Carisoprodol/aspirin/codeine is a combination of three medications that are used to relieve sudden muscle pain in adults. The medication is a controlled substance because it contains codeine, an opioid with the risk of misuse and dependency. It's no longer available in the United States because it was discontinued.
Short-term muscle pain and discomfort
Carisoprodol/aspirin/codeine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: Personal or family history of alcohol or substance use disorder | Personal or family history of mental health conditions
Carisoprodol/aspirin/codeine has a risk of addiction and misuse, even if you take it at the recommended dose. This can cause serious problems, such as overdose and death. Because of this risk, the FDA requires this medication and all other medications containing opioids, like codeine, to be under a Risk Evaluation and Mitigation Strategy (REMS) program. This means your healthcare provider will provide you with a medication guide and talk to you about the proper use, serious risks, and appropriate storage and disposal of this medication in order to keep you and your loved ones safe. It's important that you read the medication guide every time to familiarize yourself with the safe use of this medication.
Risk factors: Taking opioids | Starting treatment with carisoprodol/aspirin/codeine | Taking higher doses carisoprodol/aspirin/codeine | Drinking alcohol | Taking other medications that affect your breathing | Severe asthma | History of severe chronic obstructive pulmonary disease (COPD) | Older people | Accidental overdose
Carisoprodol/aspirin/codeine can cause serious breathing problems (respiratory depression) and lead to death if not treated right away. If you or your loved one has shortness of breath, wheezing, slowed breathing, tiredness or sleepiness during the day, anxiety, or confusion, call for emergency medical help right away. This risk can occur at any time but it's greatest during the first 1-3 days of starting the medication and after a dose increase.
Talk to your pharmacist or healthcare provider about naloxone (Narcan). This possibly life-saving medication can be used in emergency situations in case of an overdose with carisoprodol/aspirin/codeine. Even if you use naloxone for an overdose, you'll still have to call for emergency medical help because it only lasts for a few minutes.
If you have a history of alcohol use or severe lung conditions, talk to your healthcare provider before starting carisoprodol/aspirin/codeine. Your provider might switch you to a non-opioid medication if necessary.
Risk factors: Younger than 12 years old | Using opioids after certain surgeries, like tonsil or adenoid removal | Obstructive sleep apnea (OSA) | Obesity | Severe lung conditions | Neuromuscular conditions | Taking other medications that affect your breathing | Genes that rapidly breakdown codeine
Carisoprodol/aspirin/codeine can cause life-threatening breathing problems (respiratory depression) and death in children, especially those younger than 12 years. Some children have genes that break down codeine in their body faster than others, so this raises their amount of exposure to the medication. Work with your child's provider to use the lowest dose of carisoprodol/aspirin/codeine for the shortest period of time to lower your child's risk of life-threatening breathing problems. If your child has shortness of breath, wheezing, slowed breathing, tiredness or sleepiness during the day, anxiety, or confusion, call for emergency medical help right away.
Risk factors: Children | Taking more carisoprodol/aspirin/codeine than prescribed
Taking even one more dose of carisoprodol/aspirin/codeine than prescribed can lead to deadly overdose, especially in children. You should never take more than 8 tablets of carisoprodol/aspirin/codeine per day. Symptoms of an overdose include, slowed breathing, small pupils, blue lips and fingertips, pale face, sweating, choking, or unresponsiveness. If you or anyone around you accidentally overdoses on the medication, get emergency medical help or call your local poison control center at 1-800-222-1222 right away.
Risk factors: Taking other medications that slow down brain function | Taking benzodiazepines | Drinking alcohol | Higher doses of carisoprodol/aspirin/codeine | Personal or family history of substance use disorder
Taking carisoprodol/aspirin/codeine with alcohol or medications such as benzodiazepines for anxiety, sleep medications, muscle relaxers, and other opioids, can slow down brain activity and cause severe sleepiness, slowed breathing, coma, and death. If you take any of these medications, work with your healthcare provider to take the lowest and safest doses. Don't drive or use any heavy machinery until you know how the medication affects you. Call for emergency medical help right away if you have symptoms such as sleepiness, dizziness, low heart rate, slowed breathing, muscle weakness, headache, slurred speech, blurred vision, or confusion.
Risk factors: Long-term use of carisoprodol/aspirin/codeine during pregnancy | Using opioids during labor and delivery | Exposure to breast milk containing carisoprodol/aspirin/codeine
Long-term use of carisoprodol/aspirin/codeine during pregnancy can cause neonatal opioid withdrawal syndrome, which is a life-threatening condition in newborn babies. It's important to recognize and treat this condition right away by watching your newborn baby for symptoms such as irritability, overactivity, abnormal sleeping patterns, excessive or high-pitched crying, body shaking (tremor), vomiting, diarrhea, inability to gain weight, breathing problems, fever, sweating, or seizures. If you're pregnant or breastfeeding, don't use carisoprodol/aspirin/codeine without discussing the risks and benefits with your healthcare provider because it could potentially harm your baby.
