What are the main ingredients in Alka-Seltzer Plus Cold Formula. How does this medication work to relieve cold symptoms. What are the potential side effects and precautions to consider when using Alka-Seltzer Plus Cold Formula. When should you seek medical attention while taking this medication.

Understanding Alka-Seltzer Plus Cold Formula Composition

Alka-Seltzer Plus Cold Formula is a combination medication designed to alleviate various symptoms associated with the common cold, flu, and other respiratory illnesses. The primary active ingredients in this formulation include:

• Aspirin: A non-steroidal anti-inflammatory drug (NSAID) that helps reduce pain and fever
• Chlorpheniramine: An antihistamine that combats allergy symptoms
• Phenylephrine: A decongestant that helps relieve nasal congestion
• Acetaminophen: A pain reliever and fever reducer
• Dextromethorphan: A cough suppressant

Each of these components plays a specific role in addressing the multifaceted nature of cold and flu symptoms, providing comprehensive relief to the user.

How Alka-Seltzer Plus Cold Formula Works

The combination of ingredients in Alka-Seltzer Plus Cold Formula works synergistically to target various cold and flu symptoms. Here’s a breakdown of how each component functions:

1. Aspirin reduces inflammation, alleviates pain, and lowers fever
2. Chlorpheniramine blocks histamine receptors, reducing sneezing, runny nose, and watery eyes
3. Phenylephrine constricts blood vessels in the nasal passages, decreasing congestion and improving breathing
4. Acetaminophen provides additional pain relief and fever reduction
5. Dextromethorphan suppresses the cough reflex by acting on the brain’s cough center

This multi-pronged approach allows for comprehensive symptom relief, addressing the various discomforts associated with colds and flu.

Proper Usage and Dosage Guidelines

To ensure safe and effective use of Alka-Seltzer Plus Cold Formula, it’s crucial to follow the recommended dosage guidelines. The appropriate dosage may vary depending on the specific formulation and individual factors such as age and health status.

General Dosage Instructions:

• Adults and children 12 years and older: Take 2 tablets or capsules every 4 to 6 hours, not exceeding 8 tablets or capsules in 24 hours
• Children under 12 years: Consult a healthcare professional before use

Can Alka-Seltzer Plus Cold Formula be taken with or without food? This medication can be taken with or without food. However, if stomach upset occurs, taking it with food or milk may help alleviate this side effect.

Is it important to stay hydrated while using this medication? Yes, it’s crucial to drink plenty of fluids when using Alka-Seltzer Plus Cold Formula. Adequate hydration helps loosen mucus in the lungs and supports overall recovery from cold and flu symptoms.

Potential Side Effects and Precautions

While Alka-Seltzer Plus Cold Formula is generally safe when used as directed, it’s important to be aware of potential side effects and take necessary precautions.

Common Side Effects:

• Drowsiness
• Dizziness
• Dry mouth, nose, or throat
• Nausea
• Stomach upset
• Headache
• Nervousness

Are there any serious side effects to watch out for? Yes, while rare, serious side effects can occur. These may include:

• Severe allergic reactions (rash, itching, swelling)
• Rapid heartbeat
• Difficulty urinating
• Confusion
• Seizures

If you experience any of these severe side effects, seek immediate medical attention.

Acetaminophen Overdose Risk and Liver Concerns

One of the most critical warnings associated with Alka-Seltzer Plus Cold Formula relates to the risk of acetaminophen overdose and potential liver damage.

What is the maximum safe daily dose of acetaminophen? Adults should not exceed 4000 milligrams (4 grams) of acetaminophen per day. People with liver problems and children should take lower doses as advised by a healthcare professional.

How can one avoid acetaminophen overdose? To prevent overdose:

• Check all medication labels for acetaminophen content
• Avoid using multiple acetaminophen-containing products simultaneously
• Consult a healthcare provider before combining medications
• Be cautious with alcohol consumption, as it can increase the risk of liver damage when combined with acetaminophen

What are the symptoms of acetaminophen overdose? Symptoms may include nausea, vomiting, loss of appetite, sweating, stomach pain, extreme tiredness, yellowing of the eyes or skin, and dark urine. If you suspect an overdose, seek immediate medical attention, even if you feel well.

