Generic Name: acetaminophen/dextromethorphan/phenylephrine
Brand Names: Alka-Seltzer Plus Day Cold, Theraflu Daytime Severe Cold & Cough, Tylenol Cold Multi-Symptom Daytime, Tylenol Cold Head Congestion Daytime, Vicks DayQuil Cold/Flu, Alka-Seltzer Plus Day Severe Cold, Cough & Flu, Alka-Seltzer Plus Day Sinus Congestion, Allergy & Cough, Alka-Seltzer Plus Severe Sinus Congestion & Cough
Drug Class: Cough/Cold, Non-narcotic Combos; Analgesic/Decongestant Combos
What is acetaminophen/dextromethorphan/phenylephrine, and what is it used for?
Acetaminophen/dextromethorphan/phenylephrine is a combination medication used for the temporary relief of common cold and flu symptoms, including fever, headache, body aches, cough, sore throat, and nasal and sinus congestion. The three drugs are combined in specific dosages and the combo drug is available over the counter (OTC).
Each medication in the combination works in a different way and together they provide more effective relief than any of them as a single agent.
- Acetaminophen is an analgesic and antipyretic drug used to relieve pain and fever. Acetaminophen relieves pain by blocking pain impulse generation and inhibiting the synthesis of prostaglandin in the central nervous system (CNS). Prostaglandin is a natural substance in the body that initiates inflammation. Acetaminophen reduces fever by acting on the hypothalamus region of the brain which regulates temperature.
- Dextromethorphan suppresses cough by reducing the sensitivity of cough receptors in the brain region that stimulate the cough reflex and preventing the transmission of cough impulses.
- Phenylephrine belongs to a class of medications known as alpha1 agonists. Phenylephrine stimulates alpha1 adrenergic receptors, protein molecules located in smooth muscle tissues around blood vessels, making the muscles contract. This constricts the blood vessels in the nasal and sinus passages, reducing congestion.
Warnings
- Do not use in patients with known hypersensitivity to acetaminophen, dextromethorphan, phenylephrine or any of the components in the formulation.
- Do not take concurrently with any other drug containing acetaminophen.
- Do not take concurrently or within 14 days after treatment with monoamine oxidase inhibitor (MAOI) type of antidepressant medications.
- Use with caution in elderly patients.
- Acetaminophen can damage the liver, especially with prolonged use with high doses.
- Use acetaminophen/dextromethorphan/phenylephrine with caution in patients with G6PD enzyme deficiency, a genetic disorder.
- Use acetaminophen/dextromethorphan/phenylephrine with caution in patients with any of the following conditions:
- Cardiovascular diseases including hypertension and ischemic heart disease
- Diabetes mellitus
- Active liver disease or liver function impairment
- Increased intraocular pressure or glaucoma, a condition that damages the optic nerve
- Prostate enlargement and urinary obstruction
- Thyroid dysfunction
- Use with caution in patients with alcoholic liver disease. Drinking 3 or more alcoholic drinks a day can increase the risk of liver damage. Advise patients to avoid drinking or limit to less than 3 drinks a day.
- Use with caution in patients with kidney impairment. Adjust dosage if necessary.
- Use with caution in chronic malnutrition.
- Some formulations may contain sulfites, which may cause allergic reactions in some people.
- Some formulations may contain propylene glycol, which can be toxic in large quantities.
- Some formulations may contain phenylalanine, which should be avoided in patients with phenylketonuria, a disorder with inability to metabolize phenylalanine.
- There have been rare reports of life-threatening skin reactions including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP) with symptoms such as blisters, rash, and redness. Discontinue treatment if such symptoms develop.

SLIDESHOW
Cold and Flu: Finding Fast Cough Relief See SlideshowWhat are the side effects of acetaminophen/dextromethorphan/phenylephrine?
Common side effects of acetaminophen/dextromethorphan/phenylephrine include:
- Dizziness
- Drowsiness
- Headache
- Tremor
- Excitability
- Restlessness
- Gastrointestinal disturbances
- Reflex increase in heart rate (reflex tachycardia)
- High blood pressure (hypertension)
- Blood disorders including:
- Low red blood cell count (anemia)
- Low count of neutrophil immune cells (neutropenia)
- Low count of leukocyte immune cells (leukopenia)
- Low count of all types of blood cells (pancytopenia)
- Increase in bilirubin levels
- Elevated alkaline phosphatase enzyme levels
Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:
- Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
- Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
- Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
- Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.
This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.
