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All about: acetaminophen, chlorpheniramine, dextromethorphan, and pseudoephedrine

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Generic Name: acetaminophen, chlorpheniramine, dextromethorphan, and pseudoephedrine (a seet a MIN oh fen, klor fen IR a meen, dex troe meth OR fan, soo doe e FED rin)
Brand Names: Child Tylenol Cold Multi-Symptom Plus Cough, Comtrex Cold and Flu Maximum Strength Liquid, Comtrex Cold and Flu Maximum Strength Tablet, Theraflu Flu, Cold and Cough Powder, Theraflu Night Cough and Cold and Flu, Tylenol Cold and Cough, Tylenol Cold and Flu Powder, Vicks 44 Cold, Flu and Cough

What is acetaminophen, chlorpheniramine, dextromethorphan and pseudoephedrine?

Acetaminophen is a pain reliever and fever reducer.

Chlorpheniramine is an antihistamine that reduces the natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose.

Dextromethorphan is a cough suppressant. It affects the cough reflex in the brain that triggers coughing.

Pseudoephedrine is a decongestant that shrinks blood vessels in the nasal passages. Dilated blood vessels can cause nasal congestion (stuffy nose).

The combination of acetaminophen, chlorpheniramine, dextromethorphan, and pseudoephedrine is used to treat runny or stuffy nose, sinus congestion, cough, and pain or fever caused by the common cold or flu.

Acetaminophen, chlorpheniramine, dextromethorphan and pseudoephedrine may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about acetaminophen, chlorpheniramine, dextromethorphan and pseudoephedrine?

Do not take pseudoephedrine if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take pseudoephedrine before the MAO inhibitor has cleared from your body. Do not take more of this medication than is recommended. An overdose of acetaminophen can cause damage to your liver. The maximum amount of acetaminophen for adults is 1 gram (1000 mg) per dose and 4 grams (4000 mg) per day. Do not use any other over-the-counter cough, cold, or allergy medication without first asking your doctor or pharmacist. If you take certain products together you may accidentally take too much of a certain drug. Read the label of any other medicine you are using to see if it contains acetaminophen, chlorpheniramine, dextromethorphan, or pseudoephedrine. Do not give this medicine to a child without a doctor's advice. Death can occur from the misuse of cough or cold medicine in very young children. Always ask your doctor before treating a cough or cold in a child.

What should I discuss with my healthcare provider before taking acetaminophen, chlorpheniramine, dextromethorphan and pseudoephedrine?

Do not use this medication if you are allergic to acetaminophen, chlorpheniramine, dextromethorphan or pseudoephedrine, or to similar medications such as other decongestants, diet pills, stimulants, or ADHD medications. Do not use this medication if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take a cough or cold medicine before the MAO inhibitor has cleared from your body.

Before taking acetaminophen, chlorpheniramine, dextromethorphan and pseudoephedrine, tell your doctor if you are allergic to any drugs, or if you have:

  • liver disease;

  • alcoholism or cirrhosis of the liver;

  • heart disease or high blood pressure;

  • diabetes;

  • a thyroid disorder;

  • glaucoma;

  • kidney disease;

  • an enlarged prostate; or

  • problems with urination.

If you have any of these conditions, you may not be able to use this medication, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. This medication may pass into breast milk and could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Artifically-sweetened liquid forms of cough-and-cold medications may contain phenylalanine. This would be important to know if you have phenylketonuria (PKU). Check the ingredients and warnings on the medication label if you are concerned about phenylalanine.

How should I take acetaminophen, chlorpheniramine, dextromethorphan and pseudoephedrine?

Use this medication exactly as directed on the label, or as it has been prescribed by your doctor. Do not use the medication in larger amounts, or use it for longer than recommended. Cough-and-cold medicines should be taken only for a short time until your symptoms clear up.

Drink extra fluids while you are taking acetaminophen, chlorpheniramine, dextromethorphan, and pseudoephedrine. An overdose of acetaminophen can cause serious harm. The maximum amount of acetaminophen for adults is 1 gram (1000 mg) per dose and 4 grams (4000 mg) per day. Taking more acetaminophen could cause damage to your liver. One packet of the oral powder may contain up to 1000 mg of acetaminophen. Know the amount of acetaminophen in the specific product you are taking. Always ask a doctor before giving a cough or cold medicine to a child. Death can occur from the misuse of cough and cold medicines in very young children.

Measure the liquid form of this medicine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Talk with your doctor if your symptoms do not improve after 7 days of treatment, or if you have a fever with a headache, cough, or skin rash.

