spec sheet6 rows
Citramon P is the Soviet era headache tablet, a fixed combination of aspirin, paracetamol and caffeine that remains one of the most widely used over the counter analgesics in Russia.
- Aspirin, paracetamol and caffeine in one classic headache tablet
- Two analgesic mechanisms working at once, not one
- A real improvement on any of its individual parts
- Caffeine measurably boosts the other two ingredients
- One of the most widely used analgesics in Russia
- The same combination sells worldwide under other names
- Citramon P is a Russian and post-Soviet over-the-counter tablet combining acetylsalicylic acid, paracetamol and caffeine (commonly 240 mg / 180 mg / 30 mg); the branded product has no indexed trials of its own, but the identical three-drug fixed combination is one of the best-studied OTC analgesic combinations in the world.
- The pivotal 1,743-patient trial demonstrated that the triple combination is superior not just to placebo but to the caffeine-free two-drug combination (p=0.0181) and to each single agent, on the primary endpoint of time to 50% pain relief [1]. Caffeine is a genuine active adjuvant, not filler.
- A meta-analysis of four crossover trials confirmed superiority over paracetamol alone in episodic tension-type headache [2], and the benefit held in the severe-headache subgroup [3].
- Older Soviet-era Citramon formulations contained phenacetin, which was withdrawn worldwide for nephrotoxicity and carcinogenicity; modern Citramon P uses paracetamol, and this distinction is worth stating explicitly for a Russian-market product.
- Caffeine is also the component most responsible for the medication-overuse headache risk of this class, which is the main reason for the 'no more than 10 days per month' rule.
Mechanism
Aspirin irreversibly acetylates cyclooxygenase and paracetamol acts centrally through a still disputed route, giving two analgesic mechanisms rather than one. Caffeine contributes little analgesia itself but raises the absorption rate and measurably increases the effect of the other two, which is why the same trio appears in Excedrin.
receptor fingerprint
Cyclooxygenase-1 (COX-1, PTGS1); aspirin componentIrreversible acetylation of Ser529, permanently inactivating the enzyme in that cell for its lifetime
A1 and A2A receptors; caffeine componentCompetitive antagonist at central adenosine receptors, blocking adenosine-mediated sedation and cerebral vasodilation
Platelet thromboxane A2 synthesis (via irreversibly acetylated COX-1)Anucleate platelets cannot resynthesise COX-1, so a single aspirin dose suppresses thromboxane for the platelet lifespan of 7 to 10 days
Cyclooxygenase-2 (COX-2, PTGS2); aspirin componentIrreversible acetylation of Ser516, less potently than COX-1
Central COX and the endocannabinoid/TRPV1 axis via AM404; paracetamol componentParacetamol is deacetylated to p-aminophenol and conjugated with arachidonic acid to form AM404, which acts centrally on TRPV1 and cannabinoid signalling; the classical peripheral COX story is now considered incomplete
Safetyrisks and cautions, not medical advice
Citramon P is a fixed combination product in the analgesic class. A full adverse effect profile has not been compiled for this entry yet, so nothing here should be read as evidence that it is well tolerated; the absence is missing work rather than a finding. What is documented is what the compound is and what it is used for.
Subjective profileweighing the evidence above
Two analgesics with different mechanisms plus caffeine is not folklore; the trio is a real improvement on any of its parts, which is why the same combination sells worldwide under other names. The trap is frequency, because a caffeine containing painkiller taken more than a couple of days a week is one of the most reliable routes into medication overuse headache, at which point the tablet is treating the problem it created. Aspirin also puts it out of reach for children and adolescents with a viral illness, where Reye syndrome is the reason, and for anyone with ulcer disease or taking an anticoagulant. A good tablet that is very easy to overuse.
Where to buy
Suppliers
Vendors carrying Citramon P, with live product details and codes. Links are affiliate links that support the wiki at no cost to you.
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Citramon P
Research
- 2005first citedThe fixed combination of acetylsalicylic acid, paracetamol and caffeine is more effective than…
- 2014most recentUse of a fixed combination of acetylsalicylic acid, acetaminophen and caffeine compared with ac…
- 1.The fixed combination of acetylsalicylic acid, paracetamol and caffeine is more effective than single substances and dual combination for the treatment of headache: a multicentre, randomized, double-blind, single-dose, placebo-controlled parallel group study
- 2.Use of a fixed combination of acetylsalicylic acid, acetaminophen and caffeine compared with acetaminophen alone in episodic tension-type headache: meta-analysis of four randomized, double-blind, placebo-controlled, crossover studies
- 3.The efficacy and tolerability of a fixed combination of acetylsalicylic acid, paracetamol, and caffeine in patients with severe headache: a post-hoc subgroup analysis from a multicentre, randomized, double-blind, single-dose, placebo-controlled parallel group study
- 4.Headache classification by history has only limited predictive value for headache episodes treated in controlled trials with OTC analgesics
4 listed here; entry last updated August 2026
Reviews
My notesprivate to this device
Notes and cautions
- The aspirin component means this product must not be given to children or adolescents with viral illness because of Reye's syndrome, a restriction not always well observed for OTC combination products in the markets where Citramon P is sold.
- Aspirin carries dose-dependent risk of gastrointestinal ulceration and bleeding, amplified by alcohol, anticoagulants and other NSAIDs, and irreversibly inhibits platelet function for 7 to 10 days after a single dose.
- The paracetamol component makes accidental hepatotoxic overdose easy when patients simultaneously take separate paracetamol products, and the threshold is lower in chronic alcohol use and malnutrition.
- Regular use of caffeine-containing combination analgesics on more than 10 days per month causes medication-overuse headache, which perpetuates exactly the symptom the product is bought to treat.