aspirin/chlorpheniramine/phenylephrine (Alka-Seltzer Plus Cold)
Dosing and uses of Alka-Seltzer Plus Cold (aspirin/chlorpheniramine/phenylephrine)
Adult dosage forms and strengths
aspirin/chlorpheniramine/phenylephrine
effervescent tablet
- 325mg/2mg/7.8mg
Temporary Relief of Common Cold Cough & Upper Respiratory Symptoms
Alka-Seltzer Plus Cold: 2 tablets fully dissolved in 4 oz of water q4hr; not to exceed 8 tablets/day
Pediatric dosage forms and strengths
aspirin/chlorpheniramine/phenylephrine
effervescent tablet
- 325mg/2mg/7.8mg
Temporary Relief of Common Cold Cough & Upper Respiratory Symptoms
Alka-Seltzer Plus Cold
- <12 years old: Ask a pediatrician
- >12 years old: 2 tablets fully dissolved in 4 oz of water q4hr; not to exceed 8 tablets/day
Alka-Seltzer Plus Cold (aspirin/chlorpheniramine/phenylephrine) adverse (side) effects
Frequency not defined
Dysrhythmias
Hypotension
Tachycardia
Agitation
Cerebral edema
Coma
Confusion
Dizziness
Headache
Subdural or intracranial hemorrhage
Lethargy
Hives
Rashes
May potentiate peptic ulcer and cause stomach distress or heartburn
Dyspepsia
GI bleeding
Ulceration and perforation
Nausea
Vomiting
Prolonged prothrombin time
Palpitations
Sedation
Fatigue
Confusion
Depression
Tremors
Irritability
Insomnia
Euphoria
Hemolytic anemia
Thrombocytopenia
Agranulocytosis
Anorexia
Wheezing
Thickening of bronchial secretions
Restlessness
Headache
Hypertension
Severe peripheral and visceral vasoconstriction
Warnings
Contraindications
Hypersensitivity
Liver damage
Hypoprothrombinemia
Vitamin K deficiency
Bleeding disorders
Asthma
Due to association of aspirin with Reye syndrome, do not use in children (<16 y) with viral infections
Narrow-angle glaucoma
Symptomatic prostate hypertrophy
Bladder-neck obstruction
Stenosing peptic ulcer
Aspirin: May cause transient decrease in renal function & aggravate chronic kidney disease; avoid use in patients with severe anemia, with history of blood coagulation defects, or taking anticoagulants
Chlorpheniramine: May cause significant confusional symptoms; not for administration to premature or full-term neonates
Phenylephrine: Caution in elderly patients, hyperthyroidism, myocardial disease, bradycardia, partial heart block or severe arteriosclerosis
Pregnancy and lactation
Pregnancy category D; avoid during pregnancy, especially during third trimester (risk for premature closure of ductus arteriosus)
Lactation: excreted in breast milk; do not breast feed
Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Alka-Seltzer Plus Cold (aspirin/chlorpheniramine/phenylephrine)
Mechanism of action
Aspirin is a stronger inhibitor of both prostaglandin synthesis and platelet aggregation than other salicylic acid derivatives. Acetyl group is responsible for inactivation of cyclooxygenase via acetylation.
Aspirin is hydrolyzed rapidly in plasma, and elimination follows zero order pharmacokinetics. Aspirin irreversibly inhibits platelet aggregation by inhibiting platelet cyclooxygenase. This, in turn, inhibits conversion of arachidonic acid to PGI2 (potent vasodilator and inhibitor of platelet activation) and thromboxane A2 (potent vasoconstrictor and platelet aggregate).
Chlorpheniramine blocks muscle responses in histamine and acts as an antagonism of the constrictor effects of histamine on respiratory smooth muscle.
Phenylephrine is a vasoconstrictor and a decongestant that relieves symptoms resulting from irritation of upper respiratory tract tissue. It shrinks swollen mucous membranes, reduces nasal congestion and tissue hyperemia.