If you need to have any type of surgery, tell the surgeon ahead of time if you have taken a cold medicine within the past few days.

Store the medicine at room temperature, away from heat, light, and moisture.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of an overdose may include dry mouth, feeling restless or nervous, dizziness, drowsiness, nausea, vomiting, diarrhea, stomach pain, loss of appetite, increased sweating, warmth or tingly feeling, seizure (convulsions), or coma.

What should I avoid while taking acetaminophen, chlorpheniramine, dextromethorphan and pseudoephedrine?

Do not use any other over-the-counter cough, cold, pain, or allergy medication without first asking your doctor or pharmacist. Acetaminophen, chlorpheniramine, dextromethorphan and pseudoephedrine are contained in many cold, pain, and allergy medicines available over the counter. If you take certain products together you may accidentally take too much of a certain drug. Read the label of any other medicine you are using to see if it contains acetaminophen, chlorpheniramine, dextromethorphan or pseudoephedrine. Avoid drinking alcohol. It can increase the risk of liver damage while you are taking acetaminophen. If you drink more than three alcoholic beverages per day, do not take acetaminophen without your doctor's advice, and never take more than 2 grams (2000 mg) of acetaminophen per day. This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid becoming overheated or dehydrated during exercise and in hot weather.

Avoid using other medicines that make you sleepy (such as pain medication, muscle relaxers, and medicine to treat depression or anxiety). They can add to sleepiness caused by an antihistamine.

Avoid taking diet pills, caffeine pills, or other stimulants (such as ADHD medications) without your doctor's advice. Taking a stimulant together with pseudoephedrine can increase your risk of unpleasant side effects.

What are the possible side effects of acetaminophen, chlorpheniramine, dextromethorphan and pseudoephedrine?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have any of these serious side effects:
  • fast, pounding, or uneven heartbeat;

  • confusion, hallucinations, unusual thoughts or behavior;

  • slow, shallow breathing;

  • severe dizziness, anxiety, restless feeling, or nervousness;

  • urinating less than usual or not at all;

  • easy bruising or bleeding, unusual weakness, fever, chills, body aches, flu symptoms;

  • increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness, seizure); or

  • nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Keep using the medication and talk with your doctor if you have any of these less serious side effects:

  • blurred vision;

  • dry mouth;

  • nausea, stomach pain, constipation;

  • mild loss of appetite, upset stomach;

  • warmth, tingling, or redness under your skin;

  • restless or excitability (especially in children);

  • sleep problems (insomnia);

  • dizziness, drowsiness;

  • problems with memory or concentration;

  • ringing in your ears; or

  • skin rash, redness, or itching.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect acetaminophen, chlorpheniramine, dextromethorphan and pseudoephedrine?

Before taking this medication, tell your doctor if you are using any of the following drugs:

  • celecoxib (Celebrex);

  • cinacalcet (Sensipar);

  • darifenacin (Enablex);

  • imatinib (Gleevec);

  • isoniazid;

  • quinidine (Quinaglute, Quinidex);

  • ranolazine (Ranexa)

  • ritonavir (Norvir);

  • sibutramine (Meridia);

  • terbinafine (Lamisil);

  • zidovudine (Retrovir, AZT);

  • an antidepressant;

  • a bronchodilator;

  • a diuretic (water pill);

  • medication to treat irritable bowel syndrome, bladder spasms, or urinary incontinence;

  • aspirin or salicylates (such as Disalcid, Doan's Pills, Dolobid, Salflex, Tricosal, and others);

  • medicines to treat high blood pressure;

  • gout medications such as probenecid (Benbemid) or sulfinpyrazone;

  • a beta-blocker such as atenolol (Tenormin), carteolol (Cartrol), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal), sotalol (Betapace), timolol (Blocadren), and others;

  • seizure medication such as phenytoin (Dilantin) or phenobarbital (Luminal, Solfoton).

If you are using any of these drugs, you may not be able to use acetaminophen, chlorpheniramine, dextromethorphan and pseudoephedrine, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect acetaminophen, chlorpheniramine, dextromethorphan and pseudoephedrine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist has information about acetaminophen, chlorpheniramine, dextromethorphan and pseudoephedrine written for health professionals that you may read.

What does my medication look like?

Acetaminophen, chlorpheniramine, dextromethorphan and pseudoephedrine is available over the counter under many brand and generic names. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2006 Cerner Multum, Inc. Version: 5.04. Revision Date: 1/22/07 1:20:20 PM.

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