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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?

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

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.

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.

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.

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.

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?

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?

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?

• 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.