Ingredient: Acetaminophen, dextromethorphan HBr, guaifenesin, and phenylephrine hydrochloride.
Cold & Flu Liquicaps: Each capsule contains acetaminophen 325 mg, dextromethorphan HBr 10 mg, and phenylephrine HCl 5 mg.
Cold & Flu Liquid: Each 15 mL contains acetaminophen 325 mg, dextromethorphan HBr 10 mg, and phenylephrine HCl 5 mg.
Cough Liquid: Each 15 mL contains dextromethorphan HBr with guaifenesin 200 mg.
Severe Cold & Flu Relief Caplets: Each caplet contains acetaminophen 325 mg, dextromethorphan HBr 10 mg, guaifenesin 200 mg, and phenylephrine 5 mg.
Severe Cold & Flu Relief Liquid: Each 15 mL contains acetaminophen 325 mg, dextromethorphan HBr 10 mg, guaifenesin 200 mg, and phenylephrine 5 mg.
Products containing phenylephrine are indicated for the treatment of nasal congestion.
Products containing dextromethorphan are indicated for the treatment of cough due to minor throat and bronchial irritation.
Products containing acetaminophen are indicated for the treatment of headache, minor aches and pains, sore throat, and fever.
Adults should take two tablespoonfuls (30 mL), or two capsules, every 4 hours as needed, not to exceed 6 doses in a 24-hour period.
Children aged 6-12 should take one tablespoonful (15 mL) every 4 hours as needed, not to exceed 5 doses in a 24-hour period.
Pharmacology:
Phenylephrine stimulates alpha-1-adrenergic receptors in smooth muscle causing vasoconstriction. The resulting vasoconstriction decreases swelling in the nasal passages and relieves congestion. Acetaminophen relieves pain by inhibiting prostaglandin synthesis in the CNS and through a peripheral action by blocking pain impulse generation. Acetaminophen also lowers the elevated temperature set-point which results in fever reduction. Dextromethorphan depresses the cough reflex in the medulla oblongata without decreasing ciliary function. Its effects last for 5 or more hours.
Evaluation:
The common cold is a term given to a disease caused by any one of over 200 airborne and nonairborne viruses. Rhinoviruses are the causative agent in many colds and infections occur more often during the warmer months. Corona viruses cause most of the adult viruses and infections occur usually in the colder months. Symptoms include rhinitis, nasal congestion, low grade fever, watery eyes, sneezing, headache, and coughing. There are three important factors to consider when treating coughs: the congestion of the lower respiratory tract, the frequency of the cough, and the ability to expectorate. Cough suppressants are used to decrease the frequency of coughing. They are not indicated in congested/productive coughs of low frequency. In fact, the productive cough is useful in removing debris and excessive phlegm from the lower respiratory tract. Suppressants are indicated in coughs of high frequency, especially dry/hacking coughs. Colds can lead to secondary infections in the lower respiratory tract, middle ear, and sinuses.
Contraindications/Precautions:
Decongestants: Do not use in patients with high blood pressure, diabetes, heart disease, or thyroid disease unless under the direction of a physician. May cause severe hypertension when combined with furazolidone or monoamine oxidase inhibitors. Urine alkalinizers including sodium bicarbonate may increase toxicity of decongestants. Prolonged use of acetaminophen at therapeutic doses may cause hepatotoxicity especially when used with hydantoins, sulfinpyrazone, or alcohol. Cough suppressants should not be used for more than 7 days or in the presence of a high fever or headache unless directed to do so by a physician. Do not use for chronic or persistent coughs such as those associated with smoking, asthma, or emphysema. Dextromethorphan may interact with monoamine oxidase inhibitors (MAOI) and cause a hypotensive crisis. Pregnancy Category B.
Adverse Effects:
The most common adverse effects seen with products containing phenylephrine are insomnia, restlessness, and tachycardia. Dextromethorphan may cause drowsiness.
Ask the patient to describe their symptoms. Coughs accompanied by excess phlegm should be treated with an expectorant or by a physician.
Ask the patient about their drug therapy including treatment of depression or Parkinson’s Disease.
Consult a physician if no improvement is seen after 7 days or in the presence of a high fever or headache.
Patients who consume 3 or more alcoholic beverages per day should consult their physician before using acetaminophen.
