cessation of alcohol intake;
low glutathione reserves;
Gilbert's syndrome.
Excessive intake of caffeine (e.g. coffee, tea and some canned drinks) should be avoided while taking this product. If symptoms persist, medical advice must be sought.
Keep out of sight and reach of children.

Use in hepatic impairment.

This medication should not be administered to patients with hepatic dysfunction (see Section 4.3 Contraindications).

Use in renal impairment.

This medication should not be administered to patients with renal dysfunction (see Section 4.3 Contraindications).

Use in the elderly.

No data available.

Paediatric use.

Not recommended in children under the age of 12 years.

Effects on laboratory tests.

Uric acid and blood glucose.

Intake of paracetamol may affect the laboratory determination of uric acid by phosphotungstic acid and of blood glucose by glucose oxidase-peroxidase.

4.5 Interactions with Other Medicines and Other Forms of Interactions

Paracetamol may increase the risk of bleeding in patients taking warfarin and other antivitamin K. Anticoagulant dosage may require reduction and patients should be monitored for appropriate coagulation and bleeding complications.
Paracetamol absorption is increased by drugs which increase gastric emptying e.g. metoclopramide and domperidone and decreased by drugs which decrease gastric emptying e.g. propantheline, antidepressants with anticholinergic properties, narcotic analgesics.
Paracetamol may increase chloramphenicol concentrations by slowing down excretion, entailing the risk of increased toxicity. The risk of paracetamol toxicity may be increased in patients receiving other potentially hepatoxic drugs or drugs that induce liver microsomal enzymes, such as antiepileptics (such as phenobarbital, phenytoin, carbamazepine, topiramate), barbiturates, hypnotics, rifampicin and alcohol.
Paracetamol excretion may be affected and plasma concentrations altered when given probenecid.
Cholestyramine reduces the absorption of paracetamol if given within 1 hour of paracetamol. Chelating resins can decrease the intestinal absorption of paracetamol and potentially decrease its efficacy if taken simultaneously. In general, there must be an interval of more than 2 hours between taking the resin and taking paracetamol, if possible.
Co-administration of flucloxacillin with paracetamol may lead to metabolic acidosis, particularly in patients presenting risk factors of glutathione depletion, such as sepsis, malnutrition or chronic alcoholism.
When used concurrently with zidovudine, an increased tendency for neutropenia may develop. Combination of paracetamol and zidovudine should be avoided.
Caffeine undergoes extensive metabolism by hepatic microsomal cytochrome P450 isoenzyme CYP1A2, and is subject to numerous interactions with other drugs and substances which enhance or reduce its metabolic clearance.
No potentially hazardous interactions with caffeine have been reported. However, patients who take medicines that decrease caffeine elimination may need to limit caffeine intake to avoid adverse events.
Caffeine may increase the elimination of lithium from the body. Concomitant use is therefore not recommended.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

No data available.
(Category A)
Both paracetamol and caffeine have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations.
Animal studies have shown an association between caffeine intake and foetal abnormalities, but only at very high doses that are not considered relevant to human consumption.
There is limited evidence that maternal caffeine intake during pregnancy may reduce birthweight. One review article indicated a correlation between caffeine consumption during pregnancy and a decrease in birthweight due to the vasoconstrictive effect of caffeine on placental circulation. Other reviews have found no correlation between caffeine intake in pregnancy and birthweight.
Paracetamol/ caffeine is not recommended for use during pregnancy due to the possible increased risk of spontaneous abortion associated with caffeine consumption.
Paracetamol is excreted in breast milk. The amount available for ingestion by the infant has been reported variously as less than 0.1% of a single dose of paracetamol 500 mg and as 0.04 to 0.23% of a single 650 mg dose. Maternal ingestion of paracetamol in usual analgesic doses does not appear to present a risk to the nursing infant.
Caffeine is excreted in breast milk. Studies examining the transfer of caffeine into breast milk after oral doses of 35 to 336 mg of caffeine have recorded peak maternal plasma concentrations of 2.4 to 4.7 microgram/mL, peak maternal saliva concentrations of 1.2 to 9.2 microgram/mL, and peak breast milk concentrations of 1.4 to 7.2 microgram/mL. At these concentrations in breast milk, the calculated daily caffeine ingestion by breastfed infants ranged from 1.3 to 3.1 mg, which was not thought to present a hazard, although irritability and a poor sleeping pattern have been reported. The American Academy of Pediatrics states that caffeine is excreted slowly by the infant and may be associated with irritability and poor sleeping pattern when ingested by breastfeeding mothers. However, no effects occur with moderate intake of caffeinated beverages (2 to 3 cups daily) and caffeine is usually compatible with breastfeeding.
Caffeine in breast milk may potentially have a stimulating effect on breast fed infants but significant toxicity has not been observed.

4.7 Effects on Ability to Drive and Use Machines

This medication has no influence on the ability to drive or use machines.