Carisoprodol/aspirin/codeine interacts with many medications, causing the levels of those medications to either go up or down in your body.
Using carisoprodol/aspirin/codeine with certain antibiotics, such as erythromycin, or antifungals, such as fluconazole (Diflucan), can lead to higher levels of carisoprodol/aspirin/codeine. This can cause life-threatening breathing problems. On the other hand, taking medications like rifampin (Rifadin), carbamazepine (Tegretol), and phenytoin (Dilantin) can lower carisoprodol/aspirin/codeine levels. And this can lessen the effects of the medication, which can cause opioid withdrawal symptoms: restlessness, sweating, chills, anxiety, nervousness, high blood pressure, or seizures.
Ask your pharmacist or healthcare provider before starting or stopping any medications while taking carisoprodol/aspirin/codeine for your safety.
Risk factors: Taking opioids for greater than 1 month | History of low cortisol levels
Taking medications containing opioids, like carisoprodol/aspirin/codeine, especially for longer than 1 month can lead to low levels of cortisol hormone (adrenal insufficiency). Cortisol helps control your mood, stress, blood pressure, and blood sugar levels. If you have symptoms such as nausea, vomiting, anorexia, tiredness, weakness, dizziness, or low blood pressure, let your healthcare provider know. You might need a blood test to confirm whether or not you have low cortisol levels. If so, your provider might slowly wean you off of carisoprodol/aspirin/codeine or switch you to another medication if necessary.
Risk factors: Taking blood pressure medications | History of low blood pressure | Taking certain antipsychotics | Dose adjustments to carisoprodol/aspirin/codeine
Carisoprodol/aspirin/codeine can cause severely low blood pressure, especially upon standing after sitting or lying down for a long period of time (orthostatic hypotension). The risk is higher if you take medications for high blood pressure or if you take certain antipsychotics. Be careful as you stand up after sitting for an extended period of time and make sure to sit back down if you feel faint or dizzy. The chances of low blood pressure are higher when you first start carisoprodol/aspirin/codeine or with dose changes. Call for emergency medical help if you have symptoms of low blood pressure including dizziness, lightheadedness, feeling thirsty or dehydrated, not being able to concentrate, tiredness or weakness, confusion, blurred vision, cold or pale skin, or fast breathing.
Risk factors: History of high pressure in the brain | History of brain tumors or head injury | Impaired consciousness or coma
Carisoprodol/aspirin/codeine can raise the pressure in the brain, especially if you have a history of a brain tumor or head injury. Carisoprodol/aspirin/codeine affects your lungs by lowering your ability to breathe, which causes higher levels of carbon dioxide and greater pressure inside of your brain. If you feel excessive sleepiness or have slowed breathing, especially when you first start taking carisoprodol/aspirin/codeine, let your healthcare provider know right away.
Risk factors: History of stomach or intestinal blockage | History of peptic ulcer disease | History of stomach bleed | Taking aspirin or other NSAIDs | Taking high doses of aspirin | Older people | Poor health | Drinking alcohol | Taking blood-thinning medications
You shouldn't take carisoprodol/aspirin/codeine if you have a history of a stomach or intestinal blockage. Carisoprodol/aspirin/codeine can cause constipation which can further complicate this condition. If you have a history of stomach ulcers (peptic ulcer disease), you shouldn't use aspirin because it can irritate your stomach lining and cause serious bleeding. If you have symptoms of a serious stomach bleed, such as black or tarry stools, bright red blood in vomit, vomit that looks like coffee grounds, stomach cramps, dizziness, tiredness or weakness, paleness, or shortness of breath, call for emergency medical help right away.
Carisoprodol/aspirin/codeine can also raise amylase levels in your body, which is a protein that helps you digest food. If these levels are too high, it can lead to swelling in your pancreas. If you have stomach pain or cramps, stomach swelling, nausea, vomiting, diarrhea, or fever, let your healthcare provider know right away because you might need to stop taking carisoprodol/aspirin/codeine.
Risk factors: History of seizures | Taking medications that cause seizures | Overdose with carisoprodol/aspirin/codeine
The codeine in carisoprodol/aspirin/codeine can raise your risk of seizures if you already have a history of seizures. If you have a seizure and it's worse or harder to control than before, let your healthcare provider know because you might have to stop taking carisoprodol/aspirin/codeine and switch to another medication.
