Acetaminophen, Dextromethorphan, and Pseudoephedrine
Pronunciation
(a seet a MIN oh fen, deks troe meth OR fan, & soo doe e FED rin)
U.S. Brand Names
Alka-Seltzer® Plus Flu Liqui-Gels® [OTC]; Comtrex® Non-Drowsy Cold and Cough Relief [OTC]; Contac® Severe Cold and Flu/Non-Drowsy [OTC]; Infants' Tylenol® Cold Plus Cough Concentrated Drops [OTC]; Sudafed® Severe Cold [OTC]; Thera-Flu® Severe Cold Non-Drowsy [OTC] [DSC]; Triaminic® Cough and Sore Throat Formula [OTC]; Tylenol® Cold Day Non-Drowsy [OTC]; Tylenol® Flu Non-Drowsy Maximum Strength [OTC]; Vicks® DayQuil® Multi-Symptom Cold and Flu [OTC]
Synonyms
Dextromethorphan, Acetaminophen, and Pseudoephedrine; Pseudoephedrine, Acetaminophen, and Dextromethorphan; Pseudoephedrine, Dextromethorphan, and Acetaminophen
Generic Available
Yes
Canadian Brand Names
Contac® Cough, Cold and Flu Day & Night™; Sudafed® Cold & Cough Extra Strength; Tylenol® Cold Daytime
Use
Treatment of mild to moderate pain and fever; symptomatic relief of cough and congestion
Adverse Reactions
See individual agents.
Drug Interactions
Acetaminophen:
Substrate
(minor) of CYP1A2, 2A6, 2C8/9, 2D6, 2E1, 3A4;
Inhibits
CYP3A4 (weak)
Dextromethorphan:
Substrate
of CYP2B6 (minor), 2C8/9 (minor), 2C19 (minor), 2D6 (major), 2E1 (minor), 3A4 (minor);
Inhibits
CYP2D6 (weak)
Also see individual agents.
Ethanol/Nutrition/Herb Interactions
Ethanol: Excessive intake of ethanol may increase the risk of acetaminophen-induced hepatotoxicity. Avoid ethanol or limit to <3 drinks/day.
Pharmacodynamics/Kinetics
See individual agents.
Dosage
Oral:
Analgesic: Based on acetaminophen component:
Children: 10-15 mg/kg/dose every 4-6 hours as needed; do
not
exceed 5 doses/24 hours
Adults: 325-650 mg every 4-7 hours as needed; do
not
exceed 4 g/day
Cough suppressant: Based on dextromethorphan component:
Children 6-12 years: 15 mg every 6-8 hours; do
not
exceed 60 mg/24 hours
Children >12 years and Adults: 10-20 mg every 4-8 hours
or
30 mg every 8 hours; do
not
exceed 120 mg/24 hours
Decongestant: Based on pseudoephedrine component:
Children:
2-6 years: 15 mg every 4 hours (maximum: 90 mg/24 hours)
6-12 years: 30 mg every 4 hours (maximum: 180 mg/24 hours)
Children >12 years and Adults: 60 mg every 4 hours (maximum: 360 mg/24 hours)
Product labeling:
Alka-Seltzer Plus® Cold and Flu Liqui-Gels®:
Children 6-12 years: 1 dose every 4 hours (maximum: 4 doses/24 hours)
Children >12 years and Adults: 2 dose every 4 hours (maximum: 4 doses/24 hours)
Infants' Tylenol® Cold Plus Cough Concentrated Drops: Children 2-3 years (24-55 lb): 2 dropperfuls every 4-6 hours (maximum: 4 doses/24 hours)
Sudafed® Severe Cold, Thera-Flu® Non-Drowsy Maximum Strength (gelcap), Tylenol® Flu Non-Drowsy Maximum Strength: Children >12 years and Adults: 2 doses every 6 hours (maximum: 8 doses/24 hours)
Tylenol® Cold Non-Drowsy:
Children 6-11 years: 1 dose every 6 hours (maximum: 4 doses/24 hours)
Children 
12 years and Adults: 2 doses every 6 hours (maximum: 8 doses/24 hours)
Thera-Flu® Non-Drowsy Maximum Strength: Children >12 years and Adults: 1 packet dissolved in hot water every 6 hours (maximum: 4 packets/24 hours)
Dietary Considerations
Thera-Flu® Severe Cold Non-Drowsy contains phenylalanine 17 mg/packet.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Pseudoephedrine: Xerostomia (normal salivary flow resumes upon discontinuation).
