acetaminophen / aspirin / caffeine
Excedrin Migraine and Excedrin Extra Strength are combination medications, both containing the same dosages of acetaminophen, aspirin, and caffeine. But they're labeled to treat different conditions. Excedrin Migraine treats migraines. But Excedrin Extra Strength is labeled to help with minor aches and pains, including headaches and muscle aches. How many tablets you can take per day depends on what product you're taking and what condition you have. Both medications are available over the counter (OTC) as tablets and caplets with brand name and generic versions. Possible side effects include trouble sleeping, dizziness, and upset stomach.
What is Excedrin Migraine?
What is Excedrin Migraine used for?
Migraine - Excedrin Migraine
Minor aches and pains (e.g., headache, arthritis, muscle aches, toothache, menstrual cramps, common cold) - Excedrin Extra Strength
How Excedrin Migraine works
Excedrin Migraine is a combination of three medications that work together to relieve aches and pains:
Acetaminophen is an analgesic. The exact way it works is unknown, but it's thought to lower pain and aches in your body by acting on the brain and spinal cord.
Aspirin is a non-steroidal inflammatory drug (NSAID) that stops the production of certain substances in your body that cause pain and inflammation.
Caffeine is an adenosine antagonist. It blocks the activity of a natural chemical in the body called adenosine that's higher during migraine attacks. Blocking adenosine has been shown to help lower the sensation of pain and relieve migraine symptoms. It has also been shown to improve the effects of acetaminophen and aspirin.
Drug Facts
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What are the side effects of Excedrin Migraine?
Common Side Effects
- Upset stomach (e.g., nausea, vomiting, stomach pain)
- Trouble sleeping
- Nervousness or restlessness
Serious Side Effects
- Severe allergic reaction: trouble breathing, blisters, hives, swelling of your tongue or lips
- Serious bleeding: feeling faint or lightheaded, dizziness, vomiting blood, bloody or dark-colored stools, severe stomach pain
- Liver problems: dark urine, feeling tired, upset stomach or stomach pain, yellowing of skin or eyes
- Kidney problems: tiredness, dry and itchy skin, low appetite, urinating less than usual, foamy or bloody urine, muscle cramps
- Severe dehydration: dry mouth, not urinating as much, lightheadedness, dizziness
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds, red or dark brown urine, small red or purple spots on skin, unusual bruising or bleeding
- Hearing loss, ringing in ears
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Rash, fever, and swollen lymph nodes
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Round red or dark patches on the skin that may itch, burn, and blister
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Anxiety, nervousness
- Headache
- Loss of appetite
- Nausea
- Tremors or shaking
- Trouble sleeping
- Upset stomach
Pros and cons of Excedrin Migraine
Pros
Combines three medications into one pill for convenience
Works well to treat minor aches and pains
Works for some people in as little as 15 minutes
Available over the counter
Available as generic medications
Cons
Need to limit caffeine while taking it
Not recommended to take with other medications containing acetaminophen, since it can raise the risk of liver damage
Can't be used in children
Might not be safe to use while pregnant, especially after 20 weeks
Not appropriate for people allergic to NSAIDs
Pharmacist tips for Excedrin Migraine
You can take Excedrin Migraine with or without food. If it upsets your stomach, try taking the medication with food.
Avoid drinking alcohol while taking Excedrin Migraine. Drinking 3 or more alcoholic beverages a day while taking products that contain acetaminophen (Tylenol) can raise your risk of liver damage.
Stop taking Excedrin Migraine and contact your provider if you experience any of the following: 1) pain worsens or lasts more than 10 days; 2) fever gets worse or lasts more than 3 days; 3) you have redness or swelling; 4) you feel faint, vomit blood, have bloody or black stools, have stomach pain that doesn't get better; 5) ringing in the ears or loss of hearing; 6) have a painful area that's red or swollen; or 7) you have new symptoms. These might be signs of a more serious medical problem.
Tell your provider or pharmacist about all the medications you're taking, especially if you're taking other NSAIDs, warfarin (Coumadin) or other blood thinners, or other medications containing similar ingredients (e.g., NSAIDs, acetaminophen (Tylenol), or caffeine). Taking these with Excedrin Migraine can raise your risk of overdose and severe side effects (e.g., liver damage, kidney problems, heart problems, severe bleeding).
Limit the amount of caffeine-containing medications, foods, and drinks while taking Excedrin Migraine, since it also contains caffeine. Taking too much caffeine can lead to side effects like nervousness, trouble sleeping, and fast heart beat.
Caffeine can act like a water pill and cause you to become dehydrated (e.g., dry mouth, not urinating much, lightheadedness, dizziness), especially when using more than 400 mg of caffeine per day. Make sure to stay well-hydrated while taking this medication.