Risk factors: Suddenly stopping carisoprodol/aspirin/codeine | History of opioid dependence | Lowering the dose of carisoprodol/aspirin/codeine too quickly
Stopping carisoprodol/aspirin/codeine suddenly can cause serious and undesirable withdrawal symptoms, such as restlessness, watery eyes, runny nose, sleepiness, sweating, chills, muscle pain, back or joint pain, large pupils, irritability, anxiety, nervousness, weakness, stomach cramps, sleeping problems, nausea, vomiting, diarrhea, high blood pressure, fast heart rate, or seizures. If you take any opioid-containing medication, like carisoprodol/aspirin/codeine, for a long period of time, your body gets physically dependent on the medication. So you must slowly lower (taper down) the dose to prevent withdrawal. Lowering the dose too quickly might also cause your pain to come back. Taking other types of opioids, such as nalbuphine or buprenorphine, can also cause withdrawal symptoms. Let your healthcare provider know if you take any other opioids, and work closely with your provider if you want to stop taking carisoprodol/aspirin/codeine.
Risk factors: Taking aspirin | History of blood clotting conditions | Taking aspirin before surgery | Heavy alcohol use | History of liver disease | Low levels of Vitamin K
Carisoprodol/aspirin/codeine contains aspirin, which stops your body from forming blood clots and raises your risk of bleeding out if you get seriously hurt. This is especially serious if you have a history of a blood clotting condition or liver condition because your body might already have a difficult time forming blood clots. If you take any blood-thinning medications or drink more than 3 alcoholic drinks per day, your risk of bleeding is even higher. If you're worried about your bleeding risk, ask your healthcare provider if carisoprodol/aspirin/codeine is safe for you.
Risk factors: Giving aspirin to children or teenagers with viral infections
Carisoprodol/aspirin/codeine contains aspirin, which shouldn't be used to treat viral infections, with or without fever, in children or teenagers because of the risk of Reye's syndrome. This life-threatening condition can cause swelling and damage in your child's brain and liver. Discuss other non-aspirin treatment options with your child's healthcare provider.
Risk factors: History of serious skin reactions | Allergy to aspirin or other NSAIDs
Carisoprodol/aspirin/codeine contains aspirin, which can sometimes cause serious skin and allergic reactions. If you develop symptoms of an allergic reaction, such as swelling of the face, mouth, or throat, trouble breathing, hives, or vomiting, stop taking carisoprodol/aspirin/codeine and call for emergency medical help right away.
If you have symptoms of a skin reaction, such as a skin rash, fever, swollen lymph nodes, or facial swelling, stop taking carisoprodol/aspirin/codeine. Sometimes you might have a fever or swollen lymph nodes without a rash, but you should still stop taking carisoprodol/aspirin/codeine and call your healthcare provider because you might need to be switched to another medication.
Risk factors: Taking aspirin or other NSAIDs during pregnancy
Carisoprodol/aspirin/codeine contains aspirin, and taking aspirin during pregnancy can potentially cause harm to your unborn baby. Don't use any aspirin-containing products if you're 30 weeks or more pregnant because it can cause serious heart problems in your baby. Using aspirin at 20 weeks pregnant or later can cause kidney problems in your baby and can lower the amount of amniotic fluid in your womb which can lead to birth defects and prevent healthy growth in your baby. If you're 20-30 weeks pregnant and need to take aspirin, take the lowest dose for the shortest time possible. Let your healthcare provider know if you take carisoprodol/aspirin/codeine or other aspirin-containing medications for longer than 2 days so that fluid levels in your womb can be measured.
Carisoprodol/aspirin/codeine contains codeine, which can cause a rare but life-threatening condition called serotonin syndrome if combined with serotonergic medications, such as fluoxetine (Prozac) or duloxetine (Cymbalta). Call for emergency medical help right away if you have symptoms, such as agitation, restlessness, anxiety, body shaking (tremors), shivering, stiff muscles, sweating, flushed skin, vomiting, diarrhea, high blood pressure, fast heart rate, fast breathing, or large pupils. Let your healthcare provider or pharmacist know about all of the medications you're taking or plan on taking to make sure they're safe to combine with carisoprodol/aspirin/codeine.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Pain relief from minor aches and pains, such as from headaches, muscle pain, toothache, menstrual cramps, and arthritis
Fever
Heart protection (lower the risk for heart attack or stroke) in certain adults - low-dose carisoprodol/aspirin/codeine (81 mg per day) only
Short-term relief of minor aches and pains due to headache, muscle aches, minor arthritis pain, toothache, backache, the common cold, or menstrual cramps
Fever
Mild-to-moderate pain
Pain from rheumatoid arthritis (RA) or osteoarthritis (OA)
Pain from menstrual cramps
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Ingenus Pharmaceuticals, LLC. (2021). CARISOPRODOL, ASPIRIN AND CODEINE PHOSPHATE - carisoprodol, aspirin and codeine phosphate tablet. DailyMed.
Keilman, C., et al. (2022). Oligohydramnios. StatPearls.
MedlinePlus. (n.d.). Amylase test.
U.S. Food and Drug Administration. (2023). Risk evaluation and mitigation strategies | REMS.
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