What are the dosages of acetaminophen/dextromethorphan/phenylephrine?
Acetaminophen/dextromethorphan/phenylephrine
Caplet
- 325 mg/10 mg/5 mg
Rapid Release Gelcap
- 325 mg/10 mg/5 mg
Capsule
- 325 mg/10 mg/5 mg
Liquid
- 325 mg/10 mg/5 mg/15 mL
Powder for Solution
- 650 mg/20 mg/10 mg/packet
- 500 mg/20 mg/10 mg/packet
Syrup
- 325 mg/10 mg/5 mg/15 mL
Adult:
Symptomatic Relief of Cough and Congestion
- 1 packet orally every 4 hours; not to exceed 6 doses/day
- 2 caplets/capsules orally every 4 hours; not to exceed 12 caplets/capsules/day
- 30 mL liquid/syrup orally every 4 hours; not to exceed 6 doses (12 tablespoons)/day
- 2 gelcaps every 4 hours; not to exceed 12 gelcaps/day
Pediatric:
Symptomatic Relief of Cough and Congestion
Children below 4 years old
- Not recommended for use
Children 6-12 years old
- Liquid: acetaminophen 325 mg/dextromethorphan 10 mg/phenylephrine 5 mg per 15 mL: 15 mL every 4 hours
- Not to exceed: 60 mL (acetaminophen 1,300 mg/dextromethorphan 40 mg/phenylephrine 20 mg) per 24 hours
Children above 12 years old
- 1 packet orally every 4 hours; not to exceed 6 doses/day
- 2 caplets/capsules orally every 4 hours; not to exceed 12 caplets/capsules/day
- 30 mL liquid/syrup orally every 4 hours; not to exceed 6 doses (12 tablespoons)/day
- 2 gelcaps every 4 hours; not to exceed 12 gelcaps/day
Overdose
- Overdose of acetaminophen/dextromethorphan/phenylephrine can damage the liver and cause severe adverse effects with symptoms that include nausea, vomiting, loss of appetite, sweating, abdominal pain, extreme tiredness, yellowing eyes and skin, dark urine, agitation, confusion, hallucinations and seizures.
- Overdose treatment may include administration of N-acetylcysteine, antidote to acetaminophen, and other symptomatic and supportive measures as needed.
What drugs interact with acetaminophen/dextromethorphan/phenylephrine?
Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.
- Severe interactions of acetaminophen/dextromethorphan/phenylephrine include:
- iobenguane I 123
- isocarboxazid
- linezolid
- phenelzine
- procarbazine
- selegiline transdermal
- tranylcypromine
- Acetaminophen/dextromethorphan/phenylephrine has serious interactions with at least 25 different drugs.
- Acetaminophen/dextromethorphan/phenylephrine has moderate interactions with at least 192 different drugs.
- Acetaminophen/dextromethorphan/phenylephrine has mild interactions with at least 58 different drugs.
The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.
It is important to always tell your doctor, pharmacist, or health care provider about all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or healthcare provider if you have any questions about the medication.
Pregnancy and breastfeeding
- Acetaminophen/dextromethorphan/phenylephrine should be used by pregnant women only if clearly needed. The lowest effective dose for the shortest possible time is recommended.
- Acetaminophen/dextromethorphan/phenylephrine is likely safe to take while breastfeeding, use with caution.
- If you are pregnant or breastfeeding, do not take any OTC drug, including acetaminophen/dextromethorphan/phenylephrine, without first checking with your healthcare provider.
What else should I know about acetaminophen/dextromethorphan/phenylephrine?
- Take acetaminophen/dextromethorphan/phenylephrine exactly as prescribed or as per label instructions if taking OTC medication.
- Do not take higher or more frequent doses, do not exceed daily recommended dosage and do not take for prolonged periods.
- Avoid overdose by checking product labels carefully. Acetaminophen is found in many dosage forms and many combination products.
- Discontinue immediately if you develop hypersensitivity reactions.
- Discontinue use and consult with your healthcare provider if:
- Your cough lasts longer than seven days, reoccurs, or occurs with fever, rash, or persistent headaches. It could be a sign of a serious condition that should be diagnosed and treated.
- You experience dizziness, nervousness, or sleeplessness.
- You develop severe skin reactions.
- Check with the physician before taking acetaminophen/dextromethorphan/phenylephrine if you have chronic cough associated with smoking, asthma, or emphysema, or if it occurs with heavy phlegm or mucus.
- Avoid or limit intake of alcohol while on treatment.