Drug Interactions and Contraindications

Alka-Seltzer Plus Cold Formula can interact with various medications and medical conditions. It’s essential to be aware of these potential interactions to ensure safe usage.

Medications That May Interact:

• Blood thinners (e.g., warfarin)
• Other NSAIDs (e.g., ibuprofen, naproxen)
• Certain antidepressants (e.g., MAO inhibitors)
• Beta-blockers
• Diuretics

Can individuals with certain medical conditions use Alka-Seltzer Plus Cold Formula safely? Some medical conditions may contraindicate the use of this medication or require special precautions:

• Liver disease
• Kidney disease
• Heart conditions
• High blood pressure
• Asthma or other respiratory conditions
• Glaucoma
• Prostatic hypertrophy

Always consult a healthcare provider before using Alka-Seltzer Plus Cold Formula if you have any pre-existing medical conditions or are taking other medications.

Special Considerations for Specific Populations

Certain groups of individuals require special consideration when using Alka-Seltzer Plus Cold Formula.

Children:

Is Alka-Seltzer Plus Cold Formula safe for children? The safety and efficacy of cough and cold products, including Alka-Seltzer Plus Cold Formula, have not been established in children younger than 6 years. For children between 6 and 12 years, use should be under the guidance of a healthcare professional.

Pregnant and Breastfeeding Women:

Should pregnant or breastfeeding women use this medication? The safety of Alka-Seltzer Plus Cold Formula during pregnancy and breastfeeding has not been fully established. Consult a healthcare provider before use if you are pregnant or breastfeeding.

Elderly Individuals:

Are there special considerations for elderly users? Older adults may be more sensitive to the effects of this medication, particularly the antihistamine component. They may experience increased side effects such as dizziness, drowsiness, and confusion. Dosage adjustments may be necessary.

Alternative Treatments and Lifestyle Recommendations

While Alka-Seltzer Plus Cold Formula can provide relief from cold and flu symptoms, there are several alternative treatments and lifestyle changes that can complement or, in some cases, replace medication use.

Natural Remedies:

• Honey for cough suppression
• Ginger tea for nausea and congestion
• Saltwater gargle for sore throat
• Eucalyptus steam inhalation for congestion

Lifestyle Recommendations:

What lifestyle changes can help alleviate cold and flu symptoms?

• Get plenty of rest to support the immune system
• Stay hydrated with water, herbal teas, and clear broths
• Use a humidifier to add moisture to the air and ease congestion
• Practice good hygiene to prevent the spread of illness
• Eat a balanced diet rich in fruits and vegetables to support immune function

These natural remedies and lifestyle changes can work in conjunction with over-the-counter medications like Alka-Seltzer Plus Cold Formula to provide comprehensive relief and support recovery.

When to Seek Medical Attention

While Alka-Seltzer Plus Cold Formula can effectively manage many cold and flu symptoms, there are situations where professional medical attention is necessary.

Under what circumstances should you consult a healthcare provider? Seek medical attention if:

• Symptoms persist for more than 7 days or worsen
• You develop a high fever (above 101°F or 38.3°C) that lasts more than 3 days
• You experience severe or persistent headache, chest pain, or abdominal pain
• You have difficulty breathing or shortness of breath
• You cough up blood or have severe, persistent cough
• You show signs of dehydration (e.g., decreased urination, severe dizziness)
• You experience any severe or unusual symptoms

Is it necessary to consult a doctor before using Alka-Seltzer Plus Cold Formula if you have chronic health conditions? Yes, individuals with chronic health conditions such as heart disease, diabetes, liver disease, or kidney problems should consult their healthcare provider before using this medication to ensure it’s safe and appropriate for their specific situation.

Long-term Use and Dependency Concerns

Alka-Seltzer Plus Cold Formula is intended for short-term use to manage acute cold and flu symptoms. Prolonged use of this medication can lead to potential risks and concerns.

Can long-term use of Alka-Seltzer Plus Cold Formula lead to dependency? While this medication is not typically associated with physical dependency, prolonged use can lead to psychological reliance or mask underlying health issues that require medical attention.

What are the risks of using this medication for extended periods?