4.8 Adverse Effects (Undesirable Effects)

Events reported from extensive post marketing experience at therapeutic/ labelled dose and considered attributable are listed below by system organ class and frequency.
The following convention has been utilised for the classification of undesirable effects: very common (≥ 1/10), common (≥ 1/100, < 1/10), uncommon (≥ 1/1000, < 1/100), rare (≥ 1/10,000, < 1/1000), very rare (< 1/10,000), not known (cannot be estimated from available data).
Adverse event frequencies have been estimated from spontaneous reports received through post marketing data.

Paracetamol.

Blood and lymphatic system disorders.

Very rare: thrombocytopenia.

Immune system disorders.

Very rare: anaphylaxis, cutaneous hypersensitivity reactions including skin rashes, angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN).

Respiratory, thoracic and mediastinal disorders.

Very rare: bronchospasm, especially in patients sensitive to aspirin and other NSAIDs.

Hepatobiliary disorders.

Very rare: hepatic dysfunction.

Caffeine.

Central nervous system.

Not known: nervousness, dizziness.
When the recommended paracetamol/caffeine dosing regimen is combined with dietary caffeine intake, the resulting higher dose of caffeine may increase the potential for caffeine related adverse effects such as insomnia, restlessness, anxiety, irritability, headaches, gastrointestinal disturbances and palpitations.

Reporting suspected adverse effects.

Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at http://www.tga.gov.au/reporting-problems.

4.9 Overdose

Paracetamol.

Elderly persons, small children, patients with liver disorders, chronic alcohol consumption or chronic malnutrition, as well as patients concomitantly treated with enzymes-inducing drugs are at an increased risk of intoxication, including fatal outcome.
Symptoms. Toxic symptoms include vomiting, abdominal pain, hypotension and sweating. Nausea, vomiting, anorexia, pallor and abdominal pain generally appear during the first 24 hours of overdosage with paracetamol. Overdosage with paracetamol may cause hepatic cytolysis which can lead to hepatocellular insufficiency, gastrointestinal bleeding, metabolic acidosis, encephalopathy, disseminated intravascular coagulation, coma and death. Increased levels of hepatic transaminases, lactate dehydrogenase and bilirubin with a reduction in prothrombin level can appear 12 to 48 hours after acute overdosage. Overdosage can also lead to pancreatitis acute renal failure and pancytopenia. The most serious adverse effect of acute overdosage of paracetamol is a dose-dependent, potentially fatal hepatic necrosis. In adults, hepatotoxicity may occur after ingestion of a single dose of 12 g (24 tablets) of paracetamol; a dose of 25 g (50 tablets) or more is potentially fatal. Symptoms during the first 2 days of acute poisoning by paracetamol do not reflect the potential seriousness of the intoxication. Major manifestations of liver failure such as jaundice, hypoglycaemia and metabolic acidosis may take at least 3 days to develop.
Treatment. Despite lack of significant early symptoms, patients should be referred to hospital urgently for immediate medical attention.
Determinations of the plasma concentration of paracetamol are recommended. Plasma concentration of paracetamol should be measured at 4 hours or later after ingestion (earlier concentrations are unreliable).
Where paracetamol intoxication is suspected, intravenous administration of SH group donators such as acetylcysteine within the first 10 hours after ingestion is indicated. Although acetylcysteine is most effective if initiated within this period, it can still offer some degree of protection if given as late as 48 hours after ingestion; in this case it is taken for longer.
If the history suggests that 12 g paracetamol or more has been ingested, administer one of the following antidotes:

Acetylcysteine 20% iv.

Administer intravenously, 20% acetylcysteine immediately without waiting for positive urine test or plasma level results. For dosage instructions refer to the acetylcysteine 20% iv product information.

Oral methionine.

For dosage instructions refer to the methionine product information.
Further measures will depend on the severity, nature and course of clinical symptoms of intoxication and should follow standard intensive care protocols.

Caffeine.

Overdose of caffeine may result in epigastric pain, vomiting, diuresis, tachycardia or cardiac arrhythmia, CNS stimulation (insomnia, restlessness, excitement, agitation, anxiety, tremors and convulsions).
For clinically significant symptoms of caffeine overdose to occur, the amount ingested would be associated with serious paracetamol-related liver toxicity.
For information on the management of overdose, contact the Poisons Information Centre on 131126 (Australia).

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Mechanism of action.

Paracetamol is a para-aminophenol derivative that exhibits analgesic and antipyretic activity. It inhibits prostaglandin synthetase in the hypothalamus, prevents synthesis of spinal prostaglandin and inhibits inducible nitric oxide synthesis in macrophages. Paracetamol has minimal anti­-inflammatory action. Caffeine acts as an analgesic adjuvant which enhances the efficacy of paracetamol.

Clinical trials.

