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Paracetamol/Chlorpheniramine/Dextromethorphan/Phenylephrine

    Brands

    DEA Class;  OTC

    Common Brand Names; Children’s Dimetapp Multi-Symptom Cold & Flu

    •  Cough/Cold, Non-narcotic Combos; 
    • Analgesic/Antihistamine/Antitussive/Decongestant Combos

    Oral analgesic/antipyretic, antihistamine, non-opioid antitussive, and decongestant combination
    Used for the relief of common cold or flu symptoms including cough, fever, headache, minor aches and pain, nasal and sinus congestion, rhinorrhea, sneezing, and sore throat

    For the relief of cough, fever, headache, mild pain, rhinorrhea, sinus and nasal congestion, sneezing, and sore throat (pharyngitis) due to the common cold or flu.

    Hypersensitivity

    Hepatitis or hepatic/renal dysfunction, alcoholism

    Repeated administration in patients with anemia or cardiac, pulmonary, or renal disease

    Do not use with MAOIs or for 2 weeks after discontinuing MAOIs

    Hypertension

    Severe peripheral and visceral vasoconstriction

    Reflex tachycardia

    Dizziness

    Drowsiness

    Excitability

    Headache

    Restlessness

    Tremor

    GI disturbances

    Acetaminophen

    • Acetaminophen in many other dosage forms and products, check label carefully to avoid overdose

    • Risk of hepatotoxicity is higher in alcoholics or with use of more than one acetaminophen-containing product

    • G6PD deficiency

    • 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

    Chlorpheniramine

    • Marked drowsiness may occur; avoid other sedating drugs and alcohol

    • Paradoxical excitability reaction may occur, especially in children

    • Caution in narrow angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer, pyloroduodenal obstruction, or bladder neck obstruction

    Dextromethorphan may decrease respirations

    Phenylephrine may increase blood pressure

    Pregnancy Category: C

    Lactation: excretion in milk unknown; use with caution

    Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs

    NOTE: Do not exceed recommended dosage limits for the specific product prescribed; the following are general guidelines:

    Adults

    Acetaminophen 2000 mg/day PO; chlorpheniramine 16 mg/day PO; dextromethorphan 80 mg/day PO; phenylephrine 40 mg/day PO.

    Elderly

    Acetaminophen 2000 mg/day PO; chlorpheniramine 16 mg/day PO; dextromethorphan 80 mg/day PO; phenylephrine 40 mg/day PO.

    Adolescents

    Acetaminophen 2000 mg/day PO; chlorpheniramine 16 mg/day PO; dextromethorphan 80 mg/day PO; phenylephrine 40 mg/day PO.

    Children

    >= 12 years: Acetaminophen 2000 mg/day PO; chlorpheniramine 16 mg/day PO; dextromethorphan 80 mg/day PO; phenylephrine 40 mg/day PO.
    6—11 years: Acetaminophen 1600 mg/day PO; chlorpheniramine 10 mg/day PO; dextromethorphan 50 mg/day PO; phenylephrine 25 mg/day PO.
    < 6 years: Safety and efficacy have not been established.