• Increased risk of side effects, particularly from the decongestant and antihistamine components
• Potential liver damage from long-term acetaminophen use
• Masking of symptoms that may indicate a more serious condition
• Rebound congestion from prolonged use of decongestants

To avoid these risks, it’s crucial to use Alka-Seltzer Plus Cold Formula only as directed and for the shortest duration necessary to manage symptoms. If cold or flu symptoms persist beyond a week or frequently recur, consult a healthcare provider to rule out underlying conditions and discuss appropriate long-term management strategies.

Storage and Disposal Guidelines

Proper storage and disposal of Alka-Seltzer Plus Cold Formula are important for maintaining its effectiveness and ensuring safety.

Storage Recommendations:

• Store at room temperature, away from moisture and heat
• Keep the medication in its original container
• Store out of reach of children and pets
• Avoid storing in bathroom cabinets due to humidity

How should expired or unused medication be disposed of? To safely dispose of Alka-Seltzer Plus Cold Formula:

1. Check for local drug take-back programs in your area
2. If unavailable, mix the medication with an undesirable substance (e.g., used coffee grounds)
3. Place the mixture in a sealed plastic bag or container
4. Dispose of in household trash
5. Remove or obscure all personal information on the empty medication container before discarding

Proper storage and disposal help prevent accidental ingestion, misuse, and environmental contamination.

Comparative Analysis with Other Cold Medications

Alka-Seltzer Plus Cold Formula is one of many over-the-counter medications available for managing cold and flu symptoms. Understanding how it compares to other options can help individuals make informed decisions about their treatment.

Comparison with Single-Ingredient Medications:

How does Alka-Seltzer Plus Cold Formula differ from single-ingredient cold medications?

• Provides comprehensive symptom relief due to multiple active ingredients
• May be more convenient for those experiencing various symptoms simultaneously
• Potentially higher risk of side effects or interactions due to multiple components

Comparison with Other Multi-Symptom Cold Medications:

What distinguishes Alka-Seltzer Plus Cold Formula from other multi-symptom cold medications?

• Unique effervescent formulation that may aid in faster absorption
• Contains aspirin, which is not present in all multi-symptom cold medications
• May have a different side effect profile due to its specific combination of ingredients

When choosing between Alka-Seltzer Plus Cold Formula and other cold medications, consider your specific symptoms, any pre-existing medical conditions, and potential drug interactions. Consulting with a healthcare provider or pharmacist can help determine the most appropriate option for your individual needs.

Future Developments and Research

The field of cold and flu treatment is continually evolving, with ongoing research aimed at improving efficacy and safety of medications like Alka-Seltzer Plus Cold Formula.

What areas of research are currently being explored in cold and flu treatment?

• Development of new antiviral medications targeting specific cold and flu viruses
• Investigation of natural compounds with potential antiviral or immune-boosting properties
• Improvement of existing formulations to enhance efficacy and reduce side effects
• Exploration of novel drug delivery systems for more targeted symptom relief
• Research into the long-term effects of frequent cold medication use

These ongoing research efforts may lead to more effective and safer cold and flu treatments in the future, potentially impacting the formulation and usage recommendations for products like Alka-Seltzer Plus Cold Formula.

As our understanding of cold and flu viruses and their impact on the human body continues to grow, we can expect to see advancements in both pharmaceutical and non-pharmaceutical approaches to symptom management and disease prevention. Staying informed about these developments can help individuals make more informed decisions about their health and treatment options.

Alka-Seltzer Plus Cold/Cough (PSE) Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Warnings:

One ingredient in this product is acetaminophen. Taking too much acetaminophen may cause serious (possibly fatal) liver disease. Adults should not take more than 4000 milligrams (4 grams) of acetaminophen a day. People with liver problems and children should take less acetaminophen. Ask your doctor or pharmacist how much acetaminophen is safe to take.

Do not use with any other drug containing acetaminophen without asking your doctor or pharmacist first. Acetaminophen is in many nonprescription and prescription medications (such as pain/fever drugs or cough-and-cold products). Check the labels on all your medicines to see if they contain acetaminophen, and ask your pharmacist if you are unsure.