Frequently asked questions about Excedrin Migraine
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What are the risks and warnings for Excedrin Migraine?
Excedrin Migraine 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.
Liver damage
Risk factors: Drinking 3 or more alcoholic beverages a day | Taking other medications containing acetaminophen | Taking too much Excedrin Migraine | History of liver problems
Taking too much acetaminophen (Tylenol) can cause permanent and life-threatening liver damage. For adults, the maximum amount of acetaminophen is 3 or 4 grams in a 24-hour period, depending on your provider's instructions. For children, ask your child's provider.
Speak to your provider before using Excedrin Migraine if you have liver problems, since it can cause further damage to your liver. Avoid drinking alcohol while taking this medication.
Signs of liver problems include dark urine, feeling tired, upset stomach or stomach pain, or yellowing of the skin or whites of the eyes. If you notice any of these symptoms, call your provider right away.
Reye's syndrome in children
Risk factors: Children recovering from chickenpox or flu-like symptoms
Aspirin use in children is linked to a rare but serious condition called Reye's syndrome. It typically occurs when children who are recovering from flu-like symptoms or other viruses use aspirin. Early symptoms of Reye's syndrome include vomiting, headache, confusion, and distress, but it can lead to seizures and loss of consciousness. Don't give Excedrin Migraine to a child who has a fever due to the flu. Ask your child's provider for medication recommendations for children who are sick.
Allergic reactions
Risk factors: NSAID allergy
Severe allergic reactions to Excedrin Migraine are possible, including anaphylaxis (closing of the throat). Call 911 if you experience hives, trouble breathing, or swelling of your lips or tongue. Let your provider know if you have an allergy to aspirin or other NSAIDs before you start taking Excedrin Migraine.
Acetaminophen can also cause severe skin reactions, like painful blisters all over your body, hives, or rash. If you experience any of these, call your healthcare provider right away.
Stomach bleeding and ulcers
Risk factors: History of stomach bleeding or ulcers | Taking other NSAIDs, blood thinners, or corticosteroids while also taking Excedrin Migraine | Drinking 3 or more alcoholic beverages per day | Age 60 years or older | Taking Excedrin Migraine for a long time | Taking more Excedrin Migraine than instructed
Excedrin Migraine contains aspirin, which can irritate your stomach. This irritation can feel like stomach pain or heartburn. It can also lead to serious stomach problems, including bleeding and ulcers in this area. If you have stomach pain that doesn't get better; vomit or cough up blood or bits that look like coffee grounds; or have bloody or black, tarry stools; stop taking Excedrin Migraine and get medical attention right away. These can be signs of stomach bleeding or a stomach ulcer that your provider can help manage and treat.
Kidney problems
Risk factors: History of kidney or liver problems | History of heart failure | Taking Excedrin Migraine for a long time | Taking certain blood pressure medications (water pills, ACE inhibitors, or ARBs) | Dehydration | Age 65 and older
Excedrin Migraine contains aspirin, which can cause kidney damage. This damage can happen at any time while you're taking the medication, especially if you have any of the risk factors listed above. Tell your provider if you're taking certain blood pressure medications that can damage your kidneys, such as ACE inhibitors (e.g., lisinopril (Prinivil)) and ARBs (e.g., losartan (Cozaar)). Stop taking Excedrin Migraine, and let your provider know if you're not urinating as often as usual or have fever, muscle weakness, numbness in your arms or legs, or a fast heartbeat. These can be signs of kidney damage.
Dehydration
Risk factors: Using more than 400 mg of caffeine per day
Excedrin Migraine contains caffeine, which can remove excess fluid in your body, esepcailly at doses of more than 400 mg of caffeine per day. This can lead to dehydration (low fluids in the body). Signs of dehydration include dry mouth, not urinating as much, lightheadedness, dizziness). Make sure to stay well-hydrated while taking this medication. Contact your provider if you feel dehydrated.
Worsening of medical conditions
Risk factors: History of stomach bleeding or stomach problems | Liver problems | Kidney problems | Heart disease or high blood pressure
Don't take Excedrin Migraine if you have any of the risk factors listed above unless your provider said it's safe to do so. Taking Excedrin Migraine can worsen your condition(s) and cause serious side effects. Make sure your provider knows about all medical conditions you have or have had in the past before starting Excedrin Migraine.
