acetaminophen/chlorpheniramine/phenylephrine (Tylenol Allergy Multi-Symptom, Dristan Cold, Children's Tylenol Plus Cold, Tylenol Sinus Congestion and Pain Nighttime, Robitussin Peak Cold Nighttime Nasal Relief)

Dosing and uses of Tylenol Allergy Multi-Symptom, Dristan Cold (acetaminophen/chlorpheniramine/phenylephrine)

• Adult
• Pediatric

 

Adult dosage forms and strengths

acetaminophen/chlorpheniramine/phenylephrine

tablet

• 325mg/2mg/5mg

 

Relief of Cold & Flu Symptoms

Dristan Cold: 2 tablets PO q4hr; not to exceed 12 tablets/day

Tylenol Allergy Multi-Symptom: 2 tablets PO q4hr; not to exceed 12 tablets/day

Tylenol Sinus Congestion & Pain Nighttime: 2 tablets PO q4hr; not to exceed 12 tablets/day

Robitussin Peak Cold Nighttime Nasal Relief: 2 tablets q4hr prn; not to exceed 12 tablets/day

 

Pediatric dosage forms and strengths

acetaminophen/chlorpheniramine/phenylephrine

tablet

• 325mg/2mg/5mg

 

Relief of Cold & Flu Symptoms

<12 years

• : Ask a peditrician

>12 years

• Dristan Cold: 2 tablets PO q4hr; not to exceed 12 tablets/day
• Tylenol Allergy Multi-Symptom: 2 tablets PO q4hr; not to exceed 12 tablets/day
• Tylenol Sinus Congestion & Pain Nighttime: 2 tablets PO q4hr; not to exceed 12 tablets/day
• Robitussin Peak Cold Nighttime Nasal Relief: 2 tablets q4hr prn

 

Tylenol Allergy Multi-Symptom, Dristan Cold (acetaminophen/chlorpheniramine/phenylephrine) adverse (side) effects

Frequency not defined

Hypotension

Hypertension

Palpitations

Reflex tachycardia

Severe peripheral and visceral vasoconstriction

Tachycardia

Confusion

Depression

Distress

Dizziness

Euphoria

Excitability

Fatigue

Headache

Insomnia

Irritability

Restlessness

Sedation

Tremors

Dermatologic rash

Anorexia

Agranulocytosis

Anemia blood dyscrasias (neutropenia, pancytopenia, leukopenia)

Hemolytic anemia

Thrombocytopenia

Bilirubin and alkaline phosphatase may increase

Thickening of bronchial secretions

Wheezing

 

Warnings

Contraindications

Contraindicated in documented hypersensitivity; asthma attacks, narrow-angle glaucoma, symptomatic prostate hypertrophy, bladder-neck obstruction, and stenosing peptic ulcer; known G-6-PD deficiency

Chlorpheniramine may cause significant confusional symptoms; not for administration to < 2 years of age

Use of MAO inhibitor within 14 days

Acetaminophen hepatotoxicity possible in chronic alcoholics following various dose levels; severe or recurrent pain or high or continued fever may indicate a serious illness; contained in many OTC products and combined use with these products may result in toxicity due to cumulative doses exceeding recommended maximum dose

 

Cautions

Caution in elderly patients, hyperthyroidism, myocardial disease, bradycardia, partial heart block or severe arteriosclerosis when administering phenylephrine; in hypovolemia, phenylephrine use is not a substitute for replacement of blood, fluids and electrolytes, and plasma (promptly restore with loss); dilute IV and administer via large vein; extravasation precautions required

Caution in asthma, bladder neck obstruction, cardiovascular disease, COPD, GI obstruction, glaucoma, hepatic impairment, hyperthyroidism, increased intraocular pressure, malnutrition, renal impairment, elderly patients, patients taking CNS depressants or < 6 years of age with chlorpheniramine products

Caution in severe hypovolemia if taking acetaminophen products

Acetaminophen: Risk for rare, but serious skin reactions that can be fatal; these reactions include Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP); symptoms may include skin redness, blisters and rash

 

Pregnancy and lactation

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 Tylenol Allergy Multi-Symptom, Dristan Cold (acetaminophen/chlorpheniramine/phenylephrine)

Mechanism of action

Chlorpheniramine blocks muscle responses in histamine and acts as an antagonism of the constrictor effects of histamine on respiratory smooth muscle.

Acetaminophen blocks pain impulse generation peripherally and may inhibit the generation of prostaglandin in the CNS. Reduces fever by inhibiting the hypothalamic heat-regulating center.

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.