Get medical help right away if you take too much acetaminophen (overdose), even if you feel well. Overdose symptoms may include nausea, vomiting, loss of appetite, sweating, stomach/abdominal pain, extreme tiredness, yellowing eyes/skin, and dark urine.

Daily alcohol use, especially when combined with acetaminophen, may damage your liver. Avoid alcohol.

Warnings:

One ingredient in this product is acetaminophen. Taking too much acetaminophen may cause serious (possibly fatal) liver disease. Adults should not take more than 4000 milligrams (4 grams) of acetaminophen a day. People with liver problems and children should take less acetaminophen. Ask your doctor or pharmacist how much acetaminophen is safe to take.

Do not use with any other drug containing acetaminophen without asking your doctor or pharmacist first. Acetaminophen is in many nonprescription and prescription medications (such as pain/fever drugs or cough-and-cold products). Check the labels on all your medicines to see if they contain acetaminophen, and ask your pharmacist if you are unsure.

Get medical help right away if you take too much acetaminophen (overdose), even if you feel well. Overdose symptoms may include nausea, vomiting, loss of appetite, sweating, stomach/abdominal pain, extreme tiredness, yellowing eyes/skin, and dark urine.

Daily alcohol use, especially when combined with acetaminophen, may damage your liver. Avoid alcohol.

… Show More

Uses

This combination medication is used to temporarily treat symptoms caused by the common cold, flu, allergies, or other breathing illnesses (such as sinusitis, bronchitis). Dextromethorphan is a cough suppressant that affects a certain part of the brain, reducing the urge to cough. Decongestants help relieve stuffy nose and ear congestion symptoms. Acetaminophen (APAP) is a non-aspirin pain reliever and fever reducer. Antihistamines help relieve watery eyes, itchy eyes/nose/throat, runny nose, and sneezing.This medication is not usually used for ongoing coughs from smoking, asthma, or other long-term breathing problems (such as emphysema), or for coughs with a lot of mucus, unless directed by your doctor.Cough-and-cold products have not been shown to be safe or effective in children younger than 6 years. Do not use this product to treat cold symptoms in children younger than 6 years unless specifically directed by the doctor. Some products (such as long-acting tablets/capsules) are not recommended for use in children younger than 12 years. Ask your doctor or pharmacist for more details about using your product safely.These products do not cure or shorten the length of the common cold and may cause serious side effects. To decrease the risk for serious side effects, carefully follow all dosage directions. Do not use this product to make a child sleepy. Do not give other cough-and-cold medication that might contain the same or similar ingredients (see also Drug Interactions section). Ask the doctor or pharmacist about other ways to relieve cough and cold symptoms (such as drinking enough fluids, using a humidifier or saline nose drops/spray).

How to use Alka-Seltzer Plus C/C (PSE) Capsule

See also Warning section.

If you are taking the over-the-counter product, read and follow all directions on the package label. If your doctor has prescribed this medication for you, take as directed by your doctor. If you have any questions, consult your doctor or pharmacist.

Take this medication by mouth with or without food or as directed by your doctor. If stomach upset occurs, it may help to take this medication with food or milk. Drink plenty of fluids when you use this medication unless otherwise directed by your doctor. The fluid will help loosen the mucus in your lungs.

If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose. If your liquid form is a suspension, shake the bottle well before each dose.

If you are taking extended-release capsules, swallow them whole. Do not crush or chew extended-release capsules or tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.

If you are taking the chewable form of this medication, chew it thoroughly before swallowing.

The dosage is based on your age, medical condition, and response to treatment. Do not increase your dose, take it more often, or use it for a longer time than directed. Improper use of this medication (abuse) may result in serious harm (including brain damage, seizure, death).

Tell your doctor if your condition lasts for more than 1 week, if it gets worse, or if it occurs with a headache that doesn’t go away, rash, or fever lasting more than 3 days. These may be symptoms of a serious medical problem and should be checked by a doctor.

Side Effects

See also Warning section.

Drowsiness, dizziness, blurred vision, upset stomach, nausea, nervousness, constipation, or dry mouth/nose/throat may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

If your doctor has prescribed this medication, remember that your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as confusion, hallucinations), shaking, trouble urinating, fast/slow/irregular heartbeat, seizure.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

See also Warning section.