Accidental overdose
Risk factors: Taking with other acetaminophen- or NSAID-containing medications
Taking too much acetaminophen or NSAIDs can lead to a dangerous overdose. Too much acetaminophen can lead to serious liver damage, and too much NSAIDs can raise your risk of life-threatening bleeding, kidney damage, and heart problems. There are many over-the-counter and prescription medications that contain acetaminophen (e.g., Tylenol PM, Dayquil) or an NSAID (e.g., aspirin, naproxen (Aleve), ibuprofen in Advil products). Check if the medications you're currently taking contain any acetaminophen or NSAIDs, and ask your provider or pharmacist if you're not sure. If you need to take more than 1 product with these ingredients, you'll need to keep track of how much you're taking throughout the day to avoid overdosing. Early signs of acetaminophen overdose include vomiting, right-sided stomach pain, and severe dizziness. Early signs of taking too much NSAID include blurred vision, ringing in the ears, and stomach upset. If you suspect that you or someone you know have overdosed on Excedrin Migraine, get medical help or contact the Poison Control Center (1-800-222-1222) right away.
Excedrin Migraine dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 250mg/250mg/65mg | 30 tablets | $10.86 | $0.36 |
Typical dosing for Excedrin Migraine
Each pill of both brands contain 250 mg of acetaminophen, 250 mg of aspirin, and 65 mg of caffeine.
Excedrin Migraine and generic:
Age 18 years and older: The typical dose is 2 tablets by mouth once a day as needed with a glass of water. Don't take more than 2 tablets in 24 hours, unless directed by your provider.
Age under 18 years: Ask your child's provider.
Excedrin Extra Strength and generic:
People aged 12 years and older: The typical dose is 2 tablets by mouth every 6 hours as needed with a glass of water. Don't take more than 8 tablets in 24 hours.
Children aged 11 years and younger: Ask your child's provider.
How much does Excedrin Migraine cost?
Excedrin Migraine contraindications
Allergy to aspirin or another NSAID
Asthma, nose inflammation, or nasal polyps
Children younger than 18 years old (Excedrin Migraine) and children younger than 12 years old (Excedrin Extra Strength)
Take with any other medication containing acetaminophen
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References
Best studies we foundAgrawal, S., et al. (2023). Acetaminophen toxicity. StatPearls.
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Baratloo, A., et al. (2016). The role of caffeine in pain management: A brief literature review. Anesthesiology and Pain Medicine.
Chapman, J., et al. (2022). Reye syndrome. StatPearls.
Davis, A., et al. (2016). The dangers of NSAIDs: Look both ways. British Journal of General Practice.
Derry, C. J., et al. (2014). Caffeine as an analgesic adjuvant for acute pain in adults. The Cochrane Database of Systematic Reviews.
Drugs and Lactation Database (LactMed®) [internet]. (2021). Aspirin. National Institute of Child Health and Human Development.
Excedrin. (n.d.). Excedrin, migraine, headache, and head health FAQs.
Excedrin. (n.d.). Excedrin extra strength headache relief.
Gleason, J. L., et al. (2021). Association between maternal caffeine consumption and metabolism and neonatal anthropometry: A secondary analysis of the NICHD Fetal Growth Studies–Singletons. Journal of the American Medical Association Network Open.
Haanes, K. A., et al. (2018). Characterization of the trigeminovascular actions of several adenosine A2A receptor antagonists in an in vivo rat model of migraine. The Journal of Headache and Pain.
Hunter, L. J., et al. (2011). The patterns of toxicity and management of acute nonsteroidal anti-inflammatory drug (NSAID) overdose. Open Access Emergency Medicine.
La Leche League International. (2021). Caffeine.
Lil' Drug Store Products, Inc. (2023). Excedrin Extra Strength pain reliever- acetaminophen, aspirin, and caffeine tablet, film coated [package insert]. DailyMed.
Lil' Drug Store Products, Inc. (2023). Excedrin Migraine acetaminophen, aspirin (NSAID) and caffeine- acetaminophen, aspirin, and caffeine tablet, film coated [package insert]. DailyMed.
Lipton, R. B., et al. (1998). Efficacy and safety of acetaminophen, aspirin, and caffeine in alleviating migraine headache pain:Three double-blind, randomized, placebo-controlled trials. Journal of the American Medical Association Neurology.
Medline Industries, Lp. (2022). Extra pain relief acetaminophen, aspirin (NSAID) and caffeine- acetaminophen, salicyclic acid, caffeine tablet, film coated [package insert]. DailyMed.
MedlinePlus. (2021). Aspirin.
MedlinePlus. (2021). Caffeine.
National Kidney Foundation. (n.d.). Pain medicines (analgesics).
Ohashi, N., et al. (2020). Analgesic effect of acetaminophen: A review of known and novel mechanisms of action. Frontiers in Pharmacology.
U.S. Food and Drug Administration. (2018). Spilling the beans: How much caffeine is too much?
U.S. Food and Drug Administration. (2022). FDA recommends avoiding use of NSAIDs in pregnancy at 20 weeks or later because they can result in low amniotic fluid.
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