- Store safely out of reach of children.
- In case of overdose, seek immediate medical help or contact Poison Control.
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Summary
Acetaminophen/dextromethorphan/phenylephrine is a combination medication used for the temporary relief of common cold and flu symptoms, including fever, headache, body aches, cough, sore throat, and nasal and sinus congestion. Common side effects of acetaminophen/dextromethorphan/phenylephrine include dizziness, drowsiness, headache, tremor, excitability, restlessness, gastrointestinal disturbances, reflex increase in heart rate (reflex tachycardia), high blood pressure (hypertension), blood disorders, and others. Consult your doctor if pregnant or breastfeeding.
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What Can Trigger a Cold Sore?
After you get infected with HSV, it lies inactively in the nerve cells inside your skin and may appear as another cold sore at the same place as before.
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How Long Does a Cold Last?
Most often, a common cold lasts anywhere from 5 to 10 days in length.
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How Do You Know If Your Child Has Whooping Cough?
Whooping cough is a common issue that affects many children. Learn the signs of whooping cough, what causes it, how doctors diagnose it, and what you can do to treat it.
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What Can I Do for My Baby’s Cough?
Cough can cause significant discomfort to a baby. The baby may also have difficulty relaxing and sleeping. Numerous illnesses can cause cough as a primary symptom. Coughing is the result of the baby’s airway being affected or irritated.
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How Do I Get Rid of My Toddler's Cough?
Cough is one of the common complaints in toddlers. Get rid of your toddler's cough by making sure your child rests, stays hydrated, takes over-the-counter pain medication, uses nasal spray and uses a humidifier or steam to provide relief.
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When to See a Doctor When Your Baby Has a Cold
If your baby has a cold, signs that it may be time to see a doctor include poor feeding, dehydration, breathing difficulties, ear pain, and more.
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What Do You Give a Child With a Cold?
Unfortunately, there is no cure for the common cold. Antibiotics may be used to fight bacterial infections, but they have no effect on viruses.
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What Is Good for a Child's Cold?
The common cold is one of the main reasons for missing schools in children and missing work in adults. Children are affected more commonly with cold than adults, who may have an average of two to three colds each year.
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How Do You Tell If Your Child Has Allergies or a Cold?
Colds and allergies have different causes, but both involve the body's immune system. Since the symptoms of allergies and the symptoms of a cold overlap, it can be hard to tell which one your child has.
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How Do You Get a Cold Sore on Your Lip?
Cold sores, also called fever blisters or oral herpes, are a viral infection that leaves small blisters around your mouth. You get a cold sore on your lip due to viral infection from herpes simplex virus type 1 (HSV-1).
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How to Identify Cold Symptoms in Children
When a child is sick, their way of showing it may not always be clear. Here’s what to look for to determine whether your child is sick with a cold.
Treatment & Diagnosis
- Cold & Flu FAQs
- Common Cold FAQs
- Colds: 10 Tips to Prevent The Common Cold
- Killer Cold Virus (Adenovirus Strains)
- Common Cold . . . Social Ties Decrease Risk
- Colds: Zinc For Colds...Jury Still Out!
- Cough, Cold, Weight Loss Drug Dangerous - Warning
- What Does It Mean When Children Cough up Sulfur Granules?
- What Can You Give a Toddler for Severe Cough?
- How Long Does Bronchitis Cough Last?
- What Causes a Chronic Cough in Winter?
- How Long Does It Take Strep to Go Away?
- How Do You Treat Whooping Cough in Adults?
- Can You Cough to Give Yourself CPR?
- What Kind of Cold Medicine Can Diabetics Take?
- Whooping Cough Symptoms
- Cold Sore Treatment
- OTC Cold and Cough Medications
- When to Call the Doctor for Fever, Nausea, Diarrhea, Colds, and Coughs
- Air Travel, Colds, and Sinus Infections
Medications & Supplements
Prevention & Wellness

Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
https://reference.medscape.com/drug/alka-seltzer-plus-day-cold-theraflu-daytime-severe-cold-cough-acetaminophen-dextromethorphan-phenylephrine-iv-999372
https://www.uptodate.com/contents/acetaminophen-paracetamol-dextromethorphan-and-phenylephrine-drug-information
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=563452d1-0c19-4094-895a-805c859bc49b
https://pubmed.ncbi.nlm.nih.gov/28986045/
https://www.webmd.com/drugs/2/drug-77552/phenylephrine-dextromethorphan-acetaminophen-oral/details