Midrin (isometheptene/dichloralphenazone/acetaminophen) dosing, indications, interactions, adverse effects, and more.

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Sections isometheptene/dichloralphenazone/acetaminophen
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Dosing & Uses

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Dosage Forms & Strengths

isometheptene/dichloralphenazone/acetaminophen

capsule: Schedule IV

65mg/100mg/325mg

Migraine Headache

2 capsules PO at onset of headache, then 1 capsule PO q1hr until headache relieved up to a cumulative dose of 5 capsules/12 hr

Tension Headache

1-2 capsules PO q4hr; not to exceed 8 capsules/24 hr

Safety and efficacy not established

Interaction Checker

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Contraindicated

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Rash

Transient dizziness

Contraindications

Hypersensitivity

Hepatitis or severe hepatic/renal impairment

Glaucoma

Severe renal impairment

Hypertension

Heart disease

Hepatic impairment

Within 14 days of MAO inhibitors

Cautions

Risk of hepatotoxicity higher in alcoholics, or with use of more than one acetaminophen-containing product

Acetaminophen: Risk for rare, but serious skin reactions that can be fatal; these reactions include Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP); symptoms may include skin redness, blisters and rash

G6PD deficiency

May cause sedation; avoid driving car or operating machinery

May increase respiratory depressant effects; caution with head injury, COPD, or other conditions with decreased respiratory drive

Controlled substance (dichloralphenazone); may cause tolerance/dependence

Caution in cardiovascular disease, hepatic impairment, G6PD deficiency

Pregnancy & Lactation

Pregnancy category: C

Lactation: Excreted in breast milk; caution advised

Dichloralphenazone: prodrug of chloral hydrate and phenazone; trichloroethanol (active metabolite of chloral hydrate), acetaminophen, and phenazine are excreted in breast milk

According to the American Academy of Pediatrics, chloral hydrate and acetaminophen are compatible with breastfeeding

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Mechanism of Action

Isometheptene: Elicits sympathomimetic effect; constricts dilated cerebral/cranial arterioles

Dichloralphenazone: Elicits mild sedative effect; reduces emotional response to painful stimulus

Acetaminophen: Inhibitis prostaglandin sythesis in CNS and may block peripheral pain impulse generation; acts on hypothalamus to antipyresis

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Formulary

FormularyPatient Discounts

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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

View explanations for tiers and restrictions

Tier	Description
1	This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2	This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC	NOT COVERED – Drugs that are not covered by the plan.

Code	Definition
PA	Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL	Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST	Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR	Other Restrictions Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.

Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.

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Sections isometheptene/dichloralphenazone/acetaminophen
Dosing & Uses
Interactions
Adverse Effects
Warnings
Pregnancy
Pharmacology
Images
Patient Handout
Formulary

isometheptene/dichloralphenazone/acetaminophen (Rx)