Before taking this product, tell your doctor or pharmacist if you are allergic to any of its ingredients; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

If you have any of the following health problems, consult your doctor or pharmacist before using this medication: breathing problems (such as asthma, emphysema), diabetes, glaucoma, heart problems, high blood pressure, kidney problems, liver disease, seizures, stomach/intestinal problems (such as blockage, constipation, ulcers), overactive thyroid (hyperthyroidism), urination problems (such as trouble urinating due to enlarged prostate, urinary retention).

This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

Some brands of this product may contain sugar, alcohol, or aspartame. Caution is advised if you have diabetes, alcohol dependence, liver disease, phenylketonuria (PKU), or any other condition that requires you to limit/avoid these substances in your diet. Ask your doctor or pharmacist about using this product safely.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the effects of this drug, especially dizziness, drowsiness, mental/mood changes, constipation, trouble urinating, fast heartbeat, and blood pressure changes. Dizziness, drowsiness and confusion can increase the risk of falling.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

This medication may pass into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

Interactions

See also Warning section.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Taking certain MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking isocarboxazid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, or tranylcypromine during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.

Some products that may interact with this drug are: antihistamines applied to the skin (such as diphenhydramine cream, ointment, spray), ketoconazole, levoketoconazole, rolapitant.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or other antihistamines (such as cetirizine, diphenhydramine).

The ingredients in this product are available in many prescription and nonprescription products. Check the labels on all your medicines (such as pain/fever drugs, diet aids, or cough-and-cold/allergy products) because they may contain the same or similar ingredients. Using these drugs along with this product could increase side effects (such as fast heartbeat, increased blood pressure, or drowsiness). Ask your pharmacist about using those products safely.

This medication may interfere with certain lab tests (such as urine drug screening tests, urine 5-HIAA), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

Does Alka-Seltzer Plus C/C (PSE) Capsule interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: nausea, vomiting, loss of appetite, sweating, stomach/abdominal pain, extreme tiredness, agitation, confusion, flushing, hallucinations, yellowing eyes/skin, dark urine, seizures. In children, excitement may occur first, and may be followed by: loss of coordination, drowsiness, loss of consciousness, seizures.

Keep all medical and lab appointments.

Do not take this product for several days before allergy testing because test results can be affected.

If you are taking this product on a regular schedule and miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Store at room temperature away from light and moisture. Do not store in the bathroom. Do not freeze liquid forms of this medication. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

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Drug Survey

Have you ever purchased Alka-Seltzer Plus C/C (PSE) Capsule?

Yes, In the past 3 months

Yes, In the past 6 months

Yes, In the past year

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This survey is being conducted by the WebMD marketing sciences department.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Which Cold Medications Are Safe for the Heart?

by
Anthony Pearson, MD

January 22, 2020

Little has changed in the $8 billion world of useless and confusing over-the-counter (OTC) cold, flu, and sinus medications since the Skeptical Cardiologist first tackled “What Cold Medications Are Safe For My Heart” in 2015.

I still advise avoiding combination OTC cold meds and utilizing specific medications for specific symptoms.

The original post covers most of the usual suspects in this mostly useless arena. I updated it in 2016 with comments on a few additional OTC components. That post on Alka-Seltzer, phenylephrine, and doxylamine is included below.

Alka-Seltzer Plops Into the OTC Cold Market

I had always viewed Alka-Seltzer as an effervescent tablet for acid reflux, but the brand (now owned by Bayer) has moved aggressively into the bewildering morass of OTC cold meds. Indeed, when Alka-Seltzer began in 1931, it was a combination of aspirin and sodium bicarbonate (baking soda) marketed for upset stomachs. Popular commercials from the 1960s featured the catchy jingle (still stuck in my head) “Plop, plop, fizz, fizz. Oh what a relief it is” often sung by Speedy, an odd anthropomorphic creature with an Alka-Seltzer thorax and cap. (The jingle was written by Tom Dawes of The Cyrkle [“Red Rubber Ball”], not by the father of Julianna Margulies. )

Recently, I received a request from an out-of-town guest who was suffering from a cough and upper respiratory infection to purchase Alka-Seltzer Plus in the form of a tablet that dissolves in hot water.

