Classes
DEA Class; OTC
Common Brand Names; Alka-Seltzer Plus Night Cold & Cough Effervescent
Antitussives, Non-narcotic Combos
Description
Aspirin irreversibly inhibits platelet aggregation by inhibiting platelet cyclooxygenase; acetyl group responsible for inactivation of cyclooxygenase via acetylation; hydrolyzed rapidly in plasma, 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 is a cough suppressant that acts centrally on the cough center in medulla
Phenylephrine is a vasoconstrictor & decongestant that relieves symptoms resulting from irritation of upper respiratory tract tissue; shrinks swollen mucous membranes, reduces nasal congestion and tissue hyperemia
Uses/Indications
Indicated for Relief of Cold Symptoms
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
Adverse Effects
Dysrhythmias
Hypotension
Tachycardia
Agitation
Cerebral edema
Coma
Confusion
Dizziness
Headache
Subdural or intracranial hemorrhage
Lethargy
Hives
Rashes
May potentiate peptic ulcer and cause stomach distress or heartburn
Dyspepsia
GI bleeding
Ulceration & perforation
Nausea
Vomiting
Prolongation of prothrombin time
Warnings
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 atherosclerosis
Pregnancy and Lactation
Pregnancy category: D; avoid during pregnancy, particularly in third trimester because of risk for premature closure of the 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
Maximum Dosage
Adults
2 tablets fully dissolved in 4 oz of water qHS; may be taken q4-6hr; not to exceed 8 tablets/day
Pediatric
<12 years
Not recommended
>12 years
2 tablets fully dissolved in 4 oz of water qHS; may be taken q4-6hr; not to exceed 8 tablets/day
How supplied
Effervescent Tablet
500mg/6.25mg/10mg/7.8mg