A meta-analysis to determine the analgesic effect of the combined dosage of paracetamol (1000 mg) and caffeine (130 mg) versus paracetamol (1000 mg) alone has been undertaken. The primary outcome of the meta-analysis was to determine whether the use of paracetamol plus caffeine provided significantly superior analgesia over paracetamol alone in acute pain states.
Inclusion criteria were full journal publications reporting the results of randomised, controlled, double blind trials comparing the two treatments.
The clinical measure selected was the > 50% max TOTPAR (i.e. the number of patients in the two groups who achieved at least 50% of the maximal pain relief). The dichotomous descriptor of > 50% max TOTPAR was chosen because it is a simple clinical end point of half pain relieved. It is a well defined clinical measure of pain relief and can be used to evaluate the comparative benefit of contrasting medications.
Of the seven papers describing double blind trials, four papers met the inclusion criteria for the meta-analysis and contained eight separate studies. These eight studies spanned a number of different pain states; postpartum pain (n = 3), headache (n = 2), dental pain (n = 2) and dysmenorrhoea (n = 1).
All of the eight studies included in the meta-analysis provided efficacy results as mean TOTPAR values over 0-4 hours. The total number of patients evaluated was 1265 (paracetamol plus caffeine) and 1268 (paracetamol alone). Using the endpoint of at least half pain relief achieved (at least 50% max TOTPAR), the odds ratio of a greater likelihood of effect of the paracetamol/ caffeine combination compared to paracetamol alone is 1.34 (95% CI 1.14, 1.58). This corresponds to a relative benefit of 1.12 (95% CI 1.05-1.19). Analgesic efficacy has also been determined as the number needed to treat (NNT). For the comparison of the paracetamol/ caffeine combination with paracetamol alone, the NNT for at least 50% pain relief achieved over 0-4 hours is 14.
Compared with placebo, the relative benefit for the paracetamol/ caffeine combination is 1.42 (95% CI 1.29-1.56) and the NNT for at least 50% pain relief achieved over 0-4 hours is 5. For paracetamol alone compared with placebo, the relative benefit is 1.27 (95% CI 1.15-1.40) and the NNT is 81.
The meta-analysis indicated that the combination of paracetamol and caffeine has an added benefit in analgesic activity compared to paracetamol alone.
Time effect curves for pain relief were presented in all eight of the studies included in the meta-analysis. Overall, these studies suggested that combining paracetamol with caffeine results in an earlier analgesic effect than is achieved with paracetamol alone.
1 Palmer H, Graham G, Williams and Day R (2010). A risk-based assessment of paracetamol (acetaminophen) combined with caffeine. Pain Medicine 11: 951-965'.

5.2 Pharmacokinetic Properties

Absorption.

After oral administration, paracetamol is absorbed rapidly and completely from the small intestine; peak plasma levels occur 10 to 60 minutes after administration. Food intake delays paracetamol absorption.
Caffeine is absorbed readily after oral administration. Maximal plasma concentrations are achieved in adults within one hour and the plasma half-life is about 3 to 7 hours.

Distribution.

Paracetamol is uniformly distributed throughout most body fluids; the apparent volume of distribution is 1 to 1.2 L/kg. Paracetamol can cross the placenta and is excreted in breast milk. Plasma protein binding is negligible at usual therapeutic concentrations but increases with increasing concentrations.

Metabolism.

Paracetamol is metabolised by the hepatic microsomal enzyme system. In adults at therapeutic doses, paracetamol is mainly conjugated with glucuronide (45 to 55%) or sulfate (20 to 30%). A minor proportion (less than 20%) is metabolised to catechol derivatives and mercapturic acid compounds via oxidation. Paracetamol is metabolised differently by infants and children compared to adults, the sulfate conjugate being predominant.
Caffeine is almost completely metabolised in the liver by oxidation, demethylation and acetylation to various xanthine derivatives.

Excretion.

Paracetamol is excreted in the urine mainly as the glucuronide and sulfate conjugates. Less than 5% is excreted as unchanged paracetamol with 85 to 90% of the administered dose eliminated in the urine within 24 hours of ingestion. The elimination half-life is about 1 to 4 hours. The various xanthine derivatives or caffeine are excreted in the urine.

5.3 Preclinical Safety Data

Genotoxicity.

No data available.

Carcinogenicity.

No data available.

6 Pharmaceutical Particulars

6.1 List of Excipients

Croscarmellose sodium, maize starch, potassium sorbate, povidone, purified talc, stearic acid, hypromellose, propylene glycol, macrogol 6000 and titanium dioxide.

6.2 Incompatibilities

Incompatibilities were either not assessed or not identified as part of the registration of this medicine.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Store below 25°C.

6.5 Nature and Contents of Container

PVC-PVDC/Aluminium blister packs of 10, 18, 20, 36, 40, 64, or 72 tablets.
Not all pack sizes may be marketed.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of by taking to your local pharmacy.

6.7 Physicochemical Properties

Chemical structure.

Chemical name: Paracetamol: N-(4-Hydroxyphenyl) acetamide.
Caffeine: 1,3,7-Trimethyl-3,7-dihydro-1H-purine-2,6-dione.
Structural formula:
Molecular formula: Paracetamol: C8H9NO2.
Caffeine: C8H10N4O2.
Molecular weight: Paracetamol: 151.17.
Caffeine: 194.20.

CAS number.

Paracetamol.

103-90-2.

Caffeine.

58-08-2.

7 Medicine Schedule (Poisons Standard)

Packs of 10 - Not scheduled.
Packs of 18, 20, 36, 40 - S2, Pharmacy Medicine.
Packs of 64, 72 - S3, Pharmacist Only Medicine.

Summary Table of Changes