At his request, Alka-Seltzer Plus Day Multi-Symptom Cold and Flu was purchased at the local Walgreens.

The ingredients are typical for many of the Alka-Seltzer products:

• Dextromethorphan (promoted for cough but ineffective and with considerable side effects, see my initial post)
• Acetaminophen (Tylenol, for pain and fever)
• Phenylephrine (decongestant)

Phenylephrine: Ineffective Substitute for Pseudoephedrine

I didn’t cover phenylephrine previously. It has taken the place of pseudoephedrine in on-the-shelf OTC cold medications.

Like pseudoephedrine, phenylephrine is a sympathomimetic drug, meaning it stimulates receptors of the sympathetic nervous system. Unlike pseudoephedrine, phenylephrine is useless as a decongestant when taken in the dosages available over the counter.

A study published in 2015 confirmed what previous studies had suggested: Phenylephrine in dosages of 10 to 40 mg daily was no more effective than placebo in reducing symptoms of nasal congestion.

An accompanying editorial called on manufacturers to remove this useless drug from their products.

Alas, all of the Alka-Seltzer preparations that claim to treat congestion utilize phenylephrine as the decongestant.

The transition to useless phenylephrine took place when pseudoephedrine was taken off the shelves and put behind the counter to reduce its usage in making methamphetamine.

Therefore, Alka-Seltzer Plus Cold and Flu contains two useless ingredients plus acetaminophen (Tylenol).

You can buy a large bottle of cheap generic acetaminophen and take exactly the right dose you need for relieving fever or body aches without paying for two useless accompanying drugs that have the potential for giving you unwanted side effects.

Sleep Aids in OTC Cold Meds

I covered the most common drug found in OTC cold meds promoted for nighttime use, diphenhydramine (Benadryl), in my previous post.

Nighttime Alka-Seltzer products contain a similar sedating antihistamine called doxylamine succinate.

Doxylamine is the active ingredient in the brand-name sleep aid Unisom and the “ZzzQuil” products from the NyQuil brand that are promoted for inducing sleep. It is available in cheap, generic form.

According to DrugBank, “It is also the most powerful over-the-counter sedative available in the U.S., and more sedating than many prescription hypnotics. In a study, it was found to be superior to even the barbiturate, phenobarbital for use as a sedative.”

Note that the effective dosage recommended in separate sleep aids is 25 mg, not the 12.5 mg found in Alka-Seltzer OTC cold meds. Thus, if you want an effective dosage of doxylamine to help you sleep, you must double the recommended dosage of Alka-seltzer’s nighttime product, which then gives you too much acetaminophen and dextromethorphan.

Doubling these drugs raises the potential for side effects. Common dextromethorphan side effects include nausea/vomiting, dizziness, diarrhea, and nervousness. Too much acetaminophen can damage the liver.

In addition, both dextromethorphan and acetaminophen interact with multiple other medications. Dextromethorphan is known to interact with many medications.

Acetaminophen can interfere with warfarin and increase the risk of dangerous bleeding.

My advice for 2020 is unchanged from 2015. As I summarized previously:

“I think you are much better off avoiding these brand name mixtures of different active ingredients.

Instead, you should take what you need for a specific symptom in the appropriate dosage and time interval.

Thus, if you have pain, take the minimal dose of Tylenol that relieves it and repeat when it comes back.

If you have a cough, recognize that the OTC ingredients are no better than placebo and are being abused as recreational drugs. Most coughs go away shortly; but if one is particularly troublesome and persistent, get a cough suppressing drug from your physician.

If you have a really runny nose with a lot of sneezing, it is probably OK to take pseudoephedrine even if you are a heart patient or have high blood pressure. Take it as I described above. Start with 30 mg of the little red pseudoephedrine pills. Wait an hour to see how you feel. Take a second if it has not been effective. Repeat at 4 to 6 hour intervals as needed. Take your blood pressure at least once after starting it.

Don’t buy the multi-symptom multiple ingredient combinations, which are simply a marketing tool to get you to spend more money on something from which you won’t benefit.”

Consumer Reports seems to agree with me in a 2017 post on this topic (which doesn’t credit me).

Anthony Pearson, MD, is a private practice noninvasive cardiologist and medical director of echocardiography at St.