aspirin/doxylamine/dextromethorphan/phenylephrine (Alka-Seltzer Plus Night Cold and Cough Effervescent)
Classes: Antitussives, Non-narcotic Combos
- Dosing and uses of Alka-Seltzer Plus Night Cold & Cough Effervescent (aspirin/doxylamine/dextromethorphan/phenylephrine)
- Alka-Seltzer Plus Night Cold & Cough Effervescent (aspirin/doxylamine/dextromethorphan/phenylephrine) adverse (side) effects
- Warnings
- Pregnancy
- Pharmacology of Alka-Seltzer Plus Night Cold & Cough Effervescent (aspirin/doxylamine/dextromethorphan/phenylephrine)
Dosing and uses of Alka-Seltzer Plus Night Cold and Cough Effervescent (aspirin/doxylamine/dextromethorphan/phenylephrine)
Adult dosage forms and strengths
aspirin/doxylamine/dextromethorphan/phenylephrine
effervescent tablet
- 500mg/10mg/6.25mg/7.8mg
Relief of Cold Symptoms
Alka-Seltzer Plus Night Cold & Cough Effervescent: 2 tablets fully dissolved in 4 oz of water qHS; may be taken q4-6hr; not to exceed 8 tablets/day
Pediatric dosage forms and strengths
aspirin/doxylamine/dextromethorphan/phenylephrine
effervescent tablet
- 500mg/10mg/6.25mg/7.8mg
Relief of Cold Symptoms
Alka-Seltzer Plus Night Cold & Cough Effervescent
- <12 years old: Do not use
- >12 years old: 2 tablets fully dissolved in 4 oz of water qHS; may be taken q4-6hr; not to exceed 8 tablets/day
Alka-Seltzer Plus Night Cold and Cough Effervescent (aspirin/doxylamine/dextromethorphan/phenylephrine) adverse (side) effects
Frequency not defined
Dysrhythmias
Hypotension
Tachycardia
Agitation
Cerebral edema
Coma
Confusion
Dizziness
Headache
Subdural or intracranial hemorrhage
Lethargy
Hives
Rash
May potential peptic ulcer & cause stomach distress or heartburn
Dyspepsia
GI bleeding
Ulceration & perforation
Nausea
Vomiting
Prolonged prothrombin time
Sedation
Sleepiness
Urinary retention
Xerostomia
Increased appetite
Thickening of mucus in nose or throat
Restlessness
Headache
Hypertension
Severe peripheral & visceral vasoconstriction
Warnings
Contraindications
Hypersensitivity
Liver damage
Hypoprothrombinemia
Vitamin K deficiency
Bleeding disorders
Asthma
Due to association of aspirin w/ Reye syndrome, do not use in children (<16 y) with viral infections
Use within 14 days of MAO inhibitor therapy
Narrow-angle glaucoma
Symptomatic prostate hypertrophy
Bladder-neck obstruction
Cautions
Aspirin: May cause transient decrease in renal function and aggravate chronic kidney disease; avoid use in patients with severe anemia, history of blood coagulation defects, or taking anticoagulants
Dextromethorphan: Do not take for persistent or chronic cough associated with smoking, asthma, or emphysema, or if it is accompanied by excessive phlegm unless directed by a healthcare provider; may decrease respiration rate
Doxylamine: May exacerbate angle closure glaucoma, hyperthyroidism, peptic ulcer, or urinary tract obstruction; xerostomia may occur
Phenylephrine: Caution in elderly patients, hyperthyroidism, myocardial disease, bradycardia, partial heart block or severe arteriosclerosis
Pregnancy and lactation
Pregnancy category: D, avoid aspirin 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 Night Cold and Cough Effervescent (aspirin/doxylamine/dextromethorphan/phenylephrine)
Mechanism of action
Aspirin: Stronger inhibitor of both prostaglandin synthesis & platelet aggregation than other salicylic acid derivatives; acetyl group responsible for inactivation of cyclooxygenase via acetylation; hydrolyzed rapidly in plasma, & 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)
Doxylamine: competitively blocks histamine from binding to H1 receptors; significant antimuscarinic activity and penetrates CNS, which causes pronounced tendency to induce sedation
Dextromethorphan: cough suppressant that acts centrally on the cough center in medulla
Phenylephrine: vasoconstrictor & decongestant that relieves symptoms resulting from irritation of upper respiratory tract tissue; shrinks swollen mucous membranes, reduces nasal congestion and tissue hyperemia