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
Use with caution since pseudoephedrine is a sympathomimetic amine which could interact with epinephrine to cause a pressor response
Mental Health: Effects on Mental Status
Sedation with dextromethorphan tends to be countered by the excitability associated with pseudoephedrine; one effect may predominate in any particular patient
Mental Health: Effects on Psychiatric Treatment
Increased toxicity and hypertensive crisis may be seen with concurrent use of MAO inhibitors and CNS depressants, effects of CNS depressants may be lessened
Dosage Forms
[DSC] = Discontinued product
Caplet:
Contac® Severe Cold and Flu/Non-Drowsy, Sudafed® Severe Cold, Tylenol® Cold Non-Drowsy: Acetaminophen 325 mg, dextromethorphan hydrobromide 15 mg, and pseudoephedrine hydrochloride 30 mg
Comtrex® Non-Drowsy Cold and Cough Relief: Acetaminophen 500 mg, dextromethorphan hydrobromide 15 mg, and pseudoephedrine hydrochloride 30 mg [contains benzoic acid]
Thera-Flu® Severe Cold Non-Drowsy: Acetaminophen 500 mg, dextromethorphan hydrobromide 15 mg, and pseudoephedrine hydrochloride 30 mg [contains lactose] [DSC]
Tylenol® Cold Day Non-Drowsy: Acetaminophen 325 mg dextromethorphan hydrobromide 15 mg, and pseudoephedrine hydrochloride 30 mg
Capsule, liquid
Alka-Seltzer Plus® Flu Liqui-Gels®: Acetaminophen 325 mg, dextromethorphan hydrobromide 10 mg, and pseudoephedrine hydrochloride 30 mg
Vicks® DayQuil® Multi-Symptom Cold and Flu: Acetaminophen 250 mg, dextromethorphan hydrobromide 10 mg, and pseudoephedrine hydrochloride 30 mg
Gelcap:
Tylenol® Cold Day Non-Drowsy: Acetaminophen 325 mg dextromethorphan hydrobromide 15 mg, and pseudoephedrine hydrochloride 30 mg [contains benzyl alcohol]
Tylenol® Flu Non-Drowsy Maximum Strength: Acetaminophen 500 mg, dextromethorphan hydrobromide 15 mg, and pseudoephedrine hydrochloride 30 mg
Liquid:
Triaminic® Cough and Sore Throat Formula: Acetaminophen 160 mg, dextromethorphan hydrobromide 7.5 mg, and pseudoephedrine hydrochloride 15 mg per 5 mL (120 mL, 240 mL) [contains benzoic acid; grape flavor]
Vicks® DayQuil® Multi-Symptom Cold and Flu: Acetaminophen 325 mg, dextromethorphan hydrobromide 10 mg, and pseudoephedrine hydrochloride 30 mg per 15 mL (175 mL)
Powder for oral solution [packet] (Thera-Flu® Severe Cold Non-Drowsy): Acetaminophen 1000 mg, dextromethorphan hydrobromide 30 mg, and pseudoephedrine hydrochloride 60 mg [contains phenylalanine 17 mg/packet; lemon flavor] [DSC]
Suspension, oral drops (Infants' Tylenol® Cold Plus Cough Concentrated Drops): Acetaminophen 160 mg, dextromethorphan hydrobromide 5 mg, and pseudoephedrine hydrochloride 15 mg per 1.6 mL (15 mL) [1.6 mL = 2 dropperfuls] [cherry flavor]
International Brand Names
Contac® Cough, Cold and Flu Day & Night™ (CA); Sudafed® Cold & Cough Extra Strength (CA); Tylenol® Cold Daytime (CA)
|
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's
accreditation program
is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s
editorial process
. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
|